Skin Cancer/pigmented Lesions

Question 1

Nevus

Answer 1

Mole

Question 2

Actinic keratosis

Answer 2

Pre-cancerous lesion!
pink erythematous papules to thin plaques with rough, gritty scale. reported tenderness. Commonly in sun-exposed areas (and is a risk factor). Other risk factors include male, increasing age, fair skin, immunosuppression. 8% will progress to SCC (Tx recommended)

Question 3

Basal cell carcinoma

Answer 3

Most common skin cancer (and cancer in humans). Pink pearly papule with central depression, telangiectasias, rolled borders. Commonly on head and neck region (nose is most common). Risk factors: >40Y.o (but increasing in younger population likely due to sun exposure). locally destructive, slow growing, rarely metastasize if left untreated

Question 4

Squamous cell carcinoma

Answer 4

cancer of squamous cells of the epidermis. Can be in situ (bowen’s disease) or invasive.

Question 5

Melanoma

Answer 5

Age of Onset: Adulthood, children with GCMs or atypical mole syndromes
Location: anywhere (common on trunk in men, legs in women)
Number: 1
Size: > 6mm (could be smaller)

Question 6

Normal moles

Answer 6

Age of Onset: 6mo - 20yrs (sometimes 30s)
Location: anywhere
Number: few to hundreds
Size: <6mm

Question 7

Atypical nevi

Answer 7

Age of Onset: 6mo - 20yrs
Location: anywhere (common on trunk, esp back)
Number: 1 to hundreds
Size: > 6mm (could be smaller)

Question 8

Key melanoma questions

Answer 8

Stability (has it stayed the same over time), symmetrical, similarity to other moles.

Question 9

Congenital Melanocytic Nevus (CMN)

Answer 9

Can vary in size. Increased size has historically been correlated with higher risk for melanoma, although in practice the incidence is 5-6% higher. The lesions are raised and often darken over time. Hypertrichosis.

Question 10

Becker’s Nevus

Answer 10

Most common in males (onset around puberty and grows for 1-2 years on the back and shoulders (commonly)). Light brown and can feel slightly elevated and verrucous. Hypertrichiasis. Treatment is cosmetic

Question 11

Halo Nevus

Answer 11

Nevus with white surrounding border. Most commonly found in children (some adults). Typically located on the back. Biopsy if changing or atypical

Question 12

Spitz Nevus

Answer 12

solitary rapidly growing pink-red papulonodule. sudden onset before age 40. Histological exam to confirm dx (difficult to distinguish from melanoma)

Question 13

Blue Nevus

Answer 13

macule or papule dark blue/black in color. Most common on distal extensor extremities, scalp, or sacral area. Can resemble melanoma!

Question 14

Fitzpatrick Skin Types

Answer 14

Scale from 1-6 rating fairness and burnability/tanning ability of skin tones. 1=very fair/always burns (cannot tan)

Question 15

Actinic Keratosis treatment options

Answer 15

Cryotherapy: isoloted/small number of lesions
5-fluorouracil (efudex): chemo cream (2-3 weeks)
Imiquimod (Aldara): immune respone modifier
Photodynamic therapy
Chemical peels

Question 16

Keratinocyte carcinoma

Answer 16

cancers of keratinocytes

Question 17

SCCIS/Bowen’s Disease

Answer 17

SCC in situ. Erythematous, hyperkeratotic, well demarcated patch or plaque. Can resemble eczema or psoriasis! Risk factors include sun exposure, elderly, fair skin, immunosuppresion, arsenic, radiation

Question 18

Invasive SCC

Answer 18

Erythematous, scaly papulonodule/plaque with adherent white scale, can appear eroded. Typically located on the head/neck and dorsal extremities. Risk factors: Sun exposure, make, older age, fair skin, genetic syndromes, immunosuppression, HPV, radiation, arsenic. 3-4% chance to metastasize (higher if immunosuppressed, located on the lip/ear, larger, and poorly differentiated)

Question 19

SCC Treatment

Answer 19

Wide local excision
Moh’s procedure
ED & C
Radiation (if sx not an option)

Question 20

BCC Treatment

Answer 20

Wide local excision
Moh’s procedure
ED & C
Radiation
Topical 5-FU and imiquimod for superficial BCC
Vismodegib (inoperable or metastatic)

Question 21

ABCDEs of Melanoma

Answer 21

Asymmetry, Border, Color, Diameter, Evolving

Question 22

4 types of Melanoma

Answer 22

Superficial spreading (most common), Nodular, lentigo maligna, Acral lentiginous (least common)

Question 23

Superficial spreading Melanoma

Answer 23

Color variation

Question 24

Nodular melanoma

Answer 24

darkly pigmented, pedunculated, or polypoid nodules. Difficult to Diagnose at early stage

Question 25

Lentigo maligna

Answer 25

Melanoma in situ.
photodistributed
begins as tan-brown macule that gradually enlarges develops darker, asymmetric foci and raised areas

Question 26

Acral lentiginous

Answer 26

<5% of all melanomas but is the most common among dark-skin population. Commonly develop on palmar, plantar, and subungual surfaces. Appears dark brown/black macules/patches

Question 27

Subungual Melanoma

Answer 27

melanoma on fingernails and toenails. Typically at advanced stage of disease

Question 28

Breslow depth, Clark level

Answer 28

Measure of depth of a lesion. Depth of V reaches the subcutaneous fat

Question 29

Seborrheic keratosis

Question 30

Malignant melanoma treatment

Answer 30

Initial–Wide local excision +/- sentinel lymph node Biopsy (breslow depth/ulceration)
Advanced–Immunotherapy agents, BRAF inhibitors, MEK inhibitors, radiation (brain/bone metastasis), chemo

Question 31

Kaposi Sarcoma

Answer 31

HHV-8 induced cancer that causes lesion to grow in the skin, LN’s, organs, and mucous membranes. Often affects those with immunodeficiencies and typically presents of the trunk/midface. Slowly growling, violaceous patches/plaques/nodules. Treatment depends on underlying cause and if it is localized

Question 32

How often should you get a skin cancer screening exam?

Answer 32

ASx adults: no evidence it’s helpful
+ Personal Hx, Fam Hx, physical features, UVR overexposure should be checked annually.

Question 33

Sun protection education

Answer 33

Any sunburn is associated with increased melanoma risk and increases with the number of sunburns. use at least SPF 30 UVA (aging) and UVB (burning)

Question 34

Best types of sunscreen

Answer 34

Physical blockers (zinc oxide/titanium oxide) block and scatter UV and visible light. Chemical sunscreens absorb light.

Question 35

Vitamin D recommendations

Answer 35

Vitamin B synthesis occurs in UVB (tanning beds emit UVA). Can supplement with diet if needed

Question 36

Morphological features of different benign nevi

Question 37

when to refer patients with pigmented lesions to dermatology

Question 38

morphology of actinic keratosis

Question 39

morphology of BCC

Question 40

morphology of SCC

Question 41

morphology of melanoma

Question 42

Progonstic factors in melanoma survival

Question 43

Patient education about ABCDEs of melanoma, sun protection, and self exams

Question 44

Distinguishing factors between normal moles and atypical moles

Answer 44

atypical moles are often larger (>6mm), more likely to be on the trunk (esp back)

Question 45

Distinguishing historical features between melanoma and other moles

Answer 45

Age of onset is typically adulthood (unless child with GCMs or atypical mole syndrome), size will generally be larger than normal mole (6mm)

Question 46

Common acquired nevi

Answer 46

Junctional, dermal, compound.

Question 47

Junctional nevus

Answer 47

Flat, brown/black, present exclusively in the epidermis

Question 48

Compound nevus

Answer 48

slightly elevated, brown/light brown, spans multiple dermal and epidermal layers

Question 49

dermal nevus

Answer 49

Dome-shaped, warty or sessile. Light-brown/flesh colored. Exclusively in dermis. Most common in adults

Question 50

Nevus spilis

Answer 50

Presents w/in 1st year of life. Hairless brown patch with speckled brown/black macules/papules. Varies in size 1-20cm. Rarely transforms into melanoma->biopsy suspicious areas

Question 51

Common benign nevi

Answer 51

Moles, atypical moles, nevus spilus, becker’s nevus, spitz nevus, halo nevus, blue nevus, congenital melanocytic nevus (CMN), acquired (junctional, dermal, compound)