Bullous & pigmented skin lesions

Question 1

epidermoid cysts

Answer 1

-common cutaneous cysts
classified by anatomic location (as they can occur in any organ)
-true cysts have epithelial lining
-only true sebaceous cyst is steatocystoma

Question 2

Lipomas

Answer 2

-benign tumors of mature fat
-most common neoplasms in humans
-usually solitary
-

Question 3

epidemiology of lipomas

Answer 3

occur at any age, usually over age 40

Question 4

pathogenesis of lipomas

Answer 4

most are incidental; don’t know how they occur

-sometimes hereditary component

Question 5

Differential for lipomas

Answer 5

often mistaken for epidermoid cysts

Question 6

treatment for lipomas

Answer 6

• excised

- larger lesions-liposuction

Question 7

Milia

Answer 7

-small epidermoid cysts, common in young children and older ppl

Question 8

S/S milia

Answer 8

1-2mm white to yellow sub epidermal papules

Question 9

treatment milia

Answer 9

incising epidermis over milium

-topical retinoids in adults

Question 10

What does histologic examination show of cysts?

Answer 10

cystic cavity filled with laminated keratin lined by stratified squamous epithelium

Question 11

S/S epidermoid cysts

Answer 11

• well demarcated dermal nodules
• may have visible central punctum from follicle where it’s derived
• smell of sebum if cyst ruptures

Question 12

Treatment of cysts

Answer 12

• excision is curative
• entire wall must be removed
• inflamed epidermoid cysts may require I&D
• inject triamcinolone or kenalog

Question 13

neurofibromatosis inheritance pattern

Answer 13

autosomal dominant

Question 14

clinical features of neurofibromatosis

Answer 14

(NF1)

• cafe-au-lait macules, neurofibromas, freckling in axillae and groin
• can develop internal tumors

Question 15

Diagnostic criteria for NF-1

Answer 15

six or more cafe a lat spots, two or more neurofibromas, freckling in axilla or groin, distinctive bony lesions of sphenoid bone

Question 16

tx for neurofibromatosis

Answer 16

• multidisciplinary approach

- surgical excision, laser ablation

Question 17

Key features of hidradenitis suppuritiva (HS)

Answer 17

• poral occlusion of pilosebaceous units in axillary and anogenital regions
• secondary inflammation of the apocrine glands
• inflamed nodules and sterile abscesses followed by sinus tracts, fistulas

Question 18

epidemiology Hidradenitis suppuritiva

Answer 18

• starts soon after puberty
• woman more affected than men
• autosomal dominant
• african american higher incidence

Question 19

Pathology of HS

Answer 19

• heavy mixed inflammatory cells infiltrate lower half of dermis
• abscesses present in active cases and may connect with sinus tracts leading to skin surface
• chronic cases may have extensive fibrosis

Question 20

HS clinical features

Answer 20

• initially inflammatory nodules and sterile abscesses develop in axillae, groin, perianal areas
• tender, painful
• drainage of serous, exudate, pus, blood

Question 21

HS treatment

Answer 21

• weight reduction IF over weight
• smoking cessation IF
• absorbent powder & antiseptic soaps
• intralesional triamcinolone & topical clindamycin

Question 22

epidemiology of Albinism

Answer 22

• present at birth
• puerto ricans, madras
• different genetic pathways

Question 23

Pathology of albinism

Answer 23

-defect in melanin synthesis resulting from absence of the activity of tyrosinase

Question 24

What is tyrosinase

Answer 24

copper containing enzyme that catalyzes the oxidation of tyrosine to dopa, then dehydrogenation of dopa to dopa-quinone

Question 25

S/S of Albinism

Answer 25

"poring eyes" half closed - snow white skin - white, yellow, or light brown hair - nystagmus always present in eyes -translucency in eyes

Question 26

What type of disorder is vitiligo?

Answer 26

pigment disorder

Question 27

epidemiology of vitiligo

Answer 27

any age, all races, both sexes | -appears to be inherited

Question 28

pathophysiology of vitiligo

Answer 28

-autoimmune hypothesis, destroys melanocytes -neurogenic hypothesis: interaction b/t melanocytes & nerve cells, self destruct hypothesis: melanocytes destroyed b

Question 29

S/S vitiligo

Answer 29

- chalky, pale macules - depigmentation induced by physical trauma - lesions can occur anywhere

Question 30

Treatment for Vitiligo

Answer 30

- no cure; chronic | - sunscreens, glucocorticoids, bleaching agents

Question 31

Key features of Seborrheic Keratosis

Answer 31

- very common - brown macules, papules, plaques - usually over 30yo - often appear verrucous/stuck on - predilection for face, neck, trunk

Question 32

Rare sign of seborrheic keratosis

Answer 32

Leser-Trelat: striking proliferation or increase in size and # of SKs may be a marker for internal malignancy

Question 33

What does seborrheic keratosis resemble?

Answer 33

melanoma

Question 34

What is the textbook/test description for SK's lesions?

Answer 34

stuck on

Question 35

Epidemiology of seborrheic keratosis

Answer 35

- familial predisposition - probably autosomal dominant - risk factor MAY be sunlight

Question 36

Pathophysiology of SKs

Answer 36

base of lesion lies on flat horizontal plane flanked by normal epidermis on the other side

Question 37

treatment of SKs

Answer 37

- largely cosmetic purposes - cryosurgery, laser ablation - shave exicision

Question 38

skin tags are also called

Answer 38

acrochordon, fibroepithelial, polyp, soft fibroma

Question 39

Pathology of skin tag

Answer 39

polyploid growth or variably loose to dense collagenous storm with thin walled dilated blood vessels in center

Question 40

treatment for skin tags

Answer 40

more of a cosmetic issue unless irritated or infarcted | -scissor excision or cryosurgery

Question 41

Key features of Capillary Hemangiomata

Answer 41

- soft tissue tumor of infancy | - benign endothelial cell neoplasms

Question 42

Treatment of hemangiomas

Answer 42

- preventing function loss, etc - treat ulcerations - prevent permanent disfigurement - avoid overly aggressive, potentially scarring procedures

Question 43

Keloids have a higher incidence in which two populations?

Answer 43

darker pigmented, african american population and women

Question 44

Where do keloids appear?

Answer 44

spread outside of injury zone

Question 45

treatment for keloids

Answer 45

- often ineffective - steroids injections - laser therapy - surgery

Question 46

Pigmented lesions in dark skin

Answer 46

harder to diagnose, more likely to die from melanoma because might not know they have it