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derm > Trigger - Pigmented, Precancerous lesions > Flashcards

Trigger - Pigmented, Precancerous lesions Flashcards

1
Q

only used w immunocompetent ppl w NON hypertrophic AK on face/scalp

A

imiquimod

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2
Q

Solar keratosis Neoplastic condition in which precancerous epithelial lesions are found on sun-exposed areas of the body.

A

Actinic keratosis

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3
Q

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

A

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!!!!

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4
Q

what can you NOT use in patients with actinic keratosis who are immunocompromised or have hypertrophic AK.

A

imiquimod

used for NON-hypertrophic AK on face/scalp

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5
Q

dermoscopy shows erythema w pseudo network around hair follicles and linear-wavy vessels

A

actinic keratosis

also follicles w yellow keratotic plugs

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6
Q

causes neutrophil-mediated cytotoxicity that eliminates remaining tumor cells

A

ingenol mebutate (picato)

used in actinic keratosis

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7
Q

Malignant cutaneous epithelial cells, MC on sun-exposed areas.

A

SCC

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8
Q

what is the MC skin cancer in AA

A

SCC

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9
Q

this is more frequent and aggressive in immunosuppressed individuals and are prevalent in organ transplant recipients and HIV/AIDS patients

A

SCCIS

confined to epidermis

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10
Q

dermoscopy shows red vessels with dots that have shiny white structures and are crusty/crystalline

A

SCC

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11
Q

Dermoscopy shows red vessels with shiny structures and brown/gray dots in a linear arrangement

A

Pigmented SCC

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12
Q

A soft, fleshy papule that bleeds easily and is found on non-sun exposed areas such as trunk, LE, genitalia.

Dx and tx

A

undifferentiated SCC

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13
Q

histopathology of biopsy shows pleomorphic/hyperchromatic squamous cells with variable nuclear size

A

SCC

tx: excision w narrow margins (3-5mm)

this can be either mohs or standard surgical excision

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14
Q

a variant of SCC that grows rapidly

A

keratoacanthoma

can be solitary or multiple and involutes over time

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15
Q

histology shows craterioform endophytic nodule with well differentiated keratinocyes and a central keratin plug.

A

keratoacanthoma

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16
Q

MC subtype of basal cell carcinoma

A

nodular

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17
Q

Histology shows pleomorphic squamous cells with cariable nuclear sizes

A

SCC

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18
Q

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

A
  1. Mohs/Excision w 3-5 margins
  2. Excision w 6mm margins if Mohs cannot be done
  3. electrodissection and curettage x 3 w margins of 3-4mm
  4. imiquimod, 5-FU, electrochemo, intralesional interferon-alpha, photodynamic therapy
  5. wide local excision w 2-5 cm margins!
19
Q

A patient has a translucent and pearly papule with well defined borders. it is smooth and has telangiectasis on the surface

A

nodular BCC

20
Q

A patient has a translucent, pearly lesion with a central ulcer. what is likely diagnosis

A

ulcerating BCC

21
Q

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

A

sclerosing BCC

22
Q
A
23
Q

A patient has a thin plaque that is pink/red in color with intermittent scaling throughout. what is it

A

superficial multicentric BCC

24
Q

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

A

pigmented BCC

25
Q

what would suggest the need for Mohs surgery in BCC

A
  • recurrent
  • aggressive subtype
  • > 2cm size
  • on head/neck
  • nasolabial folds
  • morpheaform histopathology
26
Q

what is the tx for patients w BCC that are not candidates for surgery

A
  • vismodegib
  • sonidegib
27
Q

when would you use vismodegib

A

metastatic BCC

hedgehog pathway inhibitor

28
Q

whn would you use sonidegib

A

locally advanced BCC

hedgehog pathway inhibitor

29
Q

a benign overgrowth of cells are called what

A

common melanocytic nevi

30
Q

a melanocytic nevi that developes in earlyer childooh but refgresses after 60 is called what

A

acquired

this is LESS concerning than congenital nevi

31
Q

a developmental defect in melanoblasts is the patho for what diagnosis

A

congenital melanocytic nevi

32
Q

Hereditary conditions associated with BCC

A
  • A
  • Albinism
  • Xeroderma pigmentosum
  • Nevoid BCC syndrome
  • Rasmussen syndrome
  • Rombo syndrome
  • Darier dz
33
Q

Pigmented lesion resulting from proliferation of Atypical melanocytes

A

dyusplastic melanocytic nevi

I think maybe also CMN but not as common

34
Q

what is a common precursor to superficial spreadig melanoma

A

dysplastic melanocytic nevi

also CMN but not as common i think

35
Q

Exposure to what type of UV rays causes melanoma

A

UVA/UVB

36
Q

what are the two precursor lesions that can cause melanoma

A
  • DN
  • CMN
37
Q

when is Breslow thickness used

A

to determine melanoma prognosis

38
Q

What are the 5 levels of Clark staging for melanoma?

A
39
Q

If a patient has a melanoma that is 3mm, what margins should you use

A

2cm margins

40
Q

what can Mohs NOT be done for?

A

Melanoma

41
Q

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

A
  1. UVA is longest
  2. UVB = Burns
  3. UVC = Cant reach earth
  4. UVA passes through glass
  5. UVB does not pass through glass
42
Q

what is SPF

A

the ratio of time it takes for sunscreened skin to burn compared to un-sunscreened skin.

43
Q

if unprotected skin burns at 10 minutes of exposure, how long will it take someone to burn while wearing SPF 30

A

300 minutes

44
Q

what type of sunscreen protects from UVA and UVB

A

zinc oxide

also titanium dioxide and octocrylene a little bit.

derm (16 decks)

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