Norton Part 3

Question 1

what is the most common benign tumor in older individuals (40+ years)

Answer 1

seborrheic keratosis

Question 2

seborrheic keratosis starts out how and becomes what

Answer 2

light brown, flat macule

later develop a velvety or waxy to finely verrucous (wart like) surface

Question 3

what typically has an appearance of being stuck on the skin surface and crumbles with scraping

Answer 3

seborrheic keratosis

Question 4

the color of seborrheic keratosis is what

Answer 4

varies from pale brown with pink tones to dark brown or black

Question 5

what is the Leser-Trelat sign

Answer 5

multiple eruptive seborrheic keratoses with internal malignancy

Question 6

what must one do if suspicious that seborrheic keratosis is melanoma

Answer 6

biopsy it

Question 7

dermatosis papulosa nigra is a subtype of what

Answer 7

seborrheic keratosis

Question 8

dermatosis papulosa nigra appears how and on who

Answer 8

brown to black, smooth, dome-shaped papule

mostly on African Americans

Question 9

dermatosis papulosa nigra can be treated with liquid nitrogen but this can cause what

Answer 9

hypopigmentation

Question 10

what are the histological features of seborrheic keratosis

Answer 10

exophytic
show sheets of small busload cells
frequently pigmented
exuberant keratin production at surface
small keratin-filled cysts known as horn cysts
loose lamellar “shredded-wheat” or “onion-skin” keratin

Question 11

what is a horn-cyst and where is it found

Answer 11

small keratin-filled cysts

found in Seborrheic keratosis

Question 12

loose lamellar “shredded-wheat” or “onion-skin” keratin is seen in what

Answer 12

seborrheic keratosis

Question 13

where is acanthosis nigricans found

Answer 13

folds of the neck, axilla, and groin

Question 14

what is seen in acanthosis nigricans

Answer 14

hyperpigmentation (first sign)

hyperplasia of stratum spinosum makes the skin thick and velvety

Question 15

80% of acanthosis nigricans are what type and usually occur when

Answer 15

benign

usually occur in childhood or puberty

Question 16

benign acanthosis nigricans may be associated with what

Answer 16

endocrine disorders (like DM)

Question 17

the malignant type of acanthosis nigricans occurs when and is associated with what

Answer 17

middle-aged and older

associated with visceral malignancy

Question 18

epidermal (inclusion) cyst is what type of lesion

Answer 18

benign

Question 19

where and in who are epidermal (inclusion) cysts typically found

Answer 19

head and or neck in children

Question 20

what are the histological features of an inclusion cyst

Answer 20

cyst wall resembles normal epidermis, filled with strands of keratin

Question 21

what two types of epidermal (inclusion) cysts are there

Answer 21

inflamed and “quiet”

inflamed may be surgically excised

Question 22

what benign epithelial tumors are there

Answer 22

seborrheic keratosis
acanthosis nigricans
epidermal (inclusion) cyst

Question 23

what is the earlier identifiable lesion that can develop into squamous cell carcinoma

Answer 23

actinic keratosis

Question 24

up to 60% of squamous cell carcinoma develop from what

Answer 24

actinic keratosis (if patient has 10 or more the risk is 10-15%)

Question 25

what are the risk factors for actinic keratosis

Answer 25

years of sun exposure, fair skin, immunosuppression

Question 26

what is the key to early diagnosis of actinic keratosis

Answer 26

palpation

Question 27

palpation of actinic keratosis has what findings

Answer 27

rough or "gritty"skin | discrete, scaly, feels like "broken glass", surface legion

Question 28

actinic keratosis is commonly found where

Answer 28

sun exposed areas: face, scalp, ears, posterior neck, forearms and legs

Question 29

actinic keratosis develops into what kind of lesion

Answer 29

poorly-demarcated, slightly erythematous papule or plaque with adherent scale

Question 30

what is parakeratosis

Answer 30

retained nuclei

Question 31

parakeratosis in stratum corneum is seen in what

Answer 31

actinic keratosis

Question 32

what are the histological features of actinic keratosis

Answer 32

parakeratosis in stratum corneum hyperplasia and cytologic atypic of basal layer cells solar elastosis in superficial dermis

Question 33

how does one distinguish between actinic keratosis and squamous cell carcinoma

Answer 33

biopsy it

Question 34

how can actinic keratosis be treated

Answer 34

cryotherapy | topical 5-FU (intense inflammation as wise effect)

Question 35

what is the most common cancer in the US about equal to all other cancers combined

Answer 35

non melanoma skin cancer

Question 36

80% of non melanoma skin cancer is what

Answer 36

basal cell carcinoma

Question 37

after developing an initial BCC or SCC patients have what chance of developing another NMSC within 5 years

Answer 37

50%

Question 38

squamous cell carcinoma may present as what?

Answer 38

variety of primary morphologies with or without associated symptoms can present with a scaly pink patch or a thin keratotic papule

Question 39

where does squamous cell carcinoma arise and what populations is it common in

Answer 39

in epithelium | common in middle-aged and elderly

Question 40

what is the most important cause of squamous cell carcinoma

Answer 40

DNA damage by UV light (UVB is #1 w/ UVA being 2nd)

Question 41

arsenic is a risk factor for what

Answer 41

squamous cell carcinoma

Question 42

what are some risk factors for squamous cell carcinoma

Answer 42

``` male elderly UV and ionizing radiation Fair skin HPV sites with chronic infection thermal burn scars ```

Question 43

where is squamous cell carcinoma commonly found

Answer 43

scalp, dorsal upper extremities, ears

Question 44

what is bowen disease

Answer 44

a subtype of squamous cell carcinoma characterized by a sharply demarcated pink plaque and can arise on non-sun exposed skin

Question 45

what is Erythroplasia of Queyrat and how does it manifest

Answer 45

Bowen disease of the glans penis | manifests as one or more velvety red plaques

Question 46

squamous cell carcinoma in situ is characterized by what

Answer 46

``` NO invasion through basement membrane of dermoepidermal junction atypical nuclei (enlarged and hyper chromatic) involve ALL levels of the the epidermis ```

Question 47

squamous cell carcinoma (not in situ) is characterized by what

Answer 47

invasion of basement membrane variable differentiation orderly lobules of polygonal cells, areas of keratinization (well differentiated) anaplastic cells, necrosis, no organized keratin production (poorly differentiated)

Question 48

a raised, firm, pink-to-flesh colored keratotic papule or plaque arising on sun-exposed skin is commonly seeing what

Answer 48

squamous cell carcinoma

Question 49

what surface changes can be seen in squamous cell carcinoma

Answer 49

scaling, ulceration, crusting, or the presence of a cutaneous horn