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DERM > SKIN CANCER & HEALTH MAINTENANCE > Flashcards

SKIN CANCER & HEALTH MAINTENANCE Flashcards

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Dermatology Board Prep flashcards
1
Q

GENERAL SKIN CARE

A 
Treat skin gently
Limit bath time
Avoid strong soaps
Shave carefully
Pat dry
Moisturize dry skin
Eat a healthy diet
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2
Q

emollients

A 
eucerin
vanicream
cetaphil
nutraderm
aquaphor
vaseline
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3
Q

hydrating the skin

A
  • apply an emollient immediately after bathing or showering - leaving some water on skin
- best emollients are
eucerin
vanicream
cetaphil
nutraderm
aquaphor
vaseline
  • lotions contain more water & alcohols than creams & ointments, and should therefore be avoided as they can worsen dry skin
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4
Q

don’t over-exfoliate!

A
  • important not to over-exfoliate the skin, as this can disrupt the epidermis and cause increased dryness
  • as a result, the skin produces more oil, leading to possible acne
  • can also disrupt blood vessels
  • gentle exfoliation 1-2x/week or none is recommended
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5
Q

smoking damages the skin

A

causes the skin to age faster

Narrows the blood vessels in the outermost layers of skin

Damages collagen and elastin

Can contribute to wrinkles from the repetitive facial expressions made when smoking

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6
Q

Repeated low exposure to UV radiation results in

A

SKIN CANCER

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7
Q

Brief and early (childhood sunburns) increase the risk of

A

melanoma

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8
Q

A history of ____ or more severe sunburns in childhood and adolescence more than _______ the risk of developing melanoma

A

3

doubles

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9
Q

2/3 of melanoma may be attributed to excessive ______________

A

sunlight exposure

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10
Q

_________radiation causes most of the DNA damage

A

UVB

but UVA radiation is also important in the pathogenesis of melanoma

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11
Q

PRIMARY PREVENTION OF SKIN CANCER

A

Avoid Exposure to Ultraviolet Radiation
Use sunscreen > SPF 30
Protective clothing, hats and sunglasses
Schedule outdoor activities before 10am and after 4pm and seek shade when appropriate
Avoid all tanning including tanning salons
Use extra caution near water, snow and sand as they reflect damaging rays of the sun

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12
Q

sunscreen

A
  • Educating parents so children are protected
  • Generously apply sunscreen to ALL exposed skin using a SPF of 30 or higher that provides broad-protection from both UVA and UVB
  • Reapply every 2 hours
  • Reapply after swimming or sweating, use waterproof formulations
  • Needs to be applied 15 to 20 minutes before sun exposure
  • For sunscreen to work effectively it must be applied liberally and often
  • Using sunscreen should not be an excuse to spend long amounts of time in the sun
  • Sunscreen can delay sunburn
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13
Q

SKIN CANCER SCREENING / EARLY DETECTION

A

Inspect moles for changes
Remove suspicious moles
Remove actinic keratoses and other precancerous lesions

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14
Q

Monthly self-examinations are recommended for persons with:

A
  • personal history of skin cancer
    - 1st degree family history of skin cancer
    - precursor lesions
    - sun damaged skin

Yearly clinician skin exams for patients at high risk
Some patients may need exams every six months

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15
Q

skin cancers

A

melanoma
BCC
SCC
Kaposi’s Sarcoma

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16
Q

freckles vs SLs

A

freckles fade in the winter and become unapparent in older patients, whereas solar lentigines remain for life and become more prominent with aging

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17
Q

Extremely common, benign, bright red to violaceous, domed vascular lesions. They generally appear first around age 30 and increase in number over the years

A

cherry angiomas

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18
Q

Anytime a melanoma is suspected, an ______ biopsy is indicated

A

excisional

A punch biopsy from only part of the lesion may not be sufficient enough for the pathologist to make a proper histologic diagnosis or may miss the abnormal cells (false negative)

A shave biopsy will not assess the depth of a melanoma which is critical for staging

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19
Q

most serious form of skin cancer, it is a malignant tumor arising from melanocytes.

A

melanoma

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20
Q

MELANOMA IS

A

Far less common than basal cell and squamous cell cancers but accounts for the great majority of skin cancer deaths

Rapidly increasing incidence

Sex ratio 1:1

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21
Q

risk factors for melanoma

A

Fair skin (who tan poorly and burn easily)

Episodic intense sun exposure (i.e. a severe blistering sunburn history)

First degree family history

Precursor lesions include congenital nevi, especially **dysplastic nevi and giant hairy nevus

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22
Q

ABCDEs of MELANOMA

A 
Asymmetry (irregular or raised)
Border irregularity (dark or inhomogeneous)
Color (multiple colors/shades)
Diameter (>6mm)
Enlargement or evolution

“ugly duckling”

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23
Q

SEVEN POINT CHECKLIST

A

o Major Features
change in size
change in color
change in shape

o Minor Features
Inflammation
Bleeding or Crusting
Sensory change
Lesion diameter > 6mm
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24
Q

In a study evaluating both the ABCDE and seven point evaluation systems:

A

All melanomas (n = 65) were detected using the seven point checklist and all were found to have at least one of the three major criteria defined by that system

Five (7.7 percent) melanomas were not picked up by the ABCDE checklist.

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25
Q

Screening examination of the total skin surface can increase the likelihood of detecting melanoma _____-FOLD compared with partial examination.

Men have more lesions on the ____ and women on their _______ since these are common areas of sunburn; screening of those sites could particularly aid early detection

A

SIX

back

lower legs

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26
Q

nevus that has some malignant characteristics

A

dysplastic nevus

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27
Q

a congenital discoloration of a circumscribed area of the skin due to pigmentation (commonly referred to as a mole)

A

NEVUS

28
Q

tumor thickness in mm

A

Breslow

29
Q

depth of tumor

A

Clark level

refers to anatomical descriptor (anatomical planes) of depth (I-V) of the malignant cells, “to dermis but not subq” etc.

30
Q

clark levels I-V

A 
I = in epidermis, stops at basal lamina
II = past basal lamina into papillary dermis
III = through papillary dermis, stops at reticular dermis
IV = into reticular dermis
V = through reticular dermis into subcutaneous fat
31
Q

breslow _____________ = bad prognosis

A

> 4 mm

32
Q

Breslow _________ = good prognosis

A

< 1 mm

1-4mm = intermediate prognosis

33
Q

most common melanoma

A

superficial spreading melanoma

34
Q

superficial spreading melanoma

A
  • most common (70%)
  • grows superficially before spreads deep
  • great prognosis if caught early
  • has a preference for torso in men & legs in women
  • most commonly diagnosed between ages 30-50
35
Q

NODULAR MELANOMA

A
  • 2nd most common form of melanoma (15%)
  • often invasive from the onset - has a poor prognosis
  • any site has rapid vertical growth and is typically diagnosed at a later stage
  • most frequently diagnosed in 6th decade of life
36
Q

least aggressive melanoma

A

lentigo maligna melanoma

37
Q

LENTIGO MALIGNA MELANOMA

A
  • 5% of melanomas
  • tendency for head & neck
  • more common in patients > 60 with sun damaged skin
  • least aggressive melanoma
  • may be present for 5 years before invasion (termed lentigo maligna before invasion)
  • often has a favorable prognosis
38
Q

melanoma that is most common in people with darker skin types

A

acral lentiginous melanoma

39
Q

ACRAL LENTIGINOUS MELANOMA

A
  • occurs on palms, soles, subungual areas and mucous membranes
  • most common in people with darker skin types
  • commonly diagnosed at an advanced stage
  • poor prognosis
40
Q

HUTCHINSON’S SIGN

A

ACRAL LENTIGINOUS MELANOMA

longitudinal pigmented streak on nail - extends from proximal or lateral nail fold. develops quickly and may widen or darken. Often irregular in shape

  • Pigmented globules may be noted at distal clipped nail plate
  • need to refer for biopsy of nail unit
41
Q

things that can cause longitudinal melanonychia

A
  • can occur from trauma, meds (mino / chemo / anti-malarials), infections (fungal), Addison’s, B12 deficiency, Hemochromatosis
42
Q

longitudinal melanonychia

A
  • which is benign - pigmented bands / nevi on nails = found in up to 90% of blacks & 20% of asians
  • can occur from trauma, meds (mino / chemo / anti-malarials), infections (fungal), Addison’s, B12 deficiency, Hemochromatosis

Malignant subungual melanoma = usually solitary and most often involves the thumb or great toe

vs longitudinal melanonychia = will see on multiple fingers

43
Q

***UP TO 20% OF HALO NEVI CAN BE ASSOCIATED WITH

A

MELANOMA

44
Q

HALO NEVUS MAY BE THE PRESENTING SIGN OF

A

OCULAR MELANOMA

45
Q

NON-CUTANEOUS MELANOMA (rare)

A

o ocular melanoma (mostly choroid or ciliary body)

o Mucosal melanoma
⦁	head &amp; neck
⦁	vulva &amp; vagina
⦁	anal
⦁	urethral
⦁	esophageal
46
Q

BCC EPIDEMIOLOGY

A

Lifetime risk of developing a BCC is 30%….one of the most common malignancies in humans

Incidence increases with age (55-75 y/o show 100-fold higher incidence than those <20)

Incidence is rising across all subgroups

Particularly common in Caucasians

Very uncommon in dark-skinned populations

States closer to the equator have much higher incidence

47
Q

BCC arises from the

A

Basal layer of the epidermis….. Caused by DNA damage of Keratinocytes

48
Q

translucent / pearly white papule with telangiectasias over the surface that slowly enlarges, and development of a central ulceration

A

BCC

49
Q

basal cell carcinomas

A

BCC arises from the - BASAL LAYER of the epidermis
is caused by DNA damage of keratinocytes

  • rarely metastasizes, however, can be locally invasive & destructive of skin & surrounding structures, including the bone

Etiology = excess UV radiation exposure

Appearance = translucent / pearly white papule with telangiectasias over the surface that slowly enlarges, and development of a central ulceration

50
Q

majority of BCCs occur on the

A

face

51
Q

majority of BCCs are what type

A

nodular

52
Q

topical 5-FU = efudex or Imiquimoid (aldara) = only for __________ BCC

A

superficial

53
Q

treatment options for BCC

A
  • surgical excision
  • MOHS
  • radiation therapy
  • ED&C
  • Cryotherapy
  • topical 5-FU = efudex or Imiquimoid (aldara) = only for superficial BCC
54
Q

arises from the malignant proliferation of the keratinocytes of the epidermis

A

SCC

55
Q

SCC may be associated with

A

HPV

56
Q

SCCIS =

A

bowen’s disease

which is the next level after AKs

57
Q

⦁ typically presents as chronic, asymptomatic, nonhealing, slowly elarging erythematous patch with sharp but irregular outline (scaling & crusting may be present)

A

bowen’s disease (SCCIS)

58
Q

flesh-colored nodule that enlarges and often undergoes ulceration and crusting

A

invasive SCC

59
Q

AK TREATMENT

A
  • cryotherapy
  • Efudex or Aldara
  • Curettage
  • chemical peels (TCA)
  • laser
  • photodynamic therapy
60
Q

nonhypertrophic vs hypertrophic vs multiple AK treatment

A

if nonhypertrophic = LN2

if hypertrophic = surgical curettage - send these to path

multiple AKs = Efudex or Imiquimod (aldara)

61
Q

controversy exists over whether KA is a distinct disease or a variant of

A

SCC

62
Q

Cutaneous tumor that presents as a dome-shaped nodule with a central keratin-filled crater

A

KERATOACANTHOMA

63
Q

vascular tumor associated with HHV-8 (herpes virus)

A

KAPOSI’S SARCOMA

64
Q

4 forms of Kaposi’s Sarcoma

A

⦁ Classic = affects older men of Mediterranean & Jewish origin

⦁ Endemic or African = found in all parts of equatorial Africa, particularly in sub-saharan Africa. This is not typically associated with immune deficiency

⦁ Organ transplant associated

⦁ AIDS related (KS prevalence was much higher before antiretroviral therapy)

65
Q

KS presentation

A
  • KS = highly variable clinical course
  • NOT just a skin problem - also affects oral cavity, GI tract and respiratory tract
- Skin findings
⦁	papules most often
⦁	elliptical along skin tension lines
⦁	multiple colors
⦁	may be surrounded by yellow halo
66
Q

KS treatment

A 
o Local treatment
⦁	surgery
⦁	radiation therapy
⦁	cryotherapy &amp; laser therapy
⦁	intralesional therapy
⦁	topical therapy - imiquimod

o Systemic Treatments
⦁ chemotherapy
⦁ immunomodulators

DERM (12 decks)

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