Skin Tumors Flashcards
features of acrochordon
- obese adult
- intertriginous areas
- pedunculated
- can’t be removed manually
features of verruca plana
- face and trunk
- smooth surface
- can’t be removed manually
features of nevus
- early in life
- solitary or few
- flat -> thicker darker verrucous plaque
- can’t be removed manually
features of basal cell ca
- head and neck, sun exposed
- hyperpigmented nodule with ulceration and telangiectasias
- friable and bleeds, rolled borders
features of melanoma
- light skinned adult
- irregular pigments
- friable, bleeds, malignant features
- from previous nevus
most common acquired epithelial tumor
seborrheic keratosis
what is leser trelat sign
eruptive seborrheic keratosis sign of internal malignancy (gi or lymph)
presentation of dermatosis papulosa nigra
multiple, small, dark brown to black keratotic papules on the malar region with fitz patrick skin type 4 or greater
diagnosis of seborrheic keratosis
- pe: stuck on appearance
- skin punch biopsy if growing, symptomatic, and atypical
- acanthosis, papillomatosis, hyperkeratosis, pseudo-horn cysts
treatment of seborrheic keratisis
- benign: cryotherapy, electrodessication with curettage, laser ablation
- large lesions: multiple treatments
most common non melanoma skin cancer
basal cell ca
general rule in biopsy of non melanoma skin ca
- lesion should be fresh
- no medication for at least 2 wks
- biopsy nodule with intact skin (no ulceration or crust)
pathogenesis of bcc
exposure to uvb and mutation in p53
latency of 20-50 yrs
findings in nodular bcc
translucent papule or nodule with telangiectasia and rolled border, may ulcerate
findings in pigmented bcc
hyperpigmented translucent papule
findings in superficial bcc
well demarcated erythematous patch
findings in morpheaform bcc
scar like, ivory white
management of bcc
- surgical excision
- destruction by electrodissection with curettage
- large and aggresive: moh’s micrographic surgery
- topical chemo: imiquinod 5% and 5-fu
prognosis of bcc
- treatment = excellent prognosis
- monitor and inform patient for recurrence and development of new primary bcc (at least 6 mos)
2nd most common skin cancer in immunocompetent, most common in immunosuppressed organ transplant patients
scc
pathogenesis of scc
multistep process that arises from actinic keratosis and bowen’s disease
findings in scc
- on sun exposed areas
- precursor: actinic keratosis or bowen’s disease
- slowly enlarging, firm, skin colored to erythematous plaques or nodule WITH MARKED HYPERKERATOSIS
treatment for scc
- local: moh’s surgery
- locally advanced, resectable, metastatic: topical therapy, radiation, cryotherapy
prognosis of scc
- early = high cure rate, excellent prognosis
- locally advanced and progressive = poor
differentials for actinic keratosis
- verruca vulgaris
- cutaneous horn
- discoid lupus erythematosis
- scc
what is actinic keratosis
- precursor for scc
- predilection on sun exposed areas
features of actinic keratosis
- bg of damaged skin
- 2-6 mm flat, erythematous, rough, gritty, or scaly papule
diagnosis for actinic keratosis
- palpation and visual inspection
- biopsy: enlarging, bleeding, ulcerating, inflammation, strong induration, >1 cm, resistance to treatment
treatment for actinic keratosis
- lesion targeted therapies: liquid nitrogen, surgery, ablation, photodynamic therapy
- field targeted therapies
- topical therapy
differential diagnoses for benign nevus
- junctional nevus
- dermal nevus
- compound nevus
- congenital melanocytic nevus
- halo nevus
- blue nevus (tindal effect)
what are dysplastic nevi
- irregular shape, indistinct border, variable pigmentation
- sun exposed
- flat, >5 mm
management of nevi
- no treatment
- worrisome should be excised and biopsied
algorithm for evaluation of pigmented lesions
asymmetry border irregularity color varaition diameter >5 mm enlargement/ evolution
malignant tumor for melanocytic cells
melanoma
diagnosis of melanoma
- change in color and increase in size
- dermoscopy
complications of melanoma
pain, convulsion (brain), instabilities (bone)
stages of melanoma
primary (stage I/II) regional metastases (III) distant metastases (IV)
treatment for melanoma
wide local excision
adjuvant therapy (interferon alpha)
radiotherapy
