Module 7 Flashcards
1
Q
What are plane warts?
A
- Flat topped, opaque, groups small papules
- Often occurs at sites of trauma (Koebner phenomenon)
- Mainly found in children - face and dorm of hands
- Resolves spontaneously
2
Q
What is molluscum contagiosum?
A
- Multiple, grouped, opaque plaques with a depressed centre
- Usually occur in children
3
Q
What is milia?
A
- 1mm spherical papules
- Very small, superficial infundibular cysts
- Occur on cheek and eyelids
4
Q
What is sebaceous gland hyperplasia?
A
- Enlargement of sebaceous gland
- Seen in middle-aged/older people
- One or more umbilicated papule
- Found on forehead and cheek
- Yellow in colour with central depression
- Removed using curettage, cautery or excision
- Often mistaken for BCC
5
Q
What is a syringoma?
A
- Multiple small (1-5mm) flesh coloured soft papules
- Found over lower eyelids
- Harmless tumours of sweat glands
- Best left alone
- Can be removed using gentle cautery
6
Q
What are skin tags?
A
- Multiple pedunculate skin-coloured or brown papules
- Found around neck/axillar
- Snip excision or ablation with a hyrecator
7
Q
What is trichofolliculoma?
A
- Benign papule or nodule
- Face or scalp
- May be a central punctum with hair protruding from the surface
8
Q
What is trichoepithelioma?
A
- Skin-coloured papule or nodule
- Face or upper trunk
- Resembles BCC so treat as BCC unless confirmed as trichoepithelioma
- No tx required
9
Q
What is dermatosis papulosa nigra?
A
- Exclusively in black population
- Adulthood
- Multiple 1-5mm asymptomatic, hyper pigmented papules on face and neck
- Progresses with age
- Benign, needing no tx
10
Q
What is a cherry angioma?
A
- Small 1-4mm solid, red papules
- Appear on trunk and proximal limbs
- > 30 years
- Multiple lesions
- Harmless, no tx needed
11
Q
What is xanthelasmata?
A
- Yellow, flat plaques usually found medial to eyelids
- Associated with hyperlipidaemia
- Tx with trichloroacetic acid
12
Q
What is naevus sebaceous?
A
- Hairless plaques
- Congenital malformation
- Scalp or face
- Linear fashion, following Blaschko lines
- Skin coloured or yellow/orange
- Become thicker and more verrucous with age
- Increased risk of development of BCC
- Monitored and excised where possible
13
Q
What is granuloma annulare?
A
- Inflammatory condition
- Ring of multiple dermal flesh-coloured or red papules
- Distal extremities
- Localised: 50% resolve spontaneously
- Generalised: 10+ lesions at multiple sites
- Associated with diabetes and thyroid disease
- Tx: topical steroids, intralesional steroids, UVB or PUVA
14
Q
What is seborrhoeic keratosis?
A
- Benign macular or papular, velvety to verrucous lesions
- Waxy yellow to dark brown
- 1mm to several cms
- Stucco keratoses: acral region
- Common in elderly pts
- Tx: cryotherapy, curettage and shave excision
15
Q
What is a dermatofibroma?
A
- Firm round nodule, small (5-10mm)
- Skin coloured or pink/brown
- Edge is darker
- Dermal origin, attached to overlying skin
- Often follows an insect bite or trauma (e.g. shaving legs)
- Multiple dermatofibromas seen in SLE
- Squeezing causes central lesion to dimple
- Often left alone
- Tx: simple excision
16
Q
What is a pilomatricoma?
A
- Benign tumour of hair follicle
- Children: face and arms
- Pink/flesh coloured nodules, 5mm-4cms
- Some have blueish hue
- Late lesions calcify
- Tx: simple excision (may recur)
17
Q
What is a lipoma?
A
- Seen mainly on trunk
- Solitary but multiple
- Benign tumour of fat cells - soft, firm subcutaneous nodules
- Multiple familial lipomatosis: autosomal dominant
- Tx: excision
18
Q
What is a neurofibroma?
A
- Nerve sheath tumour seen in adults
- Solitary, affecting trunk and head
- Skin coloured, soft and rubbery papules or nodules
- Asymptomatic
- Soft with hole in base
- If multiple, may be part of Recklinghausen’s disease (Neurofibromatosis type 1)
19
Q
What is a leiomyoma?
A
- Benign SM tumour or erector pili muscle
- Group of superficial pinhead to pea-sized firm nodules
- Back, face or extensor surface of extremities
- Painful when cold
- Tx: excised if symptomatic
20
Q
What is a trichilemmal (pilar) cyst?
A
- Firm, spherical skin-coloured nodules
- Occur on scalp
- Tx: removal bu enucleation
21
Q
What is a infundibular (epidermoid) cyst?
A
- Found on face, neck and chest
- Small punctum
- Often rupture leading to chronic inflammation
22
Q
What is a dermoid cyst?
A
- Look like infundibular cysts
- Present from birth or early childhood
- Head and neck (midline or lateral edge of eyebrow)
23
Q
What is a pyogenic granuloma?
A
- Vascular, proliferative lesion
- Response to trauma presenting as red, ulcerated mass
- Grow rapidly over a few weeks
- Bleed easily when touched
- Ddx: amelanotic melanoma
- Tx: Refer appropriately if any doubt, curettage, cautery, sample to histology
24
Q
What is a melanocyte?
A
- Specialised pigment producing cells
- 5-10% basal cells in epidermis
- Originate in neural crest and in fetal life they migrate to the dermo-epidermal junction where they reside
- Melanocytes are dendritic and via dendritic processes secrete melanin particles (called melanosomes) into neighbouring keratinocytes
- Skin colour determined by number and distribution of melanosomes and their melanin content
25
Q
What is a mole?
A
- Benign proliferation of melanocytes -> melanocytic naevus
- Common, multiple pigmented papules
- Histologically nests of melanocytic naevus cells
- Acquired and develop during childhood or adolescence
- Reach plateau in 3rd decade
- Rare in old age, slowly disappear
- Inherited trait, more common in caucasian
- Increase following sun exposure, pregnancy, immunosuppression
- Type of mole dictated by position in dermis
26
Q
How does location dictate type of mole?
A
Junctional:
- At dermo-epidermal junction
- 0.1-1cm, dark brown, evenly pigmented, symmetrical macule or even slightly elevated
- Children - any body site
- Adults - palm, soles, genitalia
Compound:
- At both dermo-epidermal junction and within dermis
- Slightly raised, can occur at any site
- Light-brown pigmented papules to dark-brown papillomatous and sometimes hyperkeratotic
Intradermal:
- ‘mature’ mole, all intradermal
- Usually arise in 3rd decade
- Skin coloured papules
- dome-shaped, papillomatous nodules, pedunculate skin tags
27
Q
What is congenital hairy naevus?
A
- present at birth
- bigger, >1cm in size, light brown to black
- Later become protuberant and hairy
- Bathing trunk naevus - >20cm, whole trunk or gluteal region, rare, significant lifetime risk of malignant transformation
28
Q
What is atypical melanocytes (dysplastic) naevus?
A
- Mole with atypical clinical and/or histological features
- > 5mm in size, irregular border ‘smudged’ border, irregular pigmentation, erythema, papular and macular component
- Numerous moles (often >100)
- Unusual distribution, non sun-exposed areas (buttocks, genitalia, scalp, soles, dorsum of feet)
- 10-fold risk of melanoma
- autosomal dominant
- up to 400-fold risk of melanoma where first degree relative have atypical naevi
29
Q
What is a spitz?
A
- discrete, reddish brown or pink
- benign rounded nodule
- grows rapidly on face of child (called juvenile melanoma)
- stop growing after reaching 1-2cm in size
- Histologically: proliferative and spindle-shaped naevus and dilated dermal blood vessels
30
Q
What is a halo?
A
- Trunk in children or adolescents
- Destruction by body’s immune system of naevus cells within a naevus
- White halo of depigmentation surround the pre-existing mole which subsequently involutes
- ?association with vitiligo
- Appear simultaneously
31
Q
What is Becker’s naevus?
A
- much larger than most melanocytes naevi
- prescent in adolescent males
- flat, unilateral hyperpigmented area of skin
- upper back, chest or shoulder
- later becomes hairy
32
Q
What is blue naevus?
A
- deep dermal aggregate of melanocytes
- blue colour
- melanocytes migrating from neural crest to epidermis during fatal life become arrested within the dermis
- smooth solitary nodule on face of older children or hand of young adults
- Mongolian blue spots on sacral-gluteal region of newborn babies (disappears by age of 5)
33
Q
What is malignant melanoma?
A
- malignant tumour of melanocyte
- most serious form of skin cancer
- metastasises early, no curative treatment after this
- incidence is doubling every decade
- increased sun exposure - intense, excessive burning-type experienced on holiday
34
Q
What are the risk factors for malignant melanoma?
A
Sunlight:
- intensive bursts of UV radiation in childhood
- transformation of benign melanocytes into malignant phenotype
- incidence higher closer to equator
- risk greater with episodic exposure e.g. office works on holiday, than with continuous sun exposure e.g. outdoor workers
UV radiation:
- most important environmental factor
- in those who are constitutionally at risk
Skin colour:
- Fitzpatrick type 1 skin (always burns, never tans)
- Red hair and freckles
- Large number of melanocyte naevi (>100) - correlates to sun exposure in childhood
- Large congenital melanocytes naevi esp giant congenital naevus higher risk
Family Hx:
- FHx of melanoma + FHx atypical moles gives greatest risk
35
Q
What are the clinicopathological variants of melanoma?
A
Superficial spreading melanoma:
- Most common
- Female leg, male back, young
- Hx of slowly expanding pigmented lesion
- Initially flat lesions (horizontal growth), while tumour thickness less than 0.75mm good prognosis
- Later downwards vertical growth - prognosis deteriorates, increased risk of mets
- Asymmetric lesion, irregular lateral margin, irregular multicoloured pigmentation, hx of growth
- 1/3 arise from pre-existing mole or freckle
Nodular melanoma:
- Worse prognosis as tumour already has vertical downwards growth
- > males, in trunk
- Rapidly growing black nodule (much of pigmentation is due to blood not melanin)
Lentigo maligna melanoma:
- Arises in a long-standing lentigo maligna
- In situ melanoma, sun exposed part of face
- Person spent many years outdoor
- Large irregular freckle that slowly emerges over years
- At some point transforms into malignant melanoma (invasive nodule develops inside pre-existing lentigo maligna)
Acral lentigous melanoma:
- More common in asians/afro carribeans
- Non-hair bearing skin - palms, soles, nails
- Presents late, poor prognosis
- Nail melanoma - irregular pigmentation under or around nail (big toe/thumb), Hutchinson’s sign (abnormal pigmentation on proximal nail fold margin)
Amelanotic melanoma:
- non-pigmented
- delay in identifying results in poor prognosis
- these can arise anywhere where there are melanocytes inc mucosal epithelia, retina
36
Q
How to identify melanomas?
A
A - asymmetry
B - border irregularity
C - colour irregularity/variable pigmentation
D - diameter >7mm
E - elevation/enlargement (emerges over weeks to months)
Others: inflammation, bleeding, oozing, crusting, mild itch
37
Q
What is the most significant and consistent prognostic factor?
A
Tumour thickness or depth of primary melanoma (a.k.a Breslow thickness)
Clark level of invasion - tumours thinner than 0.5mm almost never metastasise
Others:
- Vertical growth phase
- Sex (M>F)
- Age (older age)
- Diameter of lesion
- Clinical ulceration
38
Q
Survival rates of melanoma.
A
95% for up to 0.75mm 85% for 0.76 to 1.5mm 70% for 1.6 - 3mm 50% for > 3mm 40% for > 3.5mm
39
Q
What is the recommended treatment for melanoma?
A
Excision margins: In situ - 0.5cm <1mm thick - 1cm 1-4mm thick - 1-2cm >4mm thick - 2-5cm
Melanoma in situ and lentigo maligna have no metastatic potential so excise with margin of 0.5cm
