Mar 7 - Common Skin Tumors/Carcinomas

Question 1

Cherry Hemangiomas

Answer 1

Common, benign growth of blood vessels. In infants, due to GLUT-1, will spontaneously involute over the years

Question 2

When do cherry hemangiomas really require medical intervention?

Answer 2

When they are around the eyes, “beard area” (larynx involvement), or on the bottom lip (ulceration)

Question 3

What common heart medication will shrink cherry hemangiomas?

Answer 3

beta-blockers (propanolol)

Question 4

Port-Wine Stain

Answer 4

Vascular malformation (mut in the GNAQ gene), equally prevalent in men & women, manifests as a violaceous streak

Question 5

Sturge-Weber Syndrome

Answer 5

Port-wine stain, but with brain and eye involvement - the earlier the error in development, the more severe the cognitive impairment

Question 6

Klippel–Trénaunay Syndrome

Answer 6

Port-Wine stain covering an entire limb - indicative of improper blood and lymph vessel development. Can lead to tissue hypertrophy

Question 7

One treatment common to both port-wine stains and cherry hemangiomas?

Answer 7

Pulsed-dye laser therapy

Question 8

Nevus Sebaceus

Answer 8

A hairless plaque usually on the face or scalp that is present at birth. (almost looks like some bubble gum stuck in the hair) RAS gene issue

Question 9

Sebaceus Hyperplasia

Answer 9

Benign, hairless papules from outgrowth of oil glands. Cosmetic issue only

Question 10

Acrochordon

Answer 10

“Skin tags” - fatty outgrowth on the face, armpit. Tx = snip excision

Question 11

Lipoma

Answer 11

Fat tumor, usually in older people or in infants on the bottom of the feet

Question 12

Dermatofibroma

Answer 12

Essentially a large freckle that dimples in the middle when pinched due to its fibrous nature. Usually on the legs

Question 13

Keloid scars - hypertrophic or hyperplastic?

Answer 13

Hypertrophic - with raised borders extending beyond the wound

Question 14

Suborrheic keratosis

Answer 14

Benign keratin pits associated with hair follicles- “the barnacles of old age”

Question 15

Leser-Trélat sign

Answer 15

Explosive growth of suborrheic keratoses (“barnacles”) which indicates other malignancies

Question 16

Nevocellular Nevi

Answer 16

Acquired moles (genes or sunlight) most commonly on photoexposed areas. Normally benign, but observe for ABCDE

Question 17

Three types of nevocellular nevi:

Answer 17

1) Intradermal Nevus
2) Junctional Nevus (most common)
3) Compound Nevus

Question 18

Blue Nevus

Answer 18

Non-vascular hyperpigmented cells (moles) that are in the dermis rather than the epidermis - look blue on exam

Question 19

Congenital Nevi

Answer 19

Mole that can be >20 cm at birth due to an error in embreyonic migratory error in the melanocytes. Generally do not turn malignant

Question 20

Dysplastic Nevus

Answer 20

Atypical mole: fuzzy border / color change / >5 mm in size - not necessarily malignant but could indicate other malignancies.

Question 21

FAMM Syndrome

Answer 21

Familial Atypical Moles and Melanoma Syndrome. Pt will have upwards of 50+ atypical moles

Question 22

Neurofibromatosis (signs and symptoms)

Answer 22

Café-au-lait spots, Lisch nodules, optic glioma, Crowe’s sign (axillary freckling), neurofibromas

Question 23

Basal cell carcinoma is from an abnormal _________ cell, but a melanoma is from an abnormal ________cell

Answer 23

BCC = keratinocytes
Melanoma = melanocytes

Question 24

BCC’s look like:

Answer 24

A rash that doesn’t heal properly- intermittent bleeding, almost pearly appearance

Question 25

When is Moh’s surgery indicated?

Answer 25

When the abnormality is large, recurrent, or in a cosmetically sensitive area

Question 26

Desmoplastic BCC

Answer 26

A BCC that infiltrates deeper into the skin - loss of function of the PATCH gene (smoothened gene now active)

Question 27

A Tx for BCC?

Answer 27

Vismodegib - re-blocks the smoothened gene

or, 5-flurouracil, diclofenac

Question 28

Actinic Keratosis

Answer 28

Precancer that can become a squamous cell carcinoma. Rough, gritty, atypical keratinocytes in the epidermis

Question 29

Squamous Cell Carcinoma

Answer 29

Pearly white, fibrous abnormalities, esp in immunosuppressed patients / chronic UV damage. Metastasis is slow/rare except on lip

Question 30

Bowen’s Disease

Answer 30

HPV-induced squamous cell carcinoma

Question 31

Keratoacanthoma

Answer 31

Common, sharply demarcated, volcano-appearance skin tumor that grows rapidly but is unlikely to metastasize. Tx = excision

Question 32

Most common cancer for ages 15-29?

Answer 32

Melanoma! Pretty damn common

Question 33

The four sub-types of melanoma?

Answer 33

1) Superficial/Spreading
2) Nodular
3) Acral Intigenous
4) Lentigo-Maligna

Question 34

Where do men vs women tend to get melanoma?

Answer 34

men = on the back
women = back and legs

Question 35

What is the Breslow depth?

Answer 35

Measuring from the top of the epidermis to the base of the growth. Use Clark’s levels for prognosis

Question 36

So is tanning associated with increased skin cancer?

Answer 36

Yes. Don’t let anyone tell you differently - UV is a class 1 carcinogen

Question 37

What is SPF and what does it protect from?

Answer 37

Sun Protection Factor - only blocks UV-B!
[If usually takes 5 mins to burn, SPF 15:
5x15 = 75 mins outside with protection]

Question 38

You can successfully treat a melanoma Pt with vemurafinib if and only if:

Answer 38

They have a BRAF mutation