Benign Skin Neoplasms

Question 1

seborrheic keratosis

Answer 1

benign superficial raised (epidermal) growth

always have a stuck-on quality, like a glob of wax smushed onto the skin

common after age 30

can arise on all body surfaces except palms and soles, tan or brown or sometimes black

sometimes have “fissures” or “cracks” on the surface

Question 2

How can you tell if a lesions is a seborrheic keratosis?

Answer 2

try gently picking at or scratching the lesion

may crumble, flake, or life off, revealing the superfiicial waxy character

Question 3

What is the treatment for seborrheic keratoses?

Answer 3

often multiple and can be extensive

individual lesions do not go away, but treatment is not necessary

Question 4

What is solar lentigo (lentigines)?

Answer 4

aka “sun spot”, “age spot”, or “liver spot”

see flat brown macules (lighter brown than typical nevi)

located on upper back, shoulders, chest, dorsal hands, arms

due to sun damage, but NOT cancerous or precancerous

not treatment is required

Question 5

What is the histological features of lentigos?

Answer 5

increased melanin, NO increase in the number of melanocyte cells

pigmented rete ridges

solar elastosis

Question 6

What is the treatment and prevention of solar lentigo?

Answer 6

no treatment required

prevention = sun protection

Question 7

How do you distinguish between solar lentigo and melanoma?

Answer 7

lentigos will not turn into melanomas, but one with a lot of these is a marker of increased melanoma risk

look for the ugly duckling:

- color (darker, multiple, variegated)

- diamter (>6 mm)

evolving

consider biopsy or referral to a dermatologist for any lesion that stands out as different

Question 8

What are acrochordons?

Answer 8

skin tags - soft fleshy papules in axilae, neck, groin, and eyelids

skin colored to brown

often pedunculated (connected to skin wil small stalk)

no need to treat unless inflamed - can be frozen off

Question 9

What is dermatofibroma?

Answer 9

single small round firm papule 0.5-1cm

pink, reddish brown, somtimes hyperpigmented

“Dimple sign” - raises up on the side and dimples down in the center when squeezed

most common on lower extremities

initiated by injuries to skin such as insect bites of inflamed hair follicles (scar)

Question 10

What is keloid?

Answer 10

firm, hyperpigmented, pink or red papule or nodule

often shiny or smooth surface

usually at the site of previous known tissue trauma (cut, laceration, burn, sometimes acne, piercing)

excess scar tissue gone “out of control”

lesions can be tendor or itchy

Question 11

What are cherry angiomas?

Answer 11

shiny bright red papules

located on trunk but can be anywhere (face, scalp)

likely genetic

common to have multiple spots

can increase in number during pregnancy

Question 12

What are the histological features of cherry angiomas?

Answer 12

raised bump with dilated capillaries

Question 13

What is pyogenic granuloma?

Answer 13

ERUPTIVE, small solitary, sessile or pedunculated vascular (RED), raised papule

bleeds easily with trauma

relative quick onset

Question 14

What is epidermal inclusion cyst (EIC)?

Answer 14

mobile subcutaneous nodule, often with an overlying punctum

EICs arise from hair follicles

debris (dead skin cells, oil, etc.) collects within a sack

may discharge foul smelling cheesy white material

Question 15

What are the histological findings of epidermal inclusion cysts?

Answer 15

sac underneath the skin

Question 16

What is the treatment for EICs?

Answer 16

benign and require no treatment

however, when traumatized, EICs may rupture in the skin, creating an abscess which may require incision and drainage

unlike a bacterial abscess, ruptured EICs tend to be sterile and and do not require oral antibiotics

presence of a preceeding EIC differentiates from bacterial abscess, and both types require I and D

Question 17

What is a lipoma?

Answer 17

soft, ill-defined, rubbery, painless subcutaneous nodule

Question 18

What is the technique for estimating body surface area?

Answer 18

use the patient’s hand -> about 1% of body surface

one fingertip unit is enough medication to cover 2% body surface area

rule of 9s - arm about 9% of BSA, leg 18%, head 9%, front of trunk 18%, back of trunk 18%

Question 19

methotrexate

Answer 19

folic acid analog

competitive antagonist of dihydrofolate reductase

blocks the synthesis of purine nucleotides required for DNA synthesis -> inhibition of cell division (S phase)

as a result, blocks proliferation and activity of lymphoid cells (T cells)

anti-inflammatory effects mediated by other pathways (adenosine)

indications - psoriasis

Question 20

azathioprine

Answer 20

purine analog (structurally similar but different enough

when incorporated into nucleic acid leads to inhibition of DNA and RNA synthesis

inhibits cell division of lymphocytes, depresses T-cell mediated functions, depresses B cell antibody production

refractory eczema, Chron’s, post-organ transplant immunosuppression

Question 21

5-fluorouracil (Efudex)

Answer 21

structural analog of uracil

when incorporated into RNA, disrupts RNA synthesis

incorporated preferentially into rapidly dividing cells

treatment of actinic keratosis - topical medication

Question 22

cyclosporine

Answer 22

calcineurin inhibitor

prevents the expression of IL-2 and other genes needed for T-cell activation

used orally for psoriasis, immune suppression in post-organ transplant

Question 23

tacrolimus

Answer 23

calcineurin inhibitor

prevents expression of IL-2 and other genes needed for T-cell activation

used topically for treatment of eczema as a steroid sparing agent

Question 24

imiquomod

Answer 24

activator of toll-like receptor 7 on dendritic cells

induces pro-inflammatory state

induces TNF-alpha, IFN-gamma, IFN-alpha, activates T cells

antiviral and anti-tumor effect

treatment for genital warts and superficial basal cell carcinomas