Papular Lesions

Question 1

Acrochordon

Answer 1

-“skin tag”, fibroepithelial polyp

Etiology: skin friction

Pathogenesis: maybe HPV 6 and 11; may be linked to colon polyposis

Risk Factors: obesity, genetic, diabetes, pregnancy

Treatment: gradle excision, electrodessication, cryosurgery

DDX: SK, nevus, neurofibroma, wart, molluscum contagiosum

Question 2

Actinic Keratosis

Answer 2

-“solar keratosis”, pre-cancer

-Etiology/Pathology: repeated UVB exposure, prolonged sun leads to damaged keratinocytes

-PE: reddish, TENDER, hyperkeratotic scales X months-years on FACE, NECK, FOREARMS, HANDS, SHINS, SCALP

-Risk Factors: middle age, male, Fitzpatrick I-III, work outdoors

-DDX: Chronic cutaneous LE, SK, flat wart, SCC, superficial BCC

-Treatment: *Cryosurgery with liquid nitrogen; if it remains, worsens then BIOPSY

*Topicals: 5 Fluorouracil cream, Carac, Zyclara: treats many lesions at home

Retinoids: good for photoaging; used chronically

Facial peels: TCA

Laser surgery: Erbium or CO2

Photodynamic therapy

Soriatane: used for transplant patients (immunosuppressed)

Question 3

Keratoacanthoma

Answer 3

-“volcano”

-Etiology: UV radiation, HPV, pitch/tar exposure

-PE: firm, red, dome-shaped nodule with central keratotic plug

-Typically seen on cheeks, nose, ears and dorsal hands

-DDx: SCC, wart

-Treatment: lesion can spontaneously regress

Surgical excision recommended (r/o SCC)

Question 4

Seborrheic Keratosis

Answer 4

-SK, “barnacles of life”

-Etiology/Pathogenesis: hereditary, autosomal dominant, 30 y.o.>, m>f

-PE: small papule or plaque–>warty, greasy plaque--> 1-6cm brown, black nodule

• can be found on face, trunk, upper extremities

Risk Factors: age, genetics, friction

Treatment: cautery, cryo, shave biopsy

DDX: lentigo (flat, NOT waxy), AK, pigmented BCC, melanoma

-can look like melanoma, but take a closer look with dermascope

Question 5

Molluscum Contagiosum

Answer 5

• Self-limited epidermal viral infection
• can show up on eczema
• Etiology/Pathogenesis: poxvirus, skin to skin transmission (VERY CONTAGIOUS)

-PE: pearly, skin colored, umbilicated papules/nodules on pop fossa, ACF, groin, face

-Risk Factors: children, sexually active adults, HIV (mult. facial lesions)

-Treatment:“beetle juice” canthacur PS, cryo, imiquimod, curettage, HAART (HIV)

-DDX: BCC?

-can clear on its own (3-5 years)

Question 6

Basal Cell Carcinoma

Answer 6

-Most common skin cancer

• Can be metastatic
• Can invade muscle, bone, dura mater–> death from meningitis or hemorrhage of eroded vessel

-Etiology:

• UV radiation esp. in Fitzpatrick I and II
• 40 y.o.
• m>f

-PE: Solitary pearly papule with or w/o ulcer

-Danger sites: periorbital, NL folds, ear canal, post-auricular sulcus

-DDx: Acne blemish, Actinic Keratosis, Nodular Melanoma

-Treatment: Curettage and Dessication, Mohs, Topical Chemotherapy, Excision, Vismodegib (for metastatic BCC)

-Prognosis excellent if found early

Question 7

Squamous Cell Carcinoma

Answer 7

-2nd most common skin cancer

• Etiology: UV radiation, x-rays, HPV
• affects Fitzpatrick I & II
• m>f
• 55y.o. >

PE: Varied- red, indurated papule, plaque or nodule with keratotic scale; solitary or multiple

-will present with hx of bleeding areas

Distribution: cheeks, nose, lips, tips of ears, scalp, dorsal hands and feet

Question 8

Verruca Vulgaris

Answer 8

-“common wart”

-Etiology/ Pathogenesis: HPV types 1-68, Affects squamous epithelia of skin and mucous membranes. Trauma and maceration, autoinoculation.

PE: firm papules, 1-10mm, hyperkeratotic. “Seeds”= thrombosing capillary loops.

Risk Factors: skin to skin contact, immunocompromise, rarely genetic- Epidermodysplasia

Treatment: cryosurgery, electrosurgery, CO2, imiquimod, squaric acid, salicylic acid

-note: do not let them pick, dark spots–> blood supply

DDX: molluscum, SK, AK, KA, SCC

-consider HIV if many warts in one area… think about immunocompromised patient