Midterm 2- Lid bumps Flashcards
Macule:
Circumscribed, flat discoloration , <1cm
Patch:
Circumscribed, flat discoloration , >1cm
Papule:
Circumscribed, elevated superficial solid lesions, < 1cm
Plaque:
Circumscribed, elevated superficial solid lesions, > 1cm
Nodule:
Solid lesions with depth above, level or below surface, < 1cm
Tumor:
Solid lesions with depth, above, level or below surface, > 1cm
Vesicle:
Circumscribed elevations containing serous fluid, < 1cm
Bulla:
Circumscribed elevations containing serous fluid, > 1cm
Petechia:
Petechia: Circumscribed deposits of blood or blood products, < 1cm
Purpura:
Circumscribed deposits of blood or blood products, < 1cm
Sessile:
A lesion fixed to the skin on a broad base
Pedunculated:
A lesion on a stalk
Papillomatous:
A lesion exhibiting a surface resembling a cauliflower or artichoke
Scales:
Shedding, dead epidermal cells, dry or greasy
Umbilicated:
The lesion exhibits a central crater like an umbilicus or belly button
Crusts:
Dried masses of skin exudates
Ulcer:
Irregularly sized and shaped excavations extending into the dermis
Hyperplasia
Increase in number of cells
Metaplasia
Change in type of adult cells which is abnormal for that tissue
Dysplasia
Alteration in size, shape, organization of adult cells
Neoplasia
Mass of new cells which proliferate without control and serve no useful function
Anaplasia
loses resemblance to cell of origin
AKA tumor or cancer
malignant tumor
- A malignant tumor can metastasize into lymph nodes & distant organs
- if untreated, may kill the patient wherever it occurs.
- infiltrates the surrounding tissue.
- when is excised, it may recur.
- a malignant tumor grows more rapidly than a benign tumor.
Benign tumor
- Usually a benign tumor may only cause death if it happens to grow in a vital organ.
- grows by expansion and is usually separated from the surrounding tissue by a capsule.
- if removed, it usually does not recur.
Carcinoma
Epithelial tissue
Sarcoma
Tumor of CT (derived from mesoderm), which develops into cartilage and bone (choristoma), fat (lipoma), and muscle (myoma)
Hemangioma
Tumor comprised of blood vessels/vasculature
Lymphoma
Tumor of lymphatic tissue (leukemia – hematopoietic cells affected)
Melanoma
Tumor of pigmented cells
Hamartoma
Tumor made of tissue normally present there
Blastoma
Tumor derived from embroyonic cells (i.e. retinoblastoma)
tumor tx
Chemotherapy
Cryotherapy
Radiotherapy
Surgery
Neoplastic considerations - Subjective
- Lesion does not act or respond as anticipated
HX of other skin lesions elsewhere on the body and other neoplasias or systemic disease
-Pts. with HX of excessive UV skin exposure
Lesion is not common for patient’s age, sex, race, demography
-Older patients
-FHX of skin cancers
-Fair-complexion pts.
-Acute vs. chronic onset & duration
-Rapid or irregular growth patterns
-Pain or irritation associated with suspicious lesion
Neoplastic considerations - Objective
- Quality of the tissue looks irregular
- Bleeding or ulceration of lesion
- Surface integrity & quality questionable
- Changes in lesion not consistent or predictable
- Neovascular patterns around or within lesion
- Recurrent infections or inflammations at site
- Uncharacteristically large lumps or bumps
- Associated tearing or conjunctival hyperemia
- Erosion of the margins or surface of a lesion
Neoplastic Considerations - Assessment / DDX and Plan/TX
- With serious doubt or suspicion regarding any lump or bump of the lid, recommend excision and biopsy
- If referral deferred or refused for any reason, document and monitor closely
- -Photodocument if possible
- -Diagram/measure accurately
If suspicious of neoplastic
Rule of thumb :
Asymmetry Borders Color Diameter (Elevation) Evolving
Ephilis
= freckle -Plural: ephilides -Larger sized melanocytes (normal in number) -Autosomal dominant inheritance pattern -Intensified by sun exposure
Solar lentigines
= “liver spots”, age spots
- Occur in response to sunlight
- Persist in the absence of sunlight
- Middle aged to older patients
- Expanding macules (flat patches)
- Normal number of melanocytes
Simple lentigines
Unlike solar lentigines, simple lentigines:
- Occur at any age
- Have no predilection for sun-exposure or lighter skin type
- Do not darken in response to sunlight
Solar lentigines laser Tx
Mechanism:
Pressure waves fragment pigment particles
Outcome:
Lesions darken or grey over several days to weeks before sloughing off
Nevus
= mole
- Plural: nevi
- common benign neoplasms or melanocytes
Congenital or early onset
Occasional changes in size or pigmentation
Cosmetic concern
Nevus Subjective:
- Congenital or early onset
- Occasional changes in size or pigmentation
- Cosmetic concern
Nevus - Objective: dermal
Most common
Located in dermis
Raised or flat
Nevus - Objective: junctional
- Dermoepidermal junction
- Superficial
- Usually flat
- May convert to melanoma
Nevus - Objective:
Compound
- Both in dermoepidermal junction and dermis
- Transitional
Nevus – Dysplastic
-“Fried egg” appearance
-Increased melanoma risk if multiple and with +FHx of melanoma
-Pigmented or amelanotic
-Commonly found at lid margins
Borders
-Less than 8 - 10 mm diameter
-May increase in size with aging
-Occasionally show hairs growing through surface
Nevus - Assessment/DDx
-R/O other pigment spots
Plan:
-Photodocument or diagram and measure
Monitor q. 3 - 6 months if suspicious
-RTC q. year if normal appearance with no change
-Refer for biopsy if changes occur
Malignant Melanoma
- Malignant tumor derived from melanocytes
- These comprise ~ 3% of primary skin cancers…
- but accounts for 79% of skin cancer related deaths!
Malignant Melanoma - Subjective
- May not directly relate to UV exposure
- Light complexion
Malignant Melanoma - Objective
- Asymmetric, pigmented lesion with irregular borders
- Variable coloration
- Variable diameter
2 types: superfocial spreadinf melanoma, nodular melanoma
Superficial spreading melanoma
Rapid increase in size
Lower incidence in metastases
Nodular melanoma
Vertical growth with more penetration into tissue
Metastasize early
Malignant Melanoma Mortality via Clark’s levels
-Level I:
-Level I: epidermis; called “in situ” melanoma; 100% cure
Malignant Melanoma Mortality via Breslow depth
- 0.75 mm deep 0% metastases
- 0.85 mm deep 97% survival in 10 years
- 3.6 mm deep 50% dead in 10 years
Malignant Melanoma Mortality via Clark’s levels
-Level II:
invasion of the papillary (upper) dermis
Malignant Melanoma Mortality via Clark’s levels
-Level III:
filling papillary dermis, not reticular (lower) dermis
Malignant Melanoma Mortality via Clark’s levels
-Level IV:
invasion of reticular dermis ~50% dead in 10 yr
Malignant Melanoma Mortality via Clark’s levels
-Level V:
invasion of the deep, subcutaneous tissue
Epiluminescence Microscopy (ELM)
- Typically x10 mag
- Oil medium between instrument and skin
- Allows inspection unobstructed by skin surface reflections
- Makes subsurface structures viewable in vivo
- New versions use polarized light to cancel reflections
- Allows magnified visualization of pigmented skin lesions beyond what is visible in normal clinical exam
- Designed for small equivocal pigmented skin lesions
Mohs Surgery
lesion and normal around is cut to diagnose and treat entire lesion
basal cell carcinoma definition
-most malignant lid tumor
basal cell carcinoma etiology
UV exposure connection, elderly, fair skin (rare in darkly-pigmented people)
basal cell carcinoma Location
1 place at inferior nasal
basal cell carcinoma two types
- Sclerosing
- Noduloulcerative
what does early form of basal cell carcinoma look like
vascularized nodules
basal cell carcinoma presentation
- Varying degrees of central umbilicated ulceration
- ”Pearly”, rolled borders
- Pigmentation
- Surface may become inflamed, infected or both
sclerosing type
- more scab like
- tends to happen on nasal side
Basal Cell Carcinoma Assessment/DDX
- Metastasis uncommon
- Inner canthal lesions require more rapid attention
- Consider all lid lumps & bumps!
- —Keratoacanthoma
- —HSV lesion
Basal Cell Carcinoma Plan/TX
- If secondarily infected or inflamed, run short course of AB steroid combo
- Derm. consult
- surgical excision & repair
- radiation
- cryotherapy (liquid nitrogen)
- curettage
- electrodessication
- Imiquimod cream (antimetabolite) (Aldara)
- 5-FU (fluorourocil) (antimetabolites- helps prevents proliferation of cells after surgery)
- PDT (photodynamic therapy)
- Pt. education
Squamous Cell Carcinoma definition
- 3RD MOST COMMON OCULAR TUMOR
- 2nd most common skin cancer
- easily confused with basal cell
- flat more linear
Squamous Cell Carcinoma etiology
Keratinizing epidermal cells
Squamous Cell Carcinoma subjective
scab that doesn’t heal
Squamous Cell Carcinoma objective
reddish, raised scaly plaque
Squamous Cell Carcinoma Assessment/DDX
- R/O all lid lumps & bumps!
- -Keratoacanthoma
- -sebborheic keratoses
- -cutaneous warts
Squamous Cell Carcinoma plan/tx
excision, radiation, PDT (photo- dynamic therapy)
Meibomian Gland Carcinoma definiton
- very rare
- Mistaken for persistent, recurrent meibomian gland chalazion
- A type of sebaceous gland carcinoma
- Can mimic a chronic eyelid/conjunctival infection (preseptal)
- lipid layer destroyed
Meibomian Gland Carcinoma definiton plan/tx
Excision
Radiation
precursor to cancer Actinic Keratosis
= solar keratosis = “sun spots”
Squamous cell dysplasia
Actinic Keratosis etiology
UV exposure
Actinic Keratosis subjective
Pt unaware
Pt notices ‘skin spots’
Actinic Keratosis objective
Dry, scaly lesions 2-5 mm
Minimally elevated
Actinic Keratosis
Assessment:
- R/O neoplasia
- R/O keratoacanthoma
- R/O melanoma, nevi, verrucae, papilloma
- R/O seborrheic keratoses
Actinic Keratosis plan/tx
- Dermatology consult
- Cryo, cutterage, topical anti-cancer cream (e.g. imiquimod), PDT
Keratoacanthoma definiton
Papular lesion originating from sebaceous glands
Benign proliferation of squamous epidermal cells
Keratoacanthoma etiology
unknown (possibly UV, trauma, age)
Keratoacanthoma subjective
fast growing
Keratoacanthoma objective
- Starts as erythematous papule
- Grows into firm, raised indurated nodule
- up to 2 cm - Keratin filled crater
- Color
- Spontaneously regresses
Keratoacanthoma assesment
R/O SCC
Keratoacanthoma Plan/TX
Derm. consult, excision
