premalignant lesion/ benign growths

Question 1

Actinic Keratosis

Answer 1

premalignant lesions that have the potential to transform into a skin cancer (if they do, it will most likely be a SCC)

may be considered a part of a dz spectrum (AK into SCC in situ-Bowen’s Dz into SCC)

Question 2

risk of AK malignant progression

Answer 2

presistence of the AK, cumulative UV, hx of skin CA, genetic susceptibility and immunosuppression

Question 3

what is the cell of origin for AK?

Answer 3

keratinocyte

Question 4

common location of AK

Answer 4

face, scalp, neck ears, hands forearsm

Question 5

actinic cheilitis

Answer 5

lower lip AK

Question 6

AK CF

Answer 6

flesh-colored, yellowish, brown, pink, or red-colored, scaly, hyperkeratotic, or rough-textured (feel like sandpaper) papules. They may also present as cutaneous horns

Question 7

lesions of AK that are most likely to progress to SCC

Answer 7

lips and ears

Question 8

tx for AK

Answer 8

5-FU, imiquimod, cyrotherapy, ED&C

Question 9

AK RF

Answer 9

UV exposure (p53 suppressor gene mutations)
increasing age, fair skin, 
light eyes/hair (Fitz skin types 1,2) genetic syndrome (xeroderma pigmentosum, albinism)

Question 10

AK dx)

Answer 10

often dx by feel (sandpaper)

always bx horns

Question 11

chronic sundamaged skin features

Answer 11

atropy and hypertrophy, telangiectasia, spotty depigmentation and hyperpigmenation, wrinkles, “leathery”

Question 12

solar lentigo

Answer 12

one/many small brown macules

Question 13

cutis rhomboidalis nuchae

Answer 13

red neck with rhomboidal furrus

Question 14

solar elastosis

Answer 14

fine nodularity, pebbly surface

Question 15

actinic (senile) purpura

Answer 15

easy brusing, extravasted erythrocytes and increased perivascular inflammation

Question 16

Seborrheic Keratosis

Answer 16

common benign epidermal growths

everywhere but palms and soles

Question 17

SK CF

Answer 17

• Surface can be smooth, velvety, verrucous, or hyperkeratotic
• Color can be white, pink, tan, light brown, dark brown, or black
• Usually appear “stuck-on” and can sometimes come off or crumble if picked
• Hereditary and usually appear after 30’s
• May become irritated due to location or patient may find them cosmetically unappealing

Question 18

clinical variations of SK

Answer 18

include dermatosis papulosis nigra in African Americans on the face and stucco keratosis in older Caucasians on lower legs, ankles, and dorsal hands and feet

Question 19

TX of SK

Answer 19

necessary unless symptomatic and includes cryotherapy, shave remove, light electrocautery, or curettage

Question 20

Leser-Trelat

Answer 20

sudden eruption of many SK’s may be a cutaneous sign of internal malignancy

Question 21

clinical pearl of SK

Answer 21

using a 10x ocular or magnifying lens may help you to see multiple keratin cysts embedded within the surface of the lesion