Trigger - Pigmented, Precancerous lesions Flashcards
only used w immunocompetent ppl w NON hypertrophic AK on face/scalp
imiquimod
Solar keratosis Neoplastic condition in which precancerous epithelial lesions are found on sun-exposed areas of the body.
Actinic keratosis
pt presents w flat scaly papules/plaques that range between 2-6mm. They are yellow/white in color with ill defined border and scaling on an erythematoius base.
Give dx and treatment
actinic keratosis
Tx:
FIRST VISIT = lesion targeted cryosurgery (can also do currettage or shave excision)
Second visit
1. 5 FU or imiquimod (if ok w SE)
2. Diclofenac (if not ok w above SE)
3. laser ablation/chemical peel/derm abrasion/cryopeeling/PDT (if wants one time in office tx and doesnt want topical therapy)
FU Q 3-6 mo with aggresive sun exposure therapy!!!!
what can you NOT use in patients with actinic keratosis who are immunocompromised or have hypertrophic AK.
imiquimod
used for NON-hypertrophic AK on face/scalp
dermoscopy shows erythema w pseudo network around hair follicles and linear-wavy vessels
actinic keratosis
also follicles w yellow keratotic plugs
causes neutrophil-mediated cytotoxicity that eliminates remaining tumor cells
ingenol mebutate (picato)
used in actinic keratosis
Malignant cutaneous epithelial cells, MC on sun-exposed areas.
SCC
what is the MC skin cancer in AA
SCC
this is more frequent and aggressive in immunosuppressed individuals and are prevalent in organ transplant recipients and HIV/AIDS patients
SCCIS
confined to epidermis
dermoscopy shows red vessels with dots that have shiny white structures and are crusty/crystalline
SCC
Dermoscopy shows red vessels with shiny structures and brown/gray dots in a linear arrangement
Pigmented SCC
A soft, fleshy papule that bleeds easily and is found on non-sun exposed areas such as trunk, LE, genitalia.
Dx and tx
undifferentiated SCC
histopathology of biopsy shows pleomorphic/hyperchromatic squamous cells with variable nuclear size
SCC
tx: excision w narrow margins (3-5mm)
this can be either mohs or standard surgical excision
a variant of SCC that grows rapidly
keratoacanthoma
can be solitary or multiple and involutes over time
histology shows craterioform endophytic nodule with well differentiated keratinocyes and a central keratin plug.
keratoacanthoma
MC subtype of basal cell carcinoma
nodular
Histology shows pleomorphic squamous cells with cariable nuclear sizes
SCC
give the treatment for the following:
1. SCC
2. high risk SCC
3. superficial SCC
4. SCC in someone who is NOT a surgical candidate
5. Well differentiated SCC or large ulcerative/nodular BCC
- Mohs/Excision w 3-5 margins
- Excision w 6mm margins if Mohs cannot be done
- electrodissection and curettage x 3 w margins of 3-4mm
- imiquimod, 5-FU, electrochemo, intralesional interferon-alpha, photodynamic therapy
- wide local excision w 2-5 cm margins!
A patient has a translucent and pearly papule with well defined borders. it is smooth and has telangiectasis on the surface
nodular BCC
A patient has a translucent, pearly lesion with a central ulcer. what is likely diagnosis
ulcerating BCC
A patient has a 4mm white/pink plaque with ill defined borders that has telangectasis and looks similar to a scar. What is the likely diagnosis
sclerosing BCC
A patient has a thin plaque that is pink/red in color with intermittent scaling throughout. what is it
superficial multicentric BCC
A patient has a firm papule that is smooth with a pearly surface and has stippled globules of pgment throughout its surface. what is it
pigmented BCC
what would suggest the need for Mohs surgery in BCC
- recurrent
- aggressive subtype
- > 2cm size
- on head/neck
- nasolabial folds
- morpheaform histopathology
what is the tx for patients w BCC that are not candidates for surgery
- vismodegib
- sonidegib
when would you use vismodegib
metastatic BCC
hedgehog pathway inhibitor
whn would you use sonidegib
locally advanced BCC
hedgehog pathway inhibitor
a benign overgrowth of cells are called what
common melanocytic nevi
a melanocytic nevi that developes in earlyer childooh but refgresses after 60 is called what
acquired
this is LESS concerning than congenital nevi
a developmental defect in melanoblasts is the patho for what diagnosis
congenital melanocytic nevi
Hereditary conditions associated with BCC
- A
- Albinism
- Xeroderma pigmentosum
- Nevoid BCC syndrome
- Rasmussen syndrome
- Rombo syndrome
- Darier dz
Pigmented lesion resulting from proliferation of Atypical melanocytes
dyusplastic melanocytic nevi
I think maybe also CMN but not as common
what is a common precursor to superficial spreadig melanoma
dysplastic melanocytic nevi
also CMN but not as common i think
Exposure to what type of UV rays causes melanoma
UVA/UVB
what are the two precursor lesions that can cause melanoma
- DN
- CMN
when is Breslow thickness used
to determine melanoma prognosis
What are the 5 levels of Clark staging for melanoma?
If a patient has a melanoma that is 3mm, what margins should you use
2cm margins
what can Mohs NOT be done for?
Melanoma
which UV light ….
1. is longest wavelength
2. is responsible for sunburns
3. is absorbed by ozone so doesnt reach earth
4. passes through glass
5. doesnt pass through glass
- UVA is longest
- UVB = Burns
- UVC = Cant reach earth
- UVA passes through glass
- UVB does not pass through glass
what is SPF
the ratio of time it takes for sunscreened skin to burn compared to un-sunscreened skin.
if unprotected skin burns at 10 minutes of exposure, how long will it take someone to burn while wearing SPF 30
300 minutes
what type of sunscreen protects from UVA and UVB
zinc oxide
also titanium dioxide and octocrylene a little bit.
