Skin Flashcards by Clyde Silverio

What are the layers of the skin

Corneum
Lucidum
Granulosum
Spinosum
Basalis

Californians Like Girls in String Bikinis

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Wha is the pressure threshold for skin pressure injury

60mmHg

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When lying, the sacral pressure is ____ mmHg

150

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When sitting the ischial pressure is ___ mmHg

300

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When lying, what are the dependent areas of the skin?

back of the head
scapupa
spinous process
elbow
sacrum
posterior calf
heel

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This solar radiation is responsible for acute and chronic skin effects

UVB

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This type of infection is due to exposure to a body of salt water

Type III

due to V. vulnificus

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[diagnose]

common in obese, smokers

painful, affecting the apocrine gland bearing areas (axilla, perineum, inframammary gland, inguinal folds)

Tender, deep nodules that expand, coalesce, spontaneously drain, form persistent sinus tract

Hidradenitis suppurativa / Acne inversa

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[Hurley Classification for H. suppurativa]

single/multiple nodules without sinus tract or scarring

Stage I

Tx: Clindamycin

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[Hurley Classification for H. suppurativa]

abscess, sinus tract, scarring

Stage II

clindamycin

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[Hurley Classification for H. suppurativa]

diffuse, interconnected sinus tracts and abscesses

Stage III

Tx: Radicala excision, laser treatment, biologic agents

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[diagnose]

presents as nodules and spread to form draining tracts following dental extraction

(+) sulfur granules

Actinomycosis

Tx: penicillin and surgical debridement

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[diagnose]

rapidly enlarging necrotic lesion with undetermined border surrounding erythema

associated with IBD, RA, hema malignancy, IgA gammopathy

pyoderma gangrenosum

Tx: steroirds, cyclosporine

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[SSSS vs TEN]

exotoxin affecting the granular layer

SSSS

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[SSSS vs TEN]

immune mediated affecting the dermoepidermal junction

TEN

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[diagnose]

“stuck on” yellow or light brown, papules/plaques with velvety, greasy texture

seborrheic keratoses

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[diagnose]

arise in sun-exposed areas. premalignant lesion to SCC, atypical appearing keratinocytes

Actinic Keratosis (solar keratosis)

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[nevi]

occur in a swimming trunk distrubution

giant hairy nevi (congenital)

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[Nevi: acquired/congenital]

premalignant to melanoma

congenital

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[diagnose]

benign neoplasm of the extremity

arise from the neuromyoarterial apparatus with blue, subungual discoloration associated with severe pain, point tenderness and cold sensitivity

glomus tumor

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nonmelanoma skin cancers are typically a disease of the ___ skinned people

fair-skinned

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[diagnose]

most common type of skin cancer

basal cell CA

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most common subtype of basal cell CA

nodular (rodent ulcer)

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most aggressive subtype of basal cell CA

morpheaform

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the most common malignant eyelid tumor

basal cell CA

most common upper lip CA

basal cell CA

[diagnose: basal cell CA type] waxy, pearly appearing papule with raised, well-demarcated border crusting that bleeds with minor trauma, telangectasia over the translucent surface or central ulceration

nodular BCC

pigmented BCC

[diagnose: basal cell CA type] marked bluish or gray cystic nodules

cystic BCC

[diagnose: basal cell CA type] scaly, patch-like or papule form that varies in color from pink to red or brown

superficial BCC

[diagnose: basal cell CA type] Well-defined border, less prone to ulceration, aggressive varian

micronodular BCC

[diagnose: basal cell CA type] ill-defined borders that extend beyond clinically visible margins scar-like appearance in a plaque or papule formation that can be mistaken for scar tissue ulceration, bleeding, crusting are uncommon

morpheaform and infiltrating BCC

Skin CA associated to exposures to arsenic, tar, polycyclic aromatic hydrocarbons

squamous cell CA

[diagnosis] arise from the basal layer of the dermis in association with an area of pre-existing skin damage

squamous cell CA

[diagnosis] enlarging bumps that may have irregular or reddened surface shallow ulcer with heaped up edges

squamous cell CA

[diagnosis] skin CA associated with cranial nerve dysfunction

squamous cell CA

[biopsy] preferred techniques for nonmelanoma skin CA

shave or incisional biopsy

staging of these cancers are not affected by the depth of the lesion

BCC and SCC

vigilance biopsy is important in these lesions

1. old burn wounds 2. chronic nonhealing wounds 3. scars

how many sunburns in early life has been associated with a doubled risk of developing malignant melanoma after life

five or more

Xeroderma pigmentosum is a risk factor for this skin CA

malignant melanoma

melanocytes are derived from what tissues

neural crest tissues

[diagnosis: melanoma subtypes] these generally arise in a preexisting nevus, most common subtype of malignant melanoma

superficial spreading, malignant melanoma

[diagnosis: melanoma subtypes] worst prognosis due to the prominence if vertical gorwuth

nodular type malignant melanoma

[diagnosis: melanoma subtypes] older patient, slowly growing, large (>3cm), flat lesions

lentigo maligna

[diagnosis: melanoma subtypes] located in the subungual regions and glaborous skin or palms and soles

acral lentigenous

[diagnosis: melanoma subtypes] rare but aggresive subtype propensity toward perineural invasion and recurrence

desmoplastic

[malignant melanoma] most common site of metastasis

lung, liver

[malignant melanoma] most common non-cutaneous site

ocular

[malignant melanoma] with the worst prognosis

mucosal melanomas

[treatment of nonmelanoma skin CA} for low-risk BCC and SCC of the trunk or extremity

excision with postoperative margin assessment (POMA) 4-6mm margins

[treatment of nonmelanoma skin CA} for face, ears, and areas where preservation of uninvolved tissues is critical for cosmesis and function; for irregularly shaped tumors to ensure clear margins

Mohs Surgery excision with complete circumferential and peripheral deep margin assessment or intraoperative frozen section

[treatment of nonmelanoma skin CA} for small, superficial lesions, high recurrence rates

curettage and electrodessication visible tumor, 2-4mm margin

[treatment of nonmelanoma skin CA} precancerous lesions and very small, superficial BCC and SCC

cryosurgery

[treatment of nonmelanoma skin CA} for extensive lesions precluding surgical resection

Radiation 50-60 Gy delivered over 4-6 weeks

Cite the ABCDE rule in diagnosing malignant melanoma

``` Asymmetry Border Irregularity Color variation Diameter Evolution ```

[biopsy: malignant melanoma] for cosmetically sensitive areas

incisional or punch biopsy

[biopsy: malignant melanoma] best diagnostic when an enlarged lymph node is palated

FNAB

[Clark Stage] Papillary dermis + Reticular dermis

Clark IV

[Clark Stage] papillary dermis + reticular dermis + SQ

Clark V

[Clark Stage] melanoma in situ

Clark I

contrast used in Sentinel Lymph node biopsy

methylene blue or isosulfan blue

drug of choice for isolated limb perfusion technique

melphalan