Benign, Neoplasms, Hyperplasias, and Pigmentary Disorders Flashcards
(77 cards)
1
Q
- extremely common benign neoplasms of the epidermis
- MC chest and the back
- Few or hundreds of these raised, “stuck-on”-appearing papules and plaques with well-defined borders
A
Seborrheic Keratosis
2
Q
cause of Seborrheic Keratosis?
A
unknown,
familial trait - autosomal dominant mode of inheritance
3
Q
SKs tend to increase in incidence and number with increasing ?
A
age
4
Q
how may SKs start of as?
A
a flat wrinkled plaque with a “postage stamp” appearance (flat seborrheic keratosis)
5
Q
T/F: SKs are MC symptomatic
A
F: asymptomatic
but when irritated or traumatized, they may become pruritic or painful with associated redness or bleeding
6
Q
inflamed seborrheic keratosis that presents as a pink shiny papule or plaque with an appearance that resembles that of a nodular or cystic basal cell cancer.
A
lichenoid keratosis
7
Q
papular seborrheic keratoses (most often seen as dark brown 1-3 mm papules) on the face of individuals with darker skin phototypes.
A
Dermatosis papulosa nigra
8
Q
Relatively rapid onset of numerous SKs
may be a cutaneous sign of ?
A
internal malignancy
9
Q
Multiple eruptive SKs is associated with?
what is the other name for it?
A
- visceral cancer - MC adenocarcinoma of GI tract.
- the sign of *Leser-Trélat *
*
10
Q
- Waxy, “stuck-on,” verrucous-appearing papules or plaques
- skin-colored, pink, light brown, yellow-brown, brownish-black to black.
- Pigmentation variable within a lesion.
- Scratching shows scaling, rough appearance
- Lesions are usually well-circumscribed.
- They may occur on any body site.
A
SKs
11
Q
pedunculated 1-2 mm, furrowed, rough-surfaced polyps appear most commonly around the neck or in the axillae
MC in middle aged and elderly
A
skin tag - acrochordon
12
Q
The stuck-on appearance of SKs can sometimes be best appreciated with ?
A
side-lighting - Hold a penlight or dermatoscope parallel to skin surface at edge of SK
13
Q
- Ridges, fissures, white pinpoint milia-like cysts, and comedo-like openings - best with non-polarized dermoscopy
- ridges + fissures = cerebriform pattern
- looped/hairpin vessels
- sharply demarcated borders.
- Early evolving has many features similar to solar lentigines: broken, interrupted lines (fingerprinting), few comedo-like openings, and borders that are scalloped or moth-eaten.
these dermoscopy features are for what lesion?
A
Seborrheic Keratosis
14
Q
how to dx SK?
A
- clinically
- Dermoscopy can help differentiating SK vs melanocytic nevi vs melanoma.
- Bx if any concern for malignancy
15
Q
histopathology findings of SKs
A
- Sharply demarcated proliferation of monotonous epidermal keratinocytes
- Flat, exophytic or endophytic
- Small keratin-filled cysts (ie, horn cysts) present within tumor
- Occasional features
- Well-demarcated intraepidermal nests of basaloid cells (Borst-Jadassohn phenomenon) in clonal variant
- Spongiosis with squamous eddies
- Reticulated, acanthotic, or papillomatous
- Variable inflammatory cell infiltrate, may be sparse lymphocytic or lichenoid
16
Q
mgmt pearls for SKs
A
- removed only for cosmetic reasons
- Patient reassurance
- if multiple SKs, a suspicious pigmented lesion may be overlooked.
- multiple eruptive SKs = prompt search for underlying internal malignancy, esp if patient hx or ROS is suspicious for cancer.
17
Q
tx options for SKs
A
- Cryosurgery (MC) - dyspigmentation
- Curettage and cautery
- Chemical peels (eg, trichloroacetic acid) - for small and superficial SKs
- Laser therapy (pulsed CO2, alexandrite, and ER:YAG)
- Shave excision - for larger lesions
18
Q
- Acquired light or dark brown pigmentation that occurs in exposed areas by the sun
- MC Face
A
Melasma
19
Q
RF for Melasma
A
- Pregnancy (“mask”)
- Genetics
- Idiopathic
- Sun exposure
- Ingested contraception
- Medications (diphenylhydantoin)
*
20
Q
- Macular
- Hyperpigmented skin
- Sharply defined
- Usually uniform
- MC on malar and frontal areas of face
- F>M; Hot climates
dx?
w/u?
tx?
A
- melasma
- clinical; Woods lamp not needed - Shows epidermal pigment enhancement
- Tri-Luma QHS (fluocinolone 0.01%, hydroquinone 4%, tretinoin 0.05%); laser
- avoid sun, SPF +30 (Titanium dioxide and zinc oxide, remove estrogen exposure
21
Q
- Localized proliferation of melanocytes resulting from acute or chronic exposure to sunlight
- 1-3 cm
- Onset: >40 y/o
A
Solar Lentigo
22
Q
Solar Lentigos are MC in who?
A
- MC on sun exposed sites
- MC Caucasians - Skin Type 1 and 2
23
Q
- Light yellow, light brown, or dark brown (variegated)
- Round, oval, with slightly irregular borders and ill defined
- Skin lesions strictly macular - 1-3 cm
dx? tx?
A
- Solar Lentigo
- Cryo, Laser
24
Q
what are the sun exposed areas?
A
- Forehead
- Cheeks
- Nose
- Dorsa of hands
- Forearms
- Upper back
- Chest
- Shins
25
acrochordons are MC in who?
* females
* obese individuals
26
Acrochordons are MC in ___ areas
intertriginous
* Axillae
* Inframammary
* Groin
* Neck
* Eyelids
27
acrochordons are seen in with what other 2 conditions
1. Acanthosis Nigricans
1. Metabolic Syndrome
28
acrochordons become larger and more in number over time especially during ?
pregnancy
29
tx for acrochordon
1. Snipping
1. Electrodesiccation
1. Cryo
30
a collection of keratin and lipid rich debris in an epithelial sac within the dermis
Epidermal Inclusion Cyst
aka: epidermal cysts, “sebaceous cysts” - *avoid using term sebaceous cyst*
31
cause of Epidermal Inclusion Cyst
* plugged pilosebaceous units
* traumatic implantation of epidermal cells into deeper tissues
32
Epidermal Inclusion Cyst MC in who?
* 2:1 M>F
* 4th and 5th decades (30-50 y/o)
33
* asx unless inflamed or infected - inflammation results from cyst wall rupture
* flesh colored, round, firm nodules - +/- central pore/punctum
* contents is malodorous - “rancid cheese”
* MC on face, trunk, neck, scrotum
Epidermal Inclusion Cyst
34
w/u for Epidermal Inclusion Cyst
* clinical dx
* C&S if recurrent infection
* Imaging or FNA if atypical location (breast, bone)
35
tx for epidermal inclusion cyst
1. asx - none unless cosmetic concern
1. inflamed - I&D
1. infected - I&D, +/- abx therapy
1. Excision: complete removal of cyst sac
- punch, minimal incision or elliptical excision
- best performed when cyst is not inflamed
1. Surgical consult if cyst is located in atypical location
36
course and prognosis of epidermal inclusion cyst
1. asx cysts may wax and wane with periods of inflammation
1. rarely becomes malignant - watch for rapid growth, friability, bleeding
37
a benign collection of fat cells inside thin fibrous capsule
MC soft tissue tumor
Lipoma
38
* Onset MC between 40-60 y/o
* soft, painless, slow growing, subcutaneous nodules
* 1-10 cm in size
* MC location - trunk, UE; hands, head, feet are less common
dx?
w/u?
tx?
1. lipoma
1. clinical; bx if painful, restricts movement, grows rapidly, firm
1. surgery if painful, comesis or dx unclear
39
* Dark blue violaceous, asymptomatic, soft papule resulting from a dilated venule
* MC on face, lips, and ears
* MC > 50 years old
Venous Lake
40
cause of venous lakes?
* *Etiology unknown*
* potentially from Solar exposure and Genetics
41
Because of its dark blue or sometimes even black color, Venous lakes may be confused with ? (3)
1. nodular melanoma
1. pigmented bcc
1. pyogenic granuloma
42
ways to r/o malignancy in venous lakes?
* Compressed with pressure
* Lightened with diascopy
* Dermoscopy = vascular
43
tx for venous lakes
*Cosmetic reasons only*
1. Electrosurgery
1. Laser
1. Surgical excision
44
pruritic, raised, well-circumscribed areas of erythema and edema
urticaria
45
pathophys of urticaria
mast cells and basophils release vasoactive substances (histamine, leukotriene C4, prostaglandins) = **extravasation of fluid into dermis**
46
causes of urticaria
1. type I allergic IgE response
2. complement-mediated - infectious, serum sickness, transfusion rxn
3. physical mediated - pressure, cold, cholingergic
4. autoimmune - SLE, RA, thyroid
5. idiopathic
47
how are urticarias categorized
1. acute < 6w - infection, allergy
2. chronic > 6w - physical, autoimmune
48
* raised, erythematous-pink-skin colored wheals with central pallor
* shape and size change rapidly - round, oval, acriform, annular, serpiginous
* individual lesion resolves < 24 h
* +/- dermatographism
* H&P should focus on underlying cause
dx?
w/u?
* Urticaria
* clinical, look for underlying cause
49
general mgmt for Urticaria
* ED eval - acute can progress to life-threatening angioedema/anaphylactic shock
* Triple Therapy: H1 (1st line) + H2 + steroid is often recommended
50
types of H2 antihistamines
1. cimetidine(Tagamet)
1. famotidine(Pepcid)
1. ranitidine(Zantac)
51
types of 2nd gen antihistamines
* loratadine(Claritin)
* desloratadine(Clarinex)
* fexofenadine(Allegra)
* cetirizine(Zyrtec)
52
types of 1st gen antihistamines
* diphenhydramine (Benadryl)
* hydroxyzine (Vistaril)
53
MOA of oral GC
* stabilize mast cell membrane, inhibits further histamine release
* Prednisone - short term, 5 day non-tapering course
54
tx for chronic urticaria
* antihistamines prn
* refer to dermatology for further evaluation/management
55
prognosis of urticaria
1. depends on identification and tx of underlying cause
- acute generally self-limiting within 24 hours
- chronic can impair quality of life
56
Rapidly developing vascular lesion usually following minor trauma
Very common solitary - Erodes, Vascular bleeds spontaneously
Pyogenic Granuloma
57
s/s of Pyogenic Granuloma
* Smooth
* +/- crusts
* +/- erosions
* Bright red
* Dusky red
* Violaceous
* Brown-black papule
58
tx for Pyogenic Granuloma
Surgical excision
ED&C
59
Pyogenic Granulomas can be misaken for ?
amelanotic nodular melanoma
60
3 dx of Hemangioma
Cherry angioma
Capillary hemangioma
Strawberry angioma
61
MC tumor in babies
vascular tumor - endothelil hyperplasia
*NOT a vascular malformation*
62
s/s of hemangiomas
* Red
* Soft
* Compressible papule nodule - 1-10cm
* Solitary
* MC on head and neck
63
4 types of hemangiomas
1. **Simple**: Resolve on own by year 5-10
1. **Deep** (aka cavernous): Lower dermis and subq fat / bluish w/ telangiectasias
1. **Multiple**: Small < 2mm papules (entire body)
1. **Congenital**: Present at birth; Purplish/telangiectasia/large veins
64
how can deep and multiple hemangiomas be problematic?
w/u?
* obstruct vital functions - vision, larynx, nose, mouth
* MRI to eval; doppler and arteriography to see blood flow
65
tx for hemangioma
* Propranolol 1st line
* Refer to Cardiology
* Prednisone
* Laser and surgical possible
66
a depigmenting disorder characterized by a patchy absence of melanocytes
results from a destruction or discontinued function of the melanocyte
Onset: (50%) 10-30 y/o
vitiligo
67
?% of a patients will have a first degree relative with vitiligo
> 30 %
68
vitiligo is likely a ___ transmission
affecting multiple gene loci responsible for immune function
polygenic
69
3 Theories about the mechanism of destruction of melanocytes
* **Autoimmune**: Selected melanocytes are destroyed by certain lymphocytes that have been activated for unknown reasons.
* **Neurogenic**: Interaction of the melanocytes and nerve cells.
* **Self-destruction**: Melanocytes are destroyed by toxic substances formed as part of normal melanin biosynthesis.
70
* individual “chalk” white macules with sharp margins - may see loss of color to mucosal membranes, retina or hair overlying areas of depigmented skin
* Ranging from 5 mm to 5 cm or larger
* Painless and without pruritus
* Often seen first in sun-exposed areas
* May report new macules in areas of recent trauma (Koebner phenomenon)
vitiligo
71
4 presentation types of vitiligo
1. generalized
2. segmental
3. localized
4. vitiligo universalis
72
* Symmetrical with widespread distribution.
* “Lip-tip” pattern involves skin around mouth, fingers and toes, as well as nipples and genitalia
which type of vitiligo
generalized
73
* Only one side or part of body in one band that do not extend beyond the initial one-sided region.
* Younger age, taking 1-2 years to progress, then stops
which type of vitiligo
segmental
74
Focal to only 1-3 macules in a single sight
which type of vitiligo
localized
75
Confluence of macules resulting in only a few pigmented areas.
which type of vitiligo
Vitiligo Universalis
76
w/u for vitiligo
* **Clinical**
* Wood’s lamp - evaluate macules on lighter skin
* Skin bx - required in cases difficult to dx; Histopathology - nml skin with lack of melanocytes
* Labs if autoimmune disorder is suspected - TSH, T4, fasting glucose, ANA, CBC for pernicious anemia, ACTH stimulation for Addison’s,
77
Course and Management of vitiligo
* No cure
* ⅓ of pts may report a few areas of spontaneous repigmentation
* Concern for social / psychological stress
* SPF >30
* Cosmetic cover-up - Dyes or makeup to hide the white macules; Self tanner applied to the white macules
