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Unit 3 D&D > DD 03-07-14 08-09am Common Skin Tumors - Morelli > Flashcards

DD 03-07-14 08-09am Common Skin Tumors - Morelli Flashcards

(78 cards)

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1
Q

(Sentile) Cherry Hemangiomas - age / how common / what it means

A
  • Typically arise in middle age
  • Most common vascular tumor in adults
  • Generally no association w/ underlying disease
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2
Q

Cherry Hemangiomas - appearance / distribution

A

Distribution: primarily truncal

Number: typically mutiple; up to many hundreds

Primary lesion:

  • 1-4 mm in size
  • bright red, smooth-topped papules
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3
Q

Cherry Hemangiomas - Treatment

A

Superficial electrodesiccation

  • best for small lesions
  • may require local anesthesia

Liquid nitrogen followed by curettage

Shave biopsy

Pulse dye laser- best for small lesions

Other vascular lasers

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4
Q

Infantile Hemangioma (Capillary / Strawberry) - defn.

A

= Benign endothelial cell neoplasm

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5
Q

Infantile Hemangioma (Capillary / Strawberry) - demographics

A

= Most common soft tissue tumor of infancy (10-12% of infants)

More common in:

  • Girls (3-5:1)
  • Premature infants (<1.5 kg)
  • Infants of mothers post-chorionic villus sampling
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6
Q

Confirmation of “Dx” of Infantile Hemangioma

A
  • Positive stain with Glut-1, a placental antigen
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7
Q

Infantile Hemangioma (Capillary / Strawberry) - development

A
  • Occasionally fully formed BUT often only a precursor lesion noted at birth
  • Rapid proliferation in first 1-3 months of life
  • Spontaneous involution over years
  • –> 50% by age 5
  • –> 70% by age 7
  • –> 90% by age 9
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8
Q

Infantile Hemangioma (Capillary / Strawberry) - troublesome areas

A

Peri-ocular
—> may interrupt visual fields & cause astigmatism or more severe ocular complications

“Beard area”
—> may be sign of airway involvement

Other troublesome areas include lip, anogenital, and nasal tip

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9
Q

Infantile Hemangioma (Capillary / Strawberry) - complications

A

Ulceration
Size
- if large, may distort normal tissue & interfere w/ function

Number
- Diffuse neonatal hemangiomatosis may be associated w/ visceral hemangiomas

Congenital syndromes (PHACES)

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10
Q

Infantile Hemangioma (Capillary / Strawberry) - treatment

A

Observation
= most involute spontaneously, without scarring

Local wound care

Pulsed dye laser

Topical, intralesional & systemic steroids

Beta-blockers

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11
Q

Port Wine Stain - overview

A

= Vascular (capillary) malformation
- Present at birth
- Persists into adulthood
= Often irregular vascular channels that do NOT stain w/ Glut-1

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12
Q

Port Wine Stain - demographics & cause

A
  • No gender or gestational predilection

- Somatic mutation in GNAQ

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13
Q

Port Wine Stain - Complications

A
  • Klippel-Trenaunay syndrome

- Sturge Weber Syndrome

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14
Q

Klippel-Trenaunay syndrome

A

= complication of port wine stain

  • Overgowth of extremity covered by large port wine stain
  • Varicose veins, venous stasis, edema, ulceration
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15
Q

Sturge Weber Syndrome

A

= complication of port wine stain

10-15% in V1 distribution are associated w/ ocular & neurologic abnormalities including:

  • glaucoma
  • seizures
  • developmental delay
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16
Q

Port Wine Stain - Treatment & Why treat

A

Pulsed dye laser

Why treat?

  • Persist into adulthood
  • Get worse with time
  • Dark purple, nodular, bleeding blebs
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17
Q

Hamartoma defn.

A

= simply put, an excess of normal tissue in a normal situation
= a benign, focal malformation that resembles a neoplasm in the tissue of its origin
- not malignant & grows at same rate as surrounding tissues
= composed of tissue elements normally found at that site, but which grow in a disorganized mass
= occur in many different parts of the body
= most often asymptomatic & undetected unless seen on an image taken for another reason.

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18
Q

Nevus Sebaceus - defn. & cause

A

= hamartoma that most commonly presents as a papillomatous yellow-orange linear plaque on face or scalp
—> Scalp lesions are associated w/ alopecia

Somatic mutations in HRAS and KRAS

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19
Q

Nevus Sebaceus - timing of growth

A

Rapid growth occurs at puberty w/ enlargement of sebaceous glands & epidermal hyperplasia

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20
Q

Nevus Sebaceus - Complications

A

Epidemal nevus syndrome
–> neurologic abnormalities

Epithelial neoplasms
- occur in 10-30%
= Basal cell carcinoma, syringocystadenoma papilliferum

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21
Q

Nevus Sebaceus - Treatment

A
  • Observation (no treatment)

- Surgical excision

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22
Q

Sebaceous Hyperplasia - defn. & appearance / distribution

A

= Common benign tumor of oil gland

Distribution:
- face > trunk > extremities

Primary lesion:
- 1-6 mm yellowish-white papule (globules) w/ central dell

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23
Q

Sebaceous Hyperplasia - age / cause

A

Increasing frequency after middle age

Possibly sunlight induced

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24
Q

Sebaceous Gland Hyperplasia - Treatment

A
  • No treatment
    = Cosmetic issue only

Electrodessication w/wo curettage

Trichloroacetic acid (50%) for 3-5 seconds

Liquid nitrogen cryotherapy (high recurrence rate)

Laser therapy (expensive)

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25
Acrochordon - aka, prevalence
- aka Skin tags, Fibroepithelial polyps | - Common (¼ of all adults have at least one)
26
Acrochordon (skin tags, fibroepithelial polyps) - appearnance
- Solitary or multiple - Soft, flesh-colored tan to brown exophytic papule (1-4 mm) with narrow base Large variants: = oftenc alled "soft fibroma"
27
Acrochordon (skin tags, fibroepithelial polyps) - Complications
Recurrent trauma | Torsion
28
Acrochordon (skin tags, fibroepithelial polyps) - Treatment
No treatment Snip excision - Narrow stalk = no anesthesia needed - Large stalk = usually require local anesthesia Cryotherapy Electrodessication- best for small lesions
29
Lipoma - defn.
= benign tumor of adipose tissue | - most common form of soft tissue tumor
30
Lipoma - appearance / feel
- soft to touch - usually movable - generally painless - many are small (6cm
31
Lipoma - age
- commonly found in adults from 40 to 60 yo | - can also be found in children
32
Lipoma - Treatment
No treatment | Surgical excision
33
Dermatofibroma
- aka fibrous histiocytoma Distribution- legs (80%) Typically solitary (80%) Primary lesion - Round to oval firm nodule - depressed or dome-shaped - Several mm to 1 cm (rarely larger) - Skin-colored to tan to brown (rarely red, blue) - May scale
34
Dermatofibroma (fibrous histiocytoma) - Signs, Complications
Positive dimple (Fitzpatrick) sign Complications: Pain, Pruritus
35
Dermatofibroma - Treatment
No treatment | Surgical excision
36
Keloid Scar - defn., composition
= a type of scar - depending on its maturity, composed of mainly type III (early) OR type I (late) collagen = result of overgrowth of granulation tissue (collagen type 3) at site of healed skin injury, which is then slowly replaced by collagen type 1 *Keloids should not be confused w/ hypertrophic scars, which are raised scars that DO NOT grow beyond the boundaries of the original wound
37
Keloids - appearance / feel
- firm, rubbery lesions OR shiny, fibrous nodules | - vary in color from pink to flesh-colored or red to dark brown
38
Keloids - treatment
Difficult Works best w/ear keloids Surgery +/- Radiation
39
Seborrheic Keratosis - aka, defn.
= "Barnacles of Life” = Benign tumor of the hair follicle
40
Seborrheic Keratosis - distribution / appearance
Distribution- primarily head, neck, trunk Primary lesion - Color- white to gray to tan to brown to black - Exophytic papule- “stuck-on appearance” - Smooth to verrucous - Often friable - Surface often studded w/ small pits (pseudohorncysts)
41
Seborrheic Keratosis - Clinical Variants
Dermatosis papulosa nigra Stucco keratosis Inflamed seborrheic keratosis Sign of Leser-Trélat
42
Dermatosis papulosa nigra - demographics
Typically seen in Black and Asian patients
43
Stucco keratosis - distribution
Typically acral areas = distal portions of limbs (hands, feet) = distal portions of head (ears, nose)
44
Sign of Leser-Trélat
- Rapid increase in size or number | - Associated w/ internal malignancies, esp. gastric adenocarcinoma (60%)
45
Seborrheic Keratosis - Treatment
Cryosurgery- treatment of choice Moisturizers - alpha-hydroxy acids (e.g., aqua glycolic acid) - Lactic acid (e.g., Am Lactin, Lac Hydrin) Liquid Nitrogen Surgical removal
46
Nevocellular Nevi - Clinical Features - Distribution
Distribution: = Any skin surface, including mucous membranes = Number of nevi increased on sun-exposed skin
47
Nevocellular Nevi - Clinical Features - Age of Onset & Number of nevi
Age of onset: Infancy to adulthood 20 years of age = 20 nevi Number peaks in 2nd & 3rd decade - Men = 43 nevi - Women = 27 nevi
48
Nevocellular Nevi - types
Moles | Melanocytic Nevi
49
Nevocellular Nevi - Growth patterns
Intradermal nevus Junctional nevus Compound nevus
50
Intradermal Nevus - Clinical Features
Location- head & neck most common Size- variable (most <6 mm) Primary lesion - Papule or nodule - Dome-shaped, papillated, pedunculated, cerebriform - Color- skin colored to tan to light brown
51
Junctional Nevus - Clinical Features
Location: Anywhere (esp. plantar/palmar surfaces) Size- variable, 1-5 mm Primary lesion - Macule; less commonly, subtle papule - Surface- typically smooth - Color- tan to brown to black
52
Compound Nevus - Clinical Features
Location: usually trunk & proximal extremities Size- variable (most <6 mm) Primary lesion - Papule or nodule - Typically dome-shaped; less commonly papillated or pedunculated - Color- tan to brown to black
53
Nevocellular Nevi - Indications for Treatment
*No treatment required for most nevi I Indications for treatment: - Atypical-appearing nevus - Atypical evolution (growth, color, symptoms) - Irritated nevus (e.g., rubbed by clothing)
54
Nevocellular Nevi - Treatment Options
Appropriate - Shave biopsy - Punch biopsy - Excision biopsy Inappropriate - Electrodessication - Cryotherapy - Dermabrasion (exception- congenital nevus?) - Laser
55
Blue Nevus - defn. & reason for color
= dermal proliferation of melanocytes that produce abundant melanin Blue color = optical effect where longer wavelengths are absorbed & shorter wavelengths are reflected back (Tyndall effect)
56
Blue Nevus - demographics / epidemiology
- Congenital (1:3000) or acquired (up to 4% of adults) - Most common in Asians & whites - Uncommon in blacks
57
Blue Nevus - appearance
Primary lesion- - blue to blue-gray to blue-white - papule or nodule - Size- 1 mm to 2 cm
58
Blue Nevus - Treatment
No treatment - Common option for unchanging lesions - Malignant blue nevus (very rare) Surgical removal - Punch biopsy - Excision biopsy
59
Congenital Nev - Clinical Features
- May be solitary or multiple - May affect any cutaneous surface Primary lesion - identical to acquired nevi only differ in size: - 1 mm to huge (i.e. bathing trunk nevi) Presence of dark hairs- no clinical significance
60
Congenital Nev - Complications
Head, neck, posterior midline- cranial and/or leptomeningeal melanocytosis
61
Congenital Nev - Prevalence
1% of newborns | - Medium to Large (>10cm) = 1:20,000 newborns
62
Congenital nevi - sizes
Small (20 cm diameter)
63
Congenital Nevi - Treatment
Highly controversial area Elective surgical excision - Most authorities do not recommend - Recommended by some if clinically feasible
64
Congenital Nevi - potentia for l/prevalence of malignancy
Calculated potential for malignant melanoma: - Risk 1% per year in large congenital nevi (>40 cm diameter) Malignant melanoma in congenital nevi: - 50% appear in first 3 years - 60% appear in first decade
65
Dysplastic Nevus - aka
aka: Atypical Nevus, Clark’s Nevus, Nevus w/ Cytologic Atypia and Architectural Disorder = Acquired melanocytic proliferation - Epidermal and/or dermal proliferation of cytologically atypical nevomelanocytes - Abnormal growth pattern (architectural disorder) - Sporadic or Familial
66
Dysplastic Nevi - Demographics
Male = Female Age of onset: usually apparent by 20 yo
67
Dysplatic Nevi - Location / Number / Appearance
Location: any cutaneous site, esp. trunk Number of lesions: solitary to hundreds Primary lesions: - Round to oval to irregular - Variegation in color (tans, brown, black, reds) - Margins often irregular & indistinct (fuzzy), w/ pigment bleeding into surrounding skin - Size- no limit
68
Dysplastic Nevi - Clinical importance
Melanomas are contiguous w/ dysplastic nevi - 6.6%-70.3% in ten studies Familial atypical mole & melanoma syndrome - Risk of melanoma approaches 100%
69
Familial Atypical Moles And Melanoma (FAMM Syndrome) - Criteria
- Occurrence of malignant melanoma in 1 or more 1st- or 2nd-degree relatives - Presence of numerous (often >50) melanocytic nevi, some of which are clinically atypical - Many of associated nevi show certain histologic features
70
FAMMM Syndrome - Pathogenesis
Germline mutations in 3 genes linked to a subset of hereditary melanomas & FAMM syndrome: - CDK2NA mapped to 9p21 - CDK4 mapped to 12q14 - CMM1 mapped to 1p. Polygenetic or multifactorial? - Found in some but not all atypical nevi - Inconsistent finding in different studies
71
Treatment of Sporadic or Familial dysplastic nevi
- Mole mapping w/ dermoscopy - Total body photography - Remove most atypical nevi, changing or symptomatic nevi
72
Treatment of Clinically solitary dysplastic nevus
Reasonable to surgically remove
73
Treatment of Biopsy-proven atypical nevi
Controversial - Some only excise lesions w/ moderate-severe atypia - NIH Consensus panel: excise w/ 2-5 mm margins
74
Neurofibromatosis (Von Recklinghausen’s disease) - defect & inheritance
Defect in neurofibromin gene = tumor suppressor - on chromosome 17 for NF-1 - AD inheritance w/ variable expression - 50% of cases due to spontaneous mutations
75
Neurofibromatosis - Criteria for Dx
Must have 2 or more of the following: 1. 6+ cafe au lait macules more than 1.5 cm in diameter (or mroe than 0.5 cm diameter in children) 2. 2+ neurofibromas or 1 plexiform neurofibroma 3. Axillary or inguinal freckling (Crowe's sign) 4. Optic glioma 5. 2+ Lisch nodules 6. Distinctive osseous lesion (such as sphenoid wing dysplasia, thinning of long bone cortex) 7. 1st degree relative (parent, sibling, child) w/ the disorder.
76
Neurofibromas
= Soft flesh-colored papules characterized by “button hole sign” - Less commonly appear to be deep, firm, subQ nodules = Focal proliferation of neural tissue w/in dermis - Solitary neurofibromas are inconsequential - Multiple neurofibromas may be sign of neurofibromatosis
77
Café-au-Lait Spots
= Subtle increase in # of melanocytes w/ increased melanin production - Congenital or early childhood Distribution- trunk and proximal extremities Typically solitary Multiple lesions associated with NF - Prepubertal child- 6 or more > 5 mm - Crowe’s sign (axillary / inguinal freckling)
78
Café-au-Lait Spots - Treatment
No treatment- cosmetic concern only Pigmented laser - Expensive - Variable results

Unit 3 D&D (18 decks)

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