Pigmented Lesions

Question 1

define ABCDE of skin exams

Answer 1

• A: asymmetry
• B: border
• C: color
• D: diameter
• E: evolving

Question 2

what is the ugly duckling sign?

Answer 2

a lesion that stands out compared to other lesions on the pt’s skin

Question 3

when to consider biopsy?

Answer 3

• pigmentary changes
• changes in border or diameter of lesion
• bleeding or itching in the lesion
• a new lesion in pt over 50 y/o
• ugly duckling sign

Question 4

what to do prior to biopsy?

Answer 4

• take a photo of the lesion
• record landmarks

Question 5

how much of the lesion should be biopsied?

Answer 5

the entire lesion, unless extremely large in size

Question 6

Lentigo

common names for lentigo?

Answer 6

freckles, sun spots, age spots

Question 7

Lentigo

what is lentigo?

color, distribution, where, characteristics

Answer 7

benign, solitary or multiple, uniform, brown macules and patches that are typically found in sun exposed areas of the body

Question 8

Lentigo

what causes lentigo

Answer 8

UV damage

Question 9

Lentigo

treatment for lentigo

Answer 9

1. no treatment
2. sun avoidance in use of sunscreen to minimize appearance

Question 10

Melasma/Chaloasma

clinical manifestation

Answer 10

characterized by patchy light to dark brown hyperpigmentation of the face

Question 11

Melasma/Chaloasma

who does this typically affect?

Answer 11

women, hereditary

Question 12

Melasma/Chaloasma

what causes worsening of hyperpigmentation?

Answer 12

exposure to UV light

Question 13

Melasma/Chaloasma

associated with?

risk factor

Answer 13

• hormonal changes (OCP, hormone replacement therapies)
• can be idiopathic

Question 14

Melasma/Chaloasma

tx

Answer 14

• strict sun avoidance
• hydroquinone 4% cream (QD/BID, 1 mo)

Question 15

Melasma/Chaloasma

when should hydroquinone use be reserved for?

Answer 15

fall/winter months

Question 16

Acanthosis Nigricans

Clinical Manifestations

Answer 16

• velvets
• hyperpigmented plaques on intertriginous areas (neck/axillary)

Question 17

Acanthosis Nigricans

associated with what?

Answer 17

• insulin resistance (DM, metabolic syndromes, PCOS)

Question 18

Acanthosis Nigricans

labs to order if pt has this?

Answer 18

1. fasting insulin
2. fasting glucose

Question 19

Acanthosis Nigricans

tx

Answer 19

strict control of blood sugar to minimize sx

Question 20

Seborrheic Keratosis

clinical manifestations

6 things

Answer 20

• well demarcated
• round/oval
• velvety, warty lesions
• greasy or stuck appearance
• variety of colors
• can be scaly

Question 21

Seborrheic Keratosis

tx

Answer 21

• no tx necessary
• can be symptomatically treated with cryotherapy

Question 22

Seborrheic Keratosis

common in who?

Answer 22

• fair skin
• elderly
• pts with hx of prolonged sun exposure

Question 23

Melanocytic Nevi

what is it?

Answer 23

• common benign skin lesion due to localizaed proliferation of melanocytes

Question 24

Melanocytic Nevi

differentiate congenital vs acquired

how long they last?

Answer 24

• congenital: tend to be the most prominent & persist through life
• acquired: follow sun exposure, may fade away

Question 25

# Melanocytic Nevi more common in who?

Answer 25

fair skinned individuals

Question 26

# Melanocytic Nevi clinical manifestations

Answer 26

* variety of presentations/sizes on any part of the body * flat/raised * flesh colored/pink/dark brown/black

Question 27

# Melanocytic Nevi tx

Answer 27

observation

Question 28

# Atypical/Dysplastic Nevi define

Answer 28

* melanocytic nevi w/ atypical features

Question 29

# Atypical/Dysplastic Nevi clinical manifestations | 5

Answer 29

Nevus w/ at least 3 of the following: * size > 5 mm * ill definied/blurry borders * irregular margin/unusal shape * vareity of colors w/in lesion * flat/bumpy components

Question 30

# Atypical/Dysplastic Nevi procedure to order?

Answer 30

shave biopsy

Question 31

# Atypical/Dysplastic Nevi spectrum of atypica?

Answer 31

* mild * moderate * severe * melanoma in situ * malignant melanoma

Question 32

# Atypical/Dysplastic Nevi tx mild

Answer 32

monitor for recurrence

Question 33

# Atypical/Dysplastic Nevi tx for moderate/severe

Answer 33

excision

Question 34

# Blue Nevus define

Answer 34

melanocytic nevus which are located deep within the dermis

Question 35

# Blue Nevus common in which population?

Answer 35

* twice as common in women as men * prevalent among Asian populations

Question 36

# Blue Nevus can transform into?

Answer 36

melanoma

Question 37

# Blue Nevus clinical manifestations

Answer 37

* solitary * blue/gray * smooth-surfaced macule, papule, or plaque

Question 38

# Blue Nevus tx

Answer 38

observation

Question 39

# Melanoma pathogenesis (cell of origin)

Answer 39

melanocyte

Question 40

# Melanoma who most commonly gets these?

Answer 40

* young women ages 15-29

Question 41

# Melanoma caused by?

Answer 41

* cumulative & prolonged UV exposure

Question 42

# Melanoma risk factors | 7

Answer 42

1. increasing age 2. Fitzpatrick skin types 1 & 2 3. greater than 25 acquired nevi 4. atypical nevi 5. immunosuppression 6. family/personal hx 7. UV exposure (tanning, blistering)

Question 43

# Melanoma Clinical Manifestations

Answer 43

* usually asx, pigmented papule, plaque, or nodule * can bleed, be eroded, or crusted * hx of changing appearance * msot are de novo (arise from w/in existing lesion) * more common in sun exposed areas

Question 44

# Melanoma prognosis

Answer 44

high cure rates if dx and tx early

Question 45

# Melanoma prognosis factors

Answer 45

1. increased Breslow's depth 2. ulceration 3. involvement of lymph nodes or distant metasteses

Question 46

# Melanoma what is Breslow's depth

Answer 46

thickness or depth of tumor invasion

Question 47

# Melanoma what to do if you suspect melanoma in pt?

Answer 47

refer to derm for biopsy

Question 48

# Melanoma Tx depends on? | 3

Answer 48

Stage * based on Breslow's depth * ulceration * lymph node involvement

Question 49

# Melanoma likely tx course | 2

Answer 49

1. surgical excision w/ wide margins 2. +/- lymph node biopsy

Question 50

# Melanoma required follow up | 3

Answer 50

1. visits every 6 mo for 10 years, then every 12 mo for life 2. annual eye exam 3. annual physical