L2 Intro and skin CA

Question 1

Stratum corneum

Answer 1

superficial layer with shedding dead skin cells

Question 2

Stratum lucidum

Answer 2

layer found on plantar and palmar surfaces

Question 3

Stratum granulosum

Answer 3

keratinization

Question 4

Stratum spinosum

Answer 4

spiny-shaped cells (strength and flexibility)

Question 5

Stratum basale

Answer 5

cells germinate: keritinocytes

Question 6

Order of epidermal layers

Answer 6

Come, (Let’s) Get SunBurn

Question 7

Types of epidermal cells

Answer 7

keratinocytes
melanocytes
merkel cells
langerhans cells

Question 8

keratinocytes

Answer 8

most common cell in epidermis
form a barrier
in deepest layer they are called basal cells

Question 9

Langerhan’s cells

Answer 9

Dendritic cells scattered through the epidermis
derived from bone marrow
“macrophages of the skin”

Question 10

Merkel cells

Answer 10

Mechanoreceptors

abundant in fingertips

Question 11

Melanocytes

Answer 11

pigmented cells that help protect against UV rad.

Question 12

Dermis

Answer 12

support structure

contains: blood & lymph vessels, nerves, hair follicles, glands, and fibrous tissue

Question 13

Layers of the dermis

Answer 13

Papillary
Reticular
Ground substance

Question 14

Papillary dermis

Answer 14

superficial, loose, fine collagen fibers

Question 15

Reticular dermis

Answer 15

deep dermis, densely packed & think collagen bundles. elastic fibers

Question 16

Ground substance

Answer 16

proteoglycans and glycosaminoglycans

Question 17

Basement Membrane Zone (BMZ)

Answer 17

dermal-epidermal junction
two layers: 
basal lamina
reticular connective tissue
defects here are the basis for many blistering diseases

Question 18

Hypodermis (subcutis)

Answer 18

Fibroblasts, adipose, and macrophages

subcutaneous fat

Question 19

Eccrine glands

Answer 19

covers most of the body
releases at the surface of the skin
function in temp reg
coiled gland in deep dermis (secretion)
Straight duct extends to epidermis (transportation)

Question 20

osmolarity of sweat

Answer 20

begins isotonic with plasma, but electrolyte reabsorption in duct causes it to be hypotonic

Question 21

apocrine glands

Answer 21

concentrated in axilla and anogenital regions
secretes into the sac of the hair follicle
fluid is odorless when released, bacteria makes it smell rank
driven by adrenaline

Question 22

vellus hair

Answer 22

short and fine hairs

Question 23

terminal hair

Answer 23

long and thick hairs

Question 24

bulb

Answer 24

enlargement at base of hair follicle

Question 25

Pathogenic mechanisms

Answer 25

``` ACID Type 1: immediate/allergy Type 2: cytotoxic Type 3: immune complex Type 4: delayed sensitivity ```

Question 26

Type 1: immediate

Answer 26

IgE allergies mast cells and basophils Ex: hives, bronchospasm

Question 27

Type 2: Cytotoxic

Answer 27

Circulating IgG or IgM | react to surface antigen

Question 28

Type 3: Immune complex

Answer 28

Antigen-antibody complexes are introduced to the tissue causing inflammation IgG or IgM

Question 29

Type 4: Delayed sensitivity

Answer 29

cell-mediated immunity | 24-48 hours after exposure

Question 30

curettage

Answer 30

scraping skin away with curette

Question 31

electrodessication

Answer 31

high freq current applied to lesion, drying it out/burning

Question 32

cryotherapy

Answer 32

tissue is destroyed using -40°C liquid nitrogen

Question 33

Punch biopsy

Answer 33

round cookie cutter that cuts through the epidermis, dermis, and subcutis

Question 34

solar lentigo

Answer 34

age spot/freckle local proliferation of melanocytes well-circumscribed margins no tx required

Question 35

Seborrheic Keratosis (SK)

Answer 35

``` common tan-black warty, waxy, "stuck-on", benign epidermal lesion proliferation of immature keratinocytes "barnacles of aging" genetic link to multiple can have Leser-Trelat sign ```

Question 36

ISK

Answer 36

irritated SK | may be pruritic, painful, or bleed if rubbed

Question 37

Leser-trelat sign

Answer 37

christmas tree-like pattern seen in SK, if also assoc with skin tags and acanthosis nigrans, there is a possible association with GI and lung cancers

Question 38

evaluation and treatment of SK

Answer 38

typically clinical may bx if needed reassurance can be removed if ISK

Question 39

Keratoacanthoma (KA)

Answer 39

benign Hallmark: rapid growth over 6-8 weeks round, flesh colored nodule w/ central keratin plug

Question 40

KA management

Answer 40

majority resolve spontaneously in 6-9 mo usually bx before then difficult to dx

Question 41

Actinic Keratosis (AK)

Answer 41

``` aka solar keratosis considered pre-cancer may progress to SCC M>F erythematous, scaly/gritty macule or papule may be tender ```

Question 42

Subtypes of AK

Answer 42

``` hypertrophic (thickened) atrophic (scale absent) cutaneous horn pigmented Actinic cheilitis (lip) ```

Question 43

Dx of AK

Answer 43

typically clinical based on visualization and touch dermoscopy shave or punch bx to differentiate from SCC

Question 44

management of AK

Answer 44

``` may resolve, but could reoccur isolated: cryotherapy or surgical excision multiple: field treatment photodynamic therapy topical 5-fluorouracil imiquimod skin surveillance for SCC progression ```

Question 45

skin cancer

Answer 45

most common cancer in the us. | melanoma vs malignant non-melanoma

Question 46

Basal Cell Carcinoma

Answer 46

``` BCC most common skin cancer arises from basal cells of epidermis Nodular is most common subtype flesh-colored, pinkish pearly papule/nodule TELANGIECTASIAS central ulceration with rolled border head and neck ```

Question 47

BCC tx and prognosis

Answer 47

``` surgical removal, cryotherapy, radiation, if superficial can use 5% FU cream metastasis is rare may recur locally invasive ```

Question 48

Squamous Cell Carcinoma (SCC)

Answer 48

``` 2nd most common skin cancer males 50-70 immunosuppressed may arise in area of previous skin injury that doesn't heal papule, plaque, nodule pink, red, skin colored might be pruritic or tender scaly, exophytic, indurated, friable appears warty/hyperkeratotic no defined border, vessels, or pearly color ```

Question 49

SCC tx

Answer 49

surgical wide excision with clear margins, MOHS, curettage and cryotherapy non-surgical radiation if poor surgical candidate if SCC in situ: creams, gels, phototherapy

Question 50

SCC prognosis

Answer 50

rate of metastasis is 5% increases if lesion is >2cm diameter and >4 mm deep or recurrent surveillance every 3-6 mo for 2 yrs then 6-12 mo for 3 years, then annually

Question 51

MOHS

Answer 51

complete margin analysis higher cure rates spares normal tissue costly/long procedure

Question 52

Excisional bx

Answer 52

fast, cheap higher recurrence rate can be done by more providers

Question 53

Malignant melanoma (MM)

Answer 53

``` 3% of skin cancers avg age at dx is 40 risk factors: >5 atypical nevi, >25 nevi immunosuppression personal/family hx UV asymptomatic mostly new lesions (de novo) some from pre-existing nevus pigmented papule/nodule ABCDE ```

Question 54

Melanoma subtypes

Answer 54

superficial spreading nodular lentigo maligna Acral lentiginious

Question 55

superficial spreading melanoma

Answer 55

``` most common subtype of melanoma confined to epidermis younger pop radial>vertical spread men: backs women: back and legs ```

Question 56

nodular melanoma

Answer 56

rapid vert growth minimal radial growth agressive inflamed and friable nodule

Question 57

lentigo maligna melanoma

Answer 57

elderly with chronic sun exp slow progression radially with rapid vertical growth typically more superficial

Question 58

acral lentiginous melanoma

Answer 58

``` darker skin spreads superficial then vertical M>F larger lesions due to delay in dx palmar, plantar, subungual ```

Question 59

subungual melanoma

Answer 59

great toe or thumb hx of trauma dark streak involving proximal nail fold

Question 60

amelanotic melanoma

Answer 60

minimal or absent pigment | extensive ddx: psoriasis, dermatitis, BCC, SCC

Question 61

Treatment of Melanomas

Answer 61

wide surgical excision is gold standard with 2 cm clear margins depending on depth and tumor size possible lymph node bx follow up every 3 months