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Derm Exam 2 > Pigmented Lesions & Skin Cancer > Flashcards

Pigmented Lesions & Skin Cancer Flashcards

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1
Q

Nevus

A
  • Circumscribed, stable malformation of
    the skin or oral mucosa
  • May involve epidermal, connective
    tissue, nervous, or vascular elements
  • Brown, black, or pink
  • Vary in size, thickness
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2
Q

Dysplastic (atypical) nevus

A
  • Unusual-looking
  • Acquired melanocytic lesions
  • Benign
  • May resemble melanoma
  • Increased risk of developing
    melanoma
  • These patients should avoid
    excessive UV exposure
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3
Q

Melanocytic Nevi

A

Acquired
* Benign neoplasm
* Composed of melanocytes
* Commonly form during childhood
* Genetic factors + UV exposure
* Develop and spread after
blistering
* 2nd degree burns
* Severe sunburn
* Almost every individual
* Fair skin

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4
Q

Melanocytic Nevi presentation

A
  • Examine all skin
  • Uniform color, even pattern of
    pigmentation
  • Round or oval
  • Regular, smooth border
  • Symmetry
  • Generally <1 cm in diameter
  • Can change
  • 16%
  • Photograph
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5
Q

Congenital melanocytic nevi (CMN)

A
  • Anomaly in embryogenesis
  • Malformation
  • Usually present at birth
  • Hypertrichosis- hair
  • Increased risk for melanoma
  • 1-2% overall; higher for large
  • Small < 1.5 cm
  • Medium 1.5-10 cm
  • Large >20 cm (neonate: >9 cm on the head
    or >6 cm on the body)
    https://dermnetnz.org/topics/melanocytic-naevus
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6
Q

Spitz nevi

A
  • 70% in < 20 yrs old
  • Red or pink dome shaped, firm papules on the head
  • Head, neck, extremities; spare soles, palms, mucous
    membranes
  • Rapid growth over 3-6 months followed by
    stabilization
  • “juvenile melanomas”
  • Histology resembles melanoma
  • Prepubertal pt and stable lesions:
  • May monitor Q 3-6 months
  • Any change or atypical features, new onset
    after puberty: Excise
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7
Q

Blue nevi

A
  • Heavily pigmented
  • Women 2x men, Asian 3x white
  • 1% to 2% of white adults and in 3% to 5% of Japanese adults
  • Onset late childhood, adolescence
  • Bluish cast
  • Tyndall phenomenon- refraction of light by overlying dermis
  • Melanocytes deeper than those of brown lesions
  • Solitary, bluish, smooth surfaced macule, papule or plaque
  • Generally round or oval, symmetric
  • Distal extremities (dorsum of hands and feet), buttocks,
    scalp and face
  • Common: 0.5-1 cm- benign, don’t change
  • Cellular: >1 cm, nodular- rarely change to malignant
    melanoma– Excise
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8
Q

Melanocytic Nevi
Diagnosis

A
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9
Q

Melanocytic Nevi
Diagnosis

A
  • Consider MRI for patients with
    multiple congenital melanocytic
    nevi
  • Excisional biopsy with
    microscopic evaluation
  • Shave
  • Punch
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10
Q

Melanocytic Nevi
Treatment

A
  • Observation
  • Removal
  • Histology or cosmetic reasons
  • Prevention
  • Limit UV exposure
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11
Q

UV Prevention recommendations

A
  • UVA/UVB sunscreen SPF 30 or
    higher, broad spectrum, water
    resistant
  • Infants?
  • Ears, scalp, lips
  • Apply 1 ounce = shot glass
  • Apply sunscreen to dry skin 15
    minutes BEFORE going outdoors
  • Reapply sunscreen approximately
    every 2 hours, or after swimming or
    sweating
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12
Q

Basal Cell Carcinoma

A
  • Nonmelanocytic
  • Arises from small cells found in the
    lower layer of the epidermis
  • Lifetime risk >20% for women,
    >30% for men
  • 85% occur on the face, neck, and
    head
  • Risk factors include alcoholism,
    immunosuppression, radiation
    exposure, gene mutations
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13
Q

Basal Cell Carcinoma presentation

A
  • Sore that does not heal
  • Gradually enlarging
  • Bleeds when irritated
  • Often mistaken for acne
    Nodular 80% of cases
  • Pearly, waxy papule with central depression
  • Central ulceration
  • Rolled borders
  • Telangiectasias
  • Metastasis is rare
  • Superficial 15% of cases
  • Slightly scaly, nonfirm macules,
    patches, or thin plaques
  • light red to pink in color, fine
    translucent papules on periphery
  • shiny
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14
Q

Basal Cell Carcinoma diagnosis

A
  • Shave biopsy
  • Excisional or punch biopsy, if
    question of melanoma
  • CT, if suspicion of spread to
    deeper structures
  • Usually not staged
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15
Q

Basal Cell Carcinoma treatment

A
  • Surgery:
    -Electrodesiccation and curettage
    -Mohs
    -Excisional surgery
  • 5-Fluorouracil (5-FU)
  • Imiquimod
  • Radiation
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16
Q

Squamous Cell Carcinoma

A
  • Cancer
  • 700,000 per year in the US
  • Incidence increasing
  • Head and neck
  • Malignant transformation of
    normal epidermal keratinocytes
  • Risk factors include UV exposure,
    immunosuppression, radiation
    exposure, HPV
17
Q

Squamous Cell Carcinoma
Presentation

A
  • Wound that will not heal
  • Ulcer
  • Plaques/nodules with scale, crust
  • Area of skin with history of UV
    exposure
  • Often preceded by actinic keratosis
  • Lesions >2 cm or located on the
    external ear or lip have a higher rate
    of metastasis
18
Q

Squamous Cell Carcinoma
Diagnosis

A
  • Full thickness biopsy
  • Shave biopsy not recommended
  • Excisional biopsy
  • Punch
  • Can present as a neck mass
  • Parotid
  • CT if needed to evaluate
    deeper structures
19
Q

Squamous Cell Carcinoma
Treatment

A
  • Electrodessication and curettage
  • Trunk, extremities
  • Mohs or surgical excision
  • Radiation
  • Chemo
  • Prevention
    -UV exposure
    -Actinic keratosis
20
Q

Melanoma

A
  • Cancer
  • Neoplasm of melanocytes
  • Affects young and middle-aged
    adults
  • Mean age of diagnosis is 63 years,
    with 15% being younger than 45
    years
  • Most common malignancy in
    women aged 25-29 years
  • One third of melanomas develop
    from a pre-existing nevus
21
Q

Melanoma
Risk factors

A
  • UV exposure
  • history of sunburns and/or heavy sun exposure
  • One blistering sunburn in childhood more than doubles a person’s
    chances of developing melanoma later in life
  • dysplastic nevi (1 doubles risk, 10+ 12x risk)
  • blue or green eyes, blonde or red hair, fair complexion
  • prior personal or family history of melanoma
  • genetic mutation- p16 mutation.
  • More than 50 nevi, ≥2 mm in diameter increases risk
22
Q

Melanoma
Growth

A
  • Radial
  • Irregular plaque
  • Epidermis
  • Vertical
  • Extends deeper
23
Q

Melanoma
Presentation

A
  • A - Asymmetry
  • B - Border irregularity
  • C - Color that is dark black, blue,
    or variable
  • D - Diameter ≥ 6 mm
  • E - Evolving
  • Head-to-toe skin examination
  • Lymph nodes
24
Q

SUPERFICIAL SPREADING MELANOMA
(SSM)

A
  • 70% of cutaneous melanomas
  • Classic ABCDE irregularities: irregular
    borders and irregular pigmentation,
    discrete focal area of darkening
    within a preexisting nevus; slowly
    changing
  • Preexisting nevi
25
Q

Nodular melanoma

A
  • 2nd most common (15-30% of
    melanomas)
  • Trunks of males, legs of women
  • More symmetrical
  • Dark brown or black
  • Short radial growth phase, quickly
    grow vertically, aggressive
  • More likely to form de novo
26
Q

Lentigo maligna melanoma

A
  • Slightly more in females; uncommon
    <40 yo
  • Sun-exposed areas-
    cheek/nose/scalp/ears
  • Initially flat, slowly enlarging, large,
    brown, frecklelike macule with irregular
    shape and differing shades of brown and
    tan, usually arising in a background of
    photodamage
27
Q

Acral lentiginous melanoma

A
  • Least common <5%; avg age 63 yo
  • Racial differences
  • However, equal incidence in whites vs other
    ethnicities
  • Hands and Feet: Palms, soles, and subungual
    areas
  • Very aggressive, rapid progression to vertical
    phase
28
Q

Melanoma
Diagnosis

A
  • Biopsy, excisional preferred
  • 1-3 mm margins
  • Shave biopsy typically
    contraindicated
  • Chest x-ray
  • CBC c diff, CMP, LDH
  • CT/PET
  • MRI
  • Lymph node dissection
29
Q

Melanoma
Treatment

A
  • Wide local excision with sentinel
    lymph node biopsy and/or
    elective lymph node dissection
  • Adjuvant radiation therapy:
  • Cryotherapy
  • Imiquimod
  • Immunotherapy, targeted
    therapy
30
Q

Clark scale

A

Level 1: (melanoma in situ) – the melanoma cells are only
in the outer layer of the skin (the epidermis)
Level 2: melanoma cells in the papillary dermis (superficial
dermis)
Level 3: melanoma cells are touching the next layer down
known as the reticular dermis (deep dermis)
Level 4: melanoma has spread into the reticular dermis
Level 5: melanoma has grown into the layer of fat under
the skin (subcutaneous fat)

31
Q

Breslow thickness

A

measurement
of the depth of the melanoma from the
surface of your skin down through to the
deepest point of the tumor

32
Q

Kaposi Sarcoma (KS)

A
  • Spindle-cell tumor
  • purplish, reddish blue, or dark brown/black
    patches, plaques, or nodules
  • Cancer that develops from the cells that line
    lymph or blood vessels
  • Most often: distal extremities
  • Ranges from minimal mucocutaneous disease
    to extensive organ involvement
  • GI tract- often asymptomatic
    (bleeding/diarrhea)
  • Rare prior to AIDS epidemic
  • Caused by Human herpes virus 8 (HHV-8)
33
Q

Who gets Classic (Sporadic) KS?

A
  • Elderly men of Mediterranean
    and Eastern European descent
  • 30% develop a second
    malignancy
  • Non-Hodgkin lymphoma
  • Risk factors include infrequent
    bathing, a history of asthma,
    and in men, a history of
    allergies
34
Q

Epidemic (AIDS-related) KS

A
  • Most aggressive form
  • Advanced disease
  • Most common malignancy in
    HIV-infected patients
  • AIDS-defining cancer
35
Q

Immunocompromised (Iatrogenic) KS

A
  • Organ transplant patients or other
    pts receiving immunosuppressive
    therapy
  • 15-30 months following transplant
  • Withdrawal of immunosuppression
    therapy may lead to regression
  • Sirolimus (Rapamune) - prevents
    transplant rejection, also seems to
    have an anti-KS effect
36
Q

Kaposi Sarcoma (KS)
Presentation

A
  • Lesions may involve the skin, oral mucosa,
    lymph nodes, visceral organs
  • The brain is spared
  • Typically appear in a linear, symmetric
    distribution, following Langer lines
  • Macular, papular, nodular, or plaquelike
  • Palpable
  • Nonpruritic
  • Brown, pink, red, or violaceous
  • Lymphedema
  • GI involvement +/- sxs
  • Pulmonary symptoms
37
Q

Kaposi Sarcoma (KS)
Diagnosis

A
  • HIV
  • CD4 lymphocytes
  • Viral load
  • Chest x-ray
  • Gallium scan
  • Punch biopsy
  • Bronchoscopy
  • Cherry red lesions
  • EGD or colonoscopy
38
Q

Kaposi Sarcoma (KS)
Treatment

A
  • Refer
  • HAART- antiviral HIV tx
  • First line
  • Chemotherapy
  • Radiation
  • Surgical excision, cryotherapy,
    topical imiquimod

Derm Exam 2 (5 decks)

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