Oral Path Final - Derm Review

Question 1

What lesion?

Superficial skin infection of face or extremities with Streptococcus pyogenes and/or Staphylococcus aureus, entering broken skin

Answer 1

Impetigo

Question 2

What lesion?

Common in children, crowded living
conditions, poor hygiene, hot/humid climates

Answer 2

Impetigo

Question 3

What lesion?

Range from fragile vesicles to flaccid bullae that rupture and leave an amber to “honey-colored” crust

Answer 3

Impetigo

Question 4

What lesion?

May resemble exfoliative cheilitis, recurrent
herpes simplex or mimic child abuse

Answer 4

Impetigo

Question 5

What lesion?

Isolated lesions are treated with topical mupirocin

Answer 5

Impetigo

Question 6

What lesion?

Bullous or more extensive lesions are treated with a 1 week course of a systemic oral antibiotic that is effective against both S. pyogenes and penicillin-resistant S. aureus

Answer 6

Impetigo

Question 7

What lesion?

Antibiotics for treatment include cephalexin, dicloxacillin, augmentin, and clindamycin for people allergic to penicillin

Answer 7

Impetigo

Question 8

What lesion?

Slow growing, fluctuant/rubbery nodule of the face or neck often derived from hair follicles

Answer 8

Epidermoid cyst

Question 9

What lesion?

May have a yellowish to white or normal skin appearance

Answer 9

Epidermoid cyst

Question 10

What lesion?

Tx includes surgical excision; good prognosis

Answer 10

Epidermoid cyst

Question 11

What lesion?

Very common, found on the skin of face and trunk in people > 40 years old

Answer 11

Seborrheic keratosis

Question 12

What lesion?

Often multiple, tan-brown to black, well-demarcated plaques

Answer 12

Seborrheic keratosis

Question 13

What lesion?

“stuck on”, “dirty candle wax”, “dried mud on brick wall” appearance

Answer 13

Seborrheic keratosis

Question 14

What lesion?

Composed of basal cells that produce keratin inclusions

Answer 14

Seborrheic keratosis

Question 15

What lesion?

No treatment necessary, removed for cosmetic purposes

Answer 15

Seborrheic keratosis

Question 16

What lesion?

A variant of this lesion is called dermatosis papulosa nigra

Answer 16

Seborrheic keratosis

Question 17

What lesion?

Multiple small dark papules that develop in 30% of African Americans >20 years old on facial skin

Answer 17

Dermatosis papulosa nigra

Question 18

What lesion?

Hundreds of seborrheic keratoses appear suddenly

Answer 18

Leser-Trelat

Question 19

What lesion?

Paraneoplastic syndrome- may have internal malignancy like GI carcinoma

Answer 19

Leser-Trelat

Question 20

What lesion?

Premalignant skin lesion caused by
chronic sun (UV-light) exposure

Answer 20

Actinic keratosis

Question 21

What lesion?

Common on facial skin and vermilion zone
(actinic cheilosis/cheilitis) of the lips in fair-skinned persons over 40 years of age

Answer 21

Actinic keratosis

Question 22

What lesion?

Average person presents with 6-8 lesions

Answer 22

Actinic keratosis

Question 23

What lesion?

Scaly plaque w/ sandpaper texture

Answer 23

Actinic keratosis

Question 24

What lesion?

Tx = cryotherapy, surgical excision, laser ablation, photodynamic therapy

Answer 24

Actinic keratosis

Question 25

What lesion? Tx = 5-fluorouracil (Effudex), imiquimod 5% cream, diclofenac 3% gel

Answer 25

Actinic keratosis

Question 26

What lesion? 1/4 may regress w/ reduced sun exposure

Answer 26

Actinic keratosis

Question 27

What lesion? Average time to progression is 2 years

Answer 27

Actinic keratosis

Question 28

What lesion? Monitor pts for progression and new lesions

Answer 28

Actinic keratosis

Question 29

What lesion? Sun-induced cancer usually in existing actinic keratosis (field effect- large exposed area causes transformation of multiple cells over time)

Answer 29

Squamous cell carcinoma

Question 30

What lesion? Slowly developing (months to years) and slow growing lesion

Answer 30

Squamous cell carcinoma

Question 31

What lesion? Fleshy, firm nodule with a keratinized, crusty or ulcerated surface

Answer 31

Squamous cell carcinoma

Question 32

What lesion? Tx = surgery or radiation; curable if not late stage

Answer 32

Squamous cell carcinoma

Question 33

What lesion? Arises from basal cells of the epidermis or germ cells in hair follicles

Answer 33

Basal cell carcinoma

Question 34

What lesion? Most common skin cancer (80%)

Answer 34

Basal cell carcinoma

Question 35

What lesion? 800,000 cases diagnosed annually in the US (80% H/N region)

Answer 35

Basal cell carcinoma

Question 36

What lesion? Affected patients are typically over 40 years of age, have a fair complexion and a history of chronic sun exposure

Answer 36

Basal cell carcinoma

Question 37

What lesion? Most develop in the middle 1/3 of the face

Answer 37

Basal cell carcinoma

Question 38

What are the 2 main subtypes of basal cell carcinoma in the head and neck?

Answer 38

Noduloulcerative Sclerosing

Question 39

Which subtype of basal cell carcinoma in the head and neck? Most common

Answer 39

Noduloulcerative

Question 40

Which subtype of basal cell carcinoma in the head and neck? Umbilicated papule that may show central ulceration/hemorrhage, rolled pearly white border, lack of adnexal skin structures (hair)

Answer 40

Noduloulcerative

Question 41

Which subtype of basal cell carcinoma in the head and neck? May be referred to as a "rodent ulcer"

Answer 41

Noduloulcerative

Question 42

Which subtype of basal cell carcinoma in the head and neck? Morpheaform

Answer 42

Sclerosing

Question 43

Which subtype of basal cell carcinoma in the head and neck? Mimics scar tissue

Answer 43

Sclerosing

Question 44

What lesion? Tx = excision, electrodessication, curettage; Mohs surgery for planes of fusion (nasolabial fold, eye)

Answer 44

Basal cell carcinoma

Question 45

What lesion? Prognosis is excellent; rare metastasis; > 95% of pts cured after first tx

Answer 45

Basal cell carcinoma

Question 46

What lesion? Larger, recurrent or tumors in embryonic planes of fusion are more aggressive and require Mohs surgery

Answer 46

Basal cell carcinoma

Question 47

What lesion? Follow-up is important: 44% chance of 2nd lesion and 6% chance of squamous cell carcinoma within 3 years

Answer 47

Basal cell carcinoma

Question 48

What lesion? Brown macule, increased pigment with sun exposure but NORMAL numbers of melanocytes

Answer 48

Ephelis (freckle)

Question 49

What lesion? Brown macule common on dorsal hand and face- shows a linear INCREASE of melanocytes in the basal layer

Answer 49

Actinic lentigo

Question 50

Any congenital skin lesion

Answer 50

Nevus

Question 51

Any benign congenital or acquired neoplasm of melanocytes

Answer 51

Melanocytic nevus

Question 52

What lesion? Benign neoplasms caused by mutation in BRAF or RAS (oncogenes)

Answer 52

Acquired melanocytic nevus

Question 53

What lesion? Develop early in life Average Caucasian has about 20 Rare intraorally

Answer 53

Acquired melanocytic nevus

Question 54

What lesion? Well defined, < 6 mm in diameter

Answer 54

Acquired melanocytic nevus

Question 55

What lesion? Progression = begin as flat lesions with a uniform color (dark brown or black) that elevate and fade with aging

Answer 55

Acquired melanocytic nevus

Question 56

What lesion? Tx = none, unless in an area of repeated trauma or a cosmetic concern

Answer 56

Acquired melanocytic nevus

Question 57

What lesion? Prognosis = excellent, malignant transformation is extremely rare

Answer 57

Acquired melanocytic nevus

Question 58

What lesion? Malignancy of melanocytic differentiation

Answer 58

Melanoma

Question 59

What lesion? Most are cutaneous; dramatic increased incidence in recent decades

Answer 59

Melanoma

Question 60

What lesion? 3rd most common skin cancer

Answer 60

Melanoma

Question 61

What lesion? <5% of skin cancers; 75% of deaths due to skin cancer

Answer 61

Melanoma

Question 62

What lesion? UV light, especially intense intermittent exposure at early age

Answer 62

Melanoma

Question 63

What lesion? Non-UV melanomas have KIT mutations

Answer 63

Melanoma

Question 64

What lesion? 5-10% have hereditary predisposition (i.e. familial dysplastic nevus Sx)

Answer 64

Melanoma

Question 65

What lesion? Germ-line mutations in CDKN2A gene which encodes cyclin-dependent kinase inhibitors (inhibit cyclins)

Answer 65

Melanoma

Question 66

What are the 4 types of melanoma?

Answer 66

Superficial spreading Lentigo maligna Acral lengtiginous Nodular

Question 67

Which melanoma? Most common type

Answer 67

Superficial spreading

Question 68

Which melanoma? BANS: back, arms, neck, scalp

Answer 68

Superficial spreading

Question 69

Which melanoma? Months to few years radial phase (plaque) before vertical phase (nodule forms)

Answer 69

Superficial spreading

Question 70

Which melanoma? Malar skin of elderly fair complexioned people w/ chronic sun exposure

Answer 70

Lentigo maligna

Question 71

Which melanoma? Flat brown macule that slowly expands radially over 10-15 yrs before entering vertical growth stage

Answer 71

Lentigo maligna

Question 72

Which melanoma? Unrelated to sun exposure; main type in Blacks and Asians

Answer 72

Acral lentiginous

Question 73

Which melanoma? Very short radial growth phases (months) before invading; poor prognosis

Answer 73

Acral lentiginous

Question 74

Which melanoma? Most mucosal melanomas are this type (including oral)

Answer 74

Acral lentiginous

Question 75

Which melanoma? Elevated, fast-growing mass

Answer 75

Nodular

Question 76

Which melanoma? Unrelated to sun exposure

Answer 76

Nodular

Question 77

Which melanoma? No radial growth, starts as vertical growth

Answer 77

Nodular

Question 78

Which melanoma? Worst prognosis

Answer 78

Nodular

Question 79

What are the ABCDEs of melanoma?

Answer 79

Asymmetry Border irregularity Color variegation (multiple colors) Diameter greater than 6 mm (pencil eraser) Evolving

Question 80

What are other warning signs of melanoma besides ABCDEs?

Answer 80

New nevus over age 20 Pigmented lesion on palms, soles, nail beds, genitalia Itching, pain, crusting, redness, ulceration, bleeding

Question 81

What lesion? Histologic assessment to determine type, depth of invasion, and stage

Answer 81

Melanoma

Question 82

What lesion? Tx = surgery w/ wide margins, sentinal lymph node biopsy (guides need for additional lymph node dissection)

Answer 82

Melanoma

Question 83

What lesion? Tx = drugs that inhibit BRAF or KIT

Answer 83

Melanoma

Question 84

What lesion? For metastatic disease, tx = immunotherapy

Answer 84

Melanoma

Question 85

What lesion? Usually solitary Comes up quickly, then doesn't enlarge more Found on lip, gingiva, buccal mucosa, palate

Answer 85

Melanotic macule