Skin Tumors

Question 1

What is Seborrheic keratosis?

Answer 1

• sharply margins fed pigmented lesions
• appears anywhere except palms & soles
• papular but could be macular
• milia like cysts seen on dermatoscopy (small white spots) & comedo-like openings (brown spots

Question 2

How is seborrhetic keratosis treated?

Answer 2

• curettage
• cryotherapy
• electrodessication
• shave removal

Question 3

Multiple small hyperpigmented sessile to filiform smooth surfaced papules seen on Morgan Freeman’s face are know as?

Answer 3

Dermatosis papulosis Nigra

- best left untreated but could be treated like SK

Question 4

Skin colored to brown pedunculated fleshy papules that arise on the eyelids, neck, axilla, & groin are know as?

Answer 4

Acrochordons

- can become painful secondary to irritation or infarction

Question 5

What are the most important things to check in case a patient presents with a Nevus?

Answer 5

ABCDEs

• Asymmetry
• Border
• Color
• Diameter
• Evolving

Question 6

How is a melanoma diagnosed?

Answer 6

Excisional biopsy

• asymmetric lesion
• melanocytes group in nests in the dermis
• nuclei large & different shapes (cytology colors atypia)

Question 7

What are the risk factors of melanoma?

Answer 7

• increasing age
• fair skin
• more than 25 acquired nevi
• atypical nevi
• immunosuppression
• family history
• UV light exposure -> blistering sunburns before puberty

Question 8

What are the types of melanoma?

Answer 8

1- Superficial spread
- most common (on back of males & on back & legs of females)

2- nodular melanoma

• rapid growth & more aggressive
• vertical growth so thick tumors

3- lentigo maligna

• in elderly
• slow progression horizontally
• in chronically sun-damaged skin

4- acral lentiginous type
- more common in dark skin

5- subungual melanoma
- nail unit melanoma

6- amelanotic melanoma

• may be confused with psoriasis, dermatitis, SCC in Situ, or BCC
• could be recognized due to evolving
• when it doubt cut it out

Question 9

What are the prognostic factors for a melanoma?

Answer 9

• thickness
• ulceration & high mitotic rate
• involvement of lymph nodes or distant metastasis

Question 10

How is basal cell carcinoma diagnosed?

Answer 10

• dermoscopy will show telangiactasia

- Biopsy (non-pigmented lesion)

Question 11

What are the causes of basal cell carcinoma?

Answer 11

• UV radiation induced DNA damage

- PTCH (tumor suppressor gene) mutation

Question 12

What are the risk factors for basal cell carcinoma?

Answer 12

• skin types I & II
• severe sun (actinic) damage
• males
• over 60 years of age
• immune suppression
• genetics

Question 13

What are the types of basal cell carcinoma?

Answer 13

1- nodular

• most common
• rolled out edges

2- superficial
- pink patch

3- pigmented

4- morpheaform

• most aggressive
• with scar like areas

Question 14

How is BCC treated?

Answer 14

• curette & desiccation
• cryosurgery
• excision sign 3-4mm margins

Question 15

Premalignant lesions that have of potential of transformation into SCC?

Answer 15

Actinic Keratosis

• could be symptomatic (tender)
• in sun exposed areas
• erythematous papule or thin plaque with rough gritty scale (like sandpaper)

Question 16

How is Actinic keratosis treated?

Answer 16

Liquid nitrogen cryotherapy

Question 17

Ulcerated crusted erythematous nodule that reveals dermal extension of well-differentiated keratinocytes on biopsy is?

Answer 17

Squamous Cell Carcinoma

• common in white skin
• increased risk with tanning (UV exposure)
• more aggressive than BCC cause it has a higher rate of metastasis

Question 18

How is SCC treated?

Answer 18

• Wide local excision with margins

- curettage & electrodesiccation or cryosurgery for in situ SCC

Question 19

What are the cells of origin of skin cancer?

Answer 19

• melanoma -> melanocytes
• BCC -> basal layer of epidermis
• Actinic keratosis & SCC -> keratinocytes