Pigmented Lesions Flashcards
define ABCDE of skin exams
- A: asymmetry
- B: border
- C: color
- D: diameter
- E: evolving
what is the ugly duckling sign?
a lesion that stands out compared to other lesions on the pt’s skin
when to consider biopsy?
- pigmentary changes
- changes in border or diameter of lesion
- bleeding or itching in the lesion
- a new lesion in pt over 50 y/o
- ugly duckling sign
what to do prior to biopsy?
- take a photo of the lesion
- record landmarks
how much of the lesion should be biopsied?
the entire lesion, unless extremely large in size
Lentigo
common names for lentigo?
freckles, sun spots, age spots
Lentigo
what is lentigo?
color, distribution, where, characteristics
benign, solitary or multiple, uniform, brown macules and patches that are typically found in sun exposed areas of the body
Lentigo
what causes lentigo
UV damage
Lentigo
treatment for lentigo
- no treatment
- sun avoidance in use of sunscreen to minimize appearance
Melasma/Chaloasma
clinical manifestation
characterized by patchy light to dark brown hyperpigmentation of the face
Melasma/Chaloasma
who does this typically affect?
women, hereditary
Melasma/Chaloasma
what causes worsening of hyperpigmentation?
exposure to UV light
Melasma/Chaloasma
associated with?
risk factor
- hormonal changes (OCP, hormone replacement therapies)
- can be idiopathic
Melasma/Chaloasma
tx
- strict sun avoidance
- hydroquinone 4% cream (QD/BID, 1 mo)
Melasma/Chaloasma
when should hydroquinone use be reserved for?
fall/winter months
Acanthosis Nigricans
Clinical Manifestations
- velvets
- hyperpigmented plaques on intertriginous areas (neck/axillary)
Acanthosis Nigricans
associated with what?
- insulin resistance (DM, metabolic syndromes, PCOS)
Acanthosis Nigricans
labs to order if pt has this?
- fasting insulin
- fasting glucose
Acanthosis Nigricans
tx
strict control of blood sugar to minimize sx
Seborrheic Keratosis
clinical manifestations
6 things
- well demarcated
- round/oval
- velvety, warty lesions
- greasy or stuck appearance
- variety of colors
- can be scaly
Seborrheic Keratosis
tx
- no tx necessary
- can be symptomatically treated with cryotherapy
Seborrheic Keratosis
common in who?
- fair skin
- elderly
- pts with hx of prolonged sun exposure
Melanocytic Nevi
what is it?
- common benign skin lesion due to localizaed proliferation of melanocytes
Melanocytic Nevi
differentiate congenital vs acquired
how long they last?
- congenital: tend to be the most prominent & persist through life
- acquired: follow sun exposure, may fade away
Melanocytic Nevi
more common in who?
fair skinned individuals
Melanocytic Nevi
clinical manifestations
- variety of presentations/sizes on any part of the body
- flat/raised
- flesh colored/pink/dark brown/black
Melanocytic Nevi
tx
observation
Atypical/Dysplastic Nevi
define
- melanocytic nevi w/ atypical features
Atypical/Dysplastic Nevi
clinical manifestations
5
Nevus w/ at least 3 of the following:
* size > 5 mm
* ill definied/blurry borders
* irregular margin/unusal shape
* vareity of colors w/in lesion
* flat/bumpy components
Atypical/Dysplastic Nevi
procedure to order?
shave biopsy
Atypical/Dysplastic Nevi
spectrum of atypica?
- mild
- moderate
- severe
- melanoma in situ
- malignant melanoma
Atypical/Dysplastic Nevi
tx mild
monitor for recurrence
Atypical/Dysplastic Nevi
tx for moderate/severe
excision
Blue Nevus
define
melanocytic nevus which are located deep within the dermis
Blue Nevus
common in which population?
- twice as common in women as men
- prevalent among Asian populations
Blue Nevus
can transform into?
melanoma
Blue Nevus
clinical manifestations
- solitary
- blue/gray
- smooth-surfaced macule, papule, or plaque
Blue Nevus
tx
observation
Melanoma
pathogenesis (cell of origin)
melanocyte
Melanoma
who most commonly gets these?
- young women ages 15-29
Melanoma
caused by?
- cumulative & prolonged UV exposure
Melanoma
risk factors
7
- increasing age
- Fitzpatrick skin types 1 & 2
- greater than 25 acquired nevi
- atypical nevi
- immunosuppression
- family/personal hx
- UV exposure (tanning, blistering)
Melanoma
Clinical Manifestations
- usually asx, pigmented papule, plaque, or nodule
- can bleed, be eroded, or crusted
- hx of changing appearance
- msot are de novo (arise from w/in existing lesion)
- more common in sun exposed areas
Melanoma
prognosis
high cure rates if dx and tx early
Melanoma
prognosis factors
- increased Breslow’s depth
- ulceration
- involvement of lymph nodes or distant metasteses
Melanoma
what is Breslow’s depth
thickness or depth of tumor invasion
Melanoma
what to do if you suspect melanoma in pt?
refer to derm for biopsy
Melanoma
Tx depends on?
3
Stage
* based on Breslow’s depth
* ulceration
* lymph node involvement
Melanoma
likely tx course
2
- surgical excision w/ wide margins
- +/- lymph node biopsy
Melanoma
required follow up
3
- visits every 6 mo for 10 years, then every 12 mo for life
- annual eye exam
- annual physical
