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derm > Lecture 10: Benign Neoplasms, Hyperplasias, and Pigmentary Disorders > Flashcards

Lecture 10: Benign Neoplasms, Hyperplasias, and Pigmentary Disorders Flashcards

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1
Q

Where do seborrheic Keratoses MC appear?

The Great Imitator

A

Chest and back

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2
Q

What does a seborrheic keratosis look like?

A

Stuck-on papules/plaque with well-defined borders

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3
Q

As you grow older, what happens to SKs?

A

Increased in incidence and number

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4
Q

A patient presents with a flat wrinkled plaque. It kinda looks like a postage stamp. What is this?

A

Flat SK

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5
Q

What symptoms are SKs associated with?

A

None.

They become itchy or painful with you irritate or traumatize them!

Leave them alone

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6
Q

Lichenoid keratosis is an inflamed SK. It has a pinky and shiny appearance that mimics that of…

A

Nodular or cystic BCC

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7
Q

What is dermatosis papulosa nigra?

A

Papular seborrheic keratoses on dark skin.

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8
Q

A patient presents with rapid onset of numerous SKs. Your preceptor says this is the sign of Leser-Trelat. You should be worried that this patient may have underlying….

A

Adenocarcinoma of the GI tract

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9
Q

Generally, how do you differentiate seborrheic Keratosis from a smooth skin tag/acrochordon?

A

Seborrheic has NO pedunculation

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10
Q

A patient presents with what you suspect is seborrheic keratosis. You aren’t too sure, so to examine it, you would….

A

Use side-lighting to look for a coarse, waxy scale that can be removed.

Hold the penlight/dermatoscope parallel to the skin surface.

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11
Q

Specifically, what kind of dermoscopy is good to view seborrheic keratosis?

A

Non-polarized dermoscopy

The ridges and fissures should form a cerebriform pattern

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12
Q

Dx of seborrheic keratosis is made…

A

Clinically

Dermoscopy is to differentiate it

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13
Q

If you biopsy SK, the histopathology would probably show…

A

Sharply demarcated proliferation of monotonous epidermal keratinocytes

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14
Q

A patient is worried about their SK diagnosis. You should let the patient know that…

A
  • SK itself is not malignant.
  • However, if they start getting a bunch suddenly, we would consider internal cancer.
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15
Q

A patient has both small and regular SKs. For the small SKs, you would use… For the regular ones, you would use…

A
  • Small: chemical peels
  • Regular: Cryosurgery (but may cause dyspigmentation)
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16
Q

A giant SK is best removed via…

A

Shave excision

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17
Q

Melasma MC appears on the…

A

face

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18
Q

Clinically, how does Melasma appear?

A
  • Macular
  • Hyperpigmented
  • Sharply defined
  • Uniform
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19
Q

How do you treat melasma?

A

Tri-Luma QHS

Fluocinolone + Hydroquinone + Tretinoin

Can also do laser stuff

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20
Q

Your patient is starting to develop melasma. To further prevent it, you counsel them to…

A
  • Wear some sunscreen > 30 SPF with titanium dioxide and zinc oxide
  • Remove estrogen exposure
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21
Q

What exactly is a solar lentigo?

A

Sun spot: melanocyte proliferation

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22
Q

Classic patient with solar lentigo

A

40yo white person

40+ & fitzpatrick type 1&2

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23
Q

How do solar lentigos feel?

A

Macular

Flat mat

Irregular borders
Ill defined

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24
Q

The two tx options for solar lentigo include…

A
  • Cryo
  • Laser
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25
Describe an acrochordon/skin tag
* **pedunculated papilloma** * Constricted at the base * Skin-brown colored | 1-10 mm
26
Classic patient for an acrochordon/skin tag
Obese middle-aged female with acanthosis nigricans or metabolic syndrome | or elderly
27
Acrochordons/skin tags are MC found in...
Intertriginous areas
28
Acrochordons can become bigger and numerous during...
Pregnancy
29
Acrochordons have 3 primary tx options, which are...
* Snipping * Electrodesiccation * Cryo
30
What is the pathology of an epidermal inclusion cyst? | Sebaceous cyst
Collection of keratin and lipid rich debris in an epithelial sac within the dermis
31
Classic patient with an epidermal inclusion cyst
30-50yo male with minor penetrating trauma into his dermis.
32
Epidermal Inclusion cysts are known for .... and they are MC found on....
* Rancid cheese odor when popped. * Face/trunk/neck/scrotum
33
Normally, epidermal inclusion cysts are asymptomatic. However, if ... occurs, inflammation will result.
Cyst wall rupture
34
You only need to C&S epidermal inclusion cysts if....
Recurrent infection
35
What two locations prompt imaging/FNA of an epidermal inclusion cyst? | Normally a clinical dx.
* Breast * Bone | Atypical locations
36
When do you I&D an epidermal inclusion cyst?
* Cosmetic concern * Inflamed * Infected (+/- abx)
37
Ideal surgical excision of an epidermal inclusion cyst is done when it is not ... and with complete removal of ....
* NOT inflamed * Complete removal of cyst sac | Punch, minimal incision, or elliptical excision
38
If you find an epidermal inclusion cyst in an atypical location, your next step after imaging and FNA is to ....
Call surgery
39
What is the MC soft tissue tumor?
Lipomas
40
What characterizes a classic lipoma?
* Soft, painless, slow growing * Found on trunk/UE * 1-10 cm in size
41
When is a biopsy of a lipoma indicated?
* Pain * Mvmt restricted * Rapid growing * Firm | Do surgery if it hurts, looks ugly, or dx is unclear.
42
Where is a venous lake MC found?
* Face * Lips * Ears
43
The symptoms of a venous lake/dilated venule include...
None, its asymptomatic
44
Venous lakes MC appear after...
50 yo
45
Just to make sure a venous lake is not melanoma, you should...
* Compress it with pressure * Light it up with diascopy * Dermoscopy showing its vascular
46
The only reason to treat venous lakes are...
Cosmetic | Electrosurgery Laser Surg excision
47
What is the pathogenesis of urticaria?
* Mast cells and basophils release vasoactive substances * **Extravasation of fluid into the dermis** | Vasoactive: histamine, leukotrienes, C4, PGEs
48
Complement-mediated Rxns with urticaria include...
* Infections * Serum sickness * Transfusion Reactions
49
An acute urticarial reaction occurs within...
6 weeks | Infection, allergy, cant see the rest
50
Describe the clinical findings associated with urticaria
* Raised erythematous wheals * **central pallor** * Resolves ideally within 24hrs. * Changes shape and size rapidly
51
The **triple regimen therapy for acute urticaria** in the ED should include a drug from these 3 classes:
* H1: loratidine, benadryl, etc * H2: -tidines (ranitidine, famotidine) * Prednisone
52
What generally precipitaes pyogenic granulomas?
Minor trauma
53
T/F : Pyogenic granuloma is filled with pus
False, i think its filled with blood
54
Pyogenic granulomas are treated via ... or ...
* Surgical excision * ED&C
55
Pyogenic granuloma can be mistaken for...
Amelanotic nodular melanoma
56
The three types of hemangiomas are...
* Cherry angioma * Capillary hemangioma * Strawberry angioma
57
The MC tumor in babies is...
Hemangiomas | Vascular tumor, NOT a malformation
58
Generally, hemangiomas are seen at weeks ....
2-4 weeks | Female preference
59
Hemangiomas are typically found on the ... (2)
* Head * Neck | Compressible
60
Which hemangioma subtype typically resolves on its own by years 5-10?
Simple
61
The main concern with hemangiomas is...
Obstruction! | Vision, larynx, nose, mouth ## Footnote Get an MRI, doppler/arteriography
62
1st line tx of a hemangioma is...
Propranolol | Prednisone 2nd ## Footnote Also call cardio to monitor
63
Vitiligo is characterized by the absence of...
Melanocytes
64
Half of all vitiligo cases begin between the ages of ....
10-30
65
The only risk factor for vitiligo appears to be...
First degree relatives | Likely polygenic transmission
66
What are the 3 proposed theories for vitiligo pathogensis?
* Autoimmune * Neurogenic * Self-destruction
67
What symptoms are associated with vitiligo?
None | Painless, not itchy
68
T/F: New white macules can appear in someone with vitiligo via Koebnerization
TRUE | Areas of recent trauma
69
The MC subtype of vitiligo is..
**Generalized** and symmetrical with a widespread distribution | Lip-tip pattern
70
If histopathology was done of the macules in vitiligo, you would see... | Normally clinical dx
Normal skin with a lack of melanocytes.
71
There are a few repigmentation methods for vitiligo, which include...
* Intermittent high-potency topical CS for **2 months max** * Topical photochemotherapy for **small/single macules**, taking 100+ treatments * Systemic photochemotherapy * Narrow-band UVB
72
The treatment of choice for repigmentation in vitiligo for children >6 (???) is .... | Not sure if he meant younger than 6
Narrow-band UVB
73
Last resort tx for vitiligo pigmentation is...
Minigrafting | Refractory cases only
74
If someone has vitligo universalis and practically has no pigmentation anywhere, we might suggest...
Bleaching their skin with hydroquinone (MEH) | Its like reverse tanning lotion ## Footnote I think he said michael jackson used this

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