Skin Tumors

Question 1

features of acrochordon

Answer 1

• obese adult
• intertriginous areas
• pedunculated
• can’t be removed manually

Question 2

features of verruca plana

Answer 2

• face and trunk
• smooth surface
• can’t be removed manually

Question 3

features of nevus

Answer 3

• early in life
• solitary or few
• flat -> thicker darker verrucous plaque
• can’t be removed manually

Question 4

features of basal cell ca

Answer 4

• head and neck, sun exposed
• hyperpigmented nodule with ulceration and telangiectasias
• friable and bleeds, rolled borders

Question 5

features of melanoma

Answer 5

• light skinned adult
• irregular pigments
• friable, bleeds, malignant features
• from previous nevus

Question 6

most common acquired epithelial tumor

Answer 6

seborrheic keratosis

Question 7

what is leser trelat sign

Answer 7

eruptive seborrheic keratosis sign of internal malignancy (gi or lymph)

Question 8

presentation of dermatosis papulosa nigra

Answer 8

multiple, small, dark brown to black keratotic papules on the malar region with fitz patrick skin type 4 or greater

Question 9

diagnosis of seborrheic keratosis

Answer 9

• pe: stuck on appearance
• skin punch biopsy if growing, symptomatic, and atypical
• acanthosis, papillomatosis, hyperkeratosis, pseudo-horn cysts

Question 10

treatment of seborrheic keratisis

Answer 10

• benign: cryotherapy, electrodessication with curettage, laser ablation
• large lesions: multiple treatments

Question 11

most common non melanoma skin cancer

Answer 11

basal cell ca

Question 12

general rule in biopsy of non melanoma skin ca

Answer 12

• lesion should be fresh
• no medication for at least 2 wks
• biopsy nodule with intact skin (no ulceration or crust)

Question 13

pathogenesis of bcc

Answer 13

exposure to uvb and mutation in p53

latency of 20-50 yrs

Question 14

findings in nodular bcc

Answer 14

translucent papule or nodule with telangiectasia and rolled border, may ulcerate

Question 15

findings in pigmented bcc

Answer 15

hyperpigmented translucent papule

Question 16

findings in superficial bcc

Answer 16

well demarcated erythematous patch

Question 17

findings in morpheaform bcc

Answer 17

scar like, ivory white

Question 18

management of bcc

Answer 18

• surgical excision
• destruction by electrodissection with curettage
• large and aggresive: moh’s micrographic surgery
• topical chemo: imiquinod 5% and 5-fu

Question 19

prognosis of bcc

Answer 19

• treatment = excellent prognosis

- monitor and inform patient for recurrence and development of new primary bcc (at least 6 mos)

Question 20

2nd most common skin cancer in immunocompetent, most common in immunosuppressed organ transplant patients

Answer 20

scc

Question 21

pathogenesis of scc

Answer 21

multistep process that arises from actinic keratosis and bowen’s disease

Question 22

findings in scc

Answer 22

• on sun exposed areas
• precursor: actinic keratosis or bowen’s disease
• slowly enlarging, firm, skin colored to erythematous plaques or nodule WITH MARKED HYPERKERATOSIS

Question 23

treatment for scc

Answer 23

• local: moh’s surgery

- locally advanced, resectable, metastatic: topical therapy, radiation, cryotherapy

Question 24

prognosis of scc

Answer 24

• early = high cure rate, excellent prognosis

- locally advanced and progressive = poor

Question 25

differentials for actinic keratosis

Answer 25

- verruca vulgaris - cutaneous horn - discoid lupus erythematosis - scc

Question 26

what is actinic keratosis

Answer 26

- precursor for scc | - predilection on sun exposed areas

Question 27

features of actinic keratosis

Answer 27

- bg of damaged skin | - 2-6 mm flat, erythematous, rough, gritty, or scaly papule

Question 28

diagnosis for actinic keratosis

Answer 28

- palpation and visual inspection | - biopsy: enlarging, bleeding, ulcerating, inflammation, strong induration, >1 cm, resistance to treatment

Question 29

treatment for actinic keratosis

Answer 29

- lesion targeted therapies: liquid nitrogen, surgery, ablation, photodynamic therapy - field targeted therapies - topical therapy

Question 30

differential diagnoses for benign nevus

Answer 30

- junctional nevus - dermal nevus - compound nevus - congenital melanocytic nevus - halo nevus - blue nevus (tindal effect)

Question 31

what are dysplastic nevi

Answer 31

- irregular shape, indistinct border, variable pigmentation - sun exposed - flat, >5 mm

Question 32

management of nevi

Answer 32

- no treatment | - worrisome should be excised and biopsied

Question 33

algorithm for evaluation of pigmented lesions

Answer 33

``` asymmetry border irregularity color varaition diameter >5 mm enlargement/ evolution ```

Question 34

malignant tumor for melanocytic cells

Answer 34

melanoma

Question 35

diagnosis of melanoma

Answer 35

- change in color and increase in size | - dermoscopy

Question 36

complications of melanoma

Answer 36

pain, convulsion (brain), instabilities (bone)

Question 37

stages of melanoma

Answer 37

``` primary (stage I/II) regional metastases (III) distant metastases (IV) ```

Question 38

treatment for melanoma

Answer 38

wide local excision adjuvant therapy (interferon alpha) radiotherapy