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OPTO3003 > W4 Lumps > Flashcards

W4 Lumps Flashcards

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1
Q

Papule:
Nodule:
Vesicle:
Cyst:

A

P: Solid raised lasion <1cm
N: >1cm papule, may be palpable
V: <0.5cm, serous filled (>0.5cm is a bulla)
C: Epith. Cavity w/fluid > forms nodule

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2
Q

Macule:
Plaque:
Pustule:
Scale:

A

M: flat discolored patch
P: solid, raised, flat skin
Pu: pus filled elevation
S: shedded keratin epith., easily detached from base epith.

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3
Q

Atrophic:
Hyperkeratosis:
Acanthosis:

A

A: thinning (layer loss)
H: thickening of keratin (from tumors) > seen as scales
Ac: thickening on epidermal prickle cell layer

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4
Q

Atypia:
Dysplasia:
Neoplasia:

A

GF coding occogenes / tumor suppressor gene disorder:
Benign N > non-invasive / localised
Malignant N > progressive / locally invasive / metastasis risk

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5
Q

Non-neoplasic lesions:

A

Hordeolum
Chalazion
Epidermal inclusion cyst
Dermoid
Cyst of zeiss/moll
Xanthelasma
Molluscum contagiosum

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5
Q

Benign epithelial tumors:

A

Verruca vulgaris
Squamous/Basal cell papilloma
Actinic/solar keratosis
Keratoacanthoma
Freckle
Melanocytic neavi
Syringoma

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6
Q

Malignant tumors:

A

Basal/Squamous cell carcinoma
Sebaceous gland carcinoma
Malignant melanoma

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6
Q

Hordeolum description:

A

Acute lid gland infection (u/Staphlococcus aureus)
External: “Stye”, lash + associated zeis/moll gland at lid margin
Internal: Meibomian in tarsel plate

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7
Q

Hordeolum pathophysiology:

A

Bacterial infection (staph) > inflammatory cascade to remove pathogen > swelling
Chronic Blepharitis > Increased staph population/vulnerability > recurrent hordeola

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8
Q

Hordeolum management:

A

Self limiting 1w
w/compress 5m bid
Lubricants as needed
Chloramphenicol .5% qid if intense

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8
Q

Hordeolum symptoms:

A

Well defined hyperemic subcutaneous nodule, (u/with cellulitis)
Internal: larger w/tarsel edema
Tender to touch w/pain on blink

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8
Q

Chalazion pathophys:

A

Obstruction of sebaceous gland (meibomian/zeis) > extracellular lipid leakage > Sterile inflammation > influx of epithelioid / giant cells, neutrophils, lymphocytes, eosinophils

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9
Q

Chalazion symptoms:

A

Well defines, enlarging nodule in tarsal plate.
Erythema, oedema, tender
Chronic lesions are firm and painless

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9
Q

Chalazion management:

A

Spontaneous resolution, otherwise chronic
Acute lesion > w/compress
Chronic > corticosteroid injection / incision
Maintain lid hygiene to prevent reoccurance

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10
Q

Epidermal inclusion cyst:

A

Epidermis enters dermis > epidermal growth with stratified squamous keratinized epith.
Firm, slow growing, round skin coloured nodule with smelly keratin fluid
Asymptomatic, unless mechanical complications occur (DED/epiphora) requiring excision

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11
Q

Dermoid:

A

Congenital (eyebrow) /aquired benign tissue malformation from epidermal inclusion in dermis.
Unlike inclusion cyst, is lined with mature epidermal formation, grows at rate of surrounding tissue
Requires excision otherwise inflammatory response when dermoid contacts other tissues

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12
Q

Cysts of zeiss/moll

A

Benign lesion on ant. Lid margin, non-tender, skin coloured
Zeis > Lash associated Sebaceous gland obstruction > ^sebum
Small round non-translucent
Moll > apocrine gland > sweat filling
Small round translucent
Requires excision to reduce recurrence

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12
Q

Xanthelasma

A

Common cutaneous lesion, ^with age / associated inflammation
^cholesterol > lipid histocyte (macrophage/foam cell) accumulation > BV cell cluster in superficial dermis
Soft yellow plaque on medial lids
Asymptomatic, excision/ablation/trichloroacetic acid (cosmetic)

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13
Q

Molluscum contagiosum symptoms and management:

A

Single/multiple small/round/raised/waxy nodules.
Related tox conjuntivitis > chronic unilateral irritation, w/conj. SPEE/hyperaemia, follicles, mucoid disc.
Self limiting in 3-12mo, associated cornea/conj. Complications required excision

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13
Q

Molluscum contagiosum patho:

A

Viral infection, ^with kids (3y)
DNA poxvirus contact/formites > skin infection > nodules w/intracytoplasmic inclusions > toxic inclusion protein contact with conj. > toxic follicular conjuntivitis

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14
Q

Squamous cell papilloma:

A

HPV infection of squamous epith. > prolif. Of keratinocytes > hyperkeratotis squamous epith. Projections
Unlike wart, presents as either, skin tag/ pale finger lesion/ broad-base lesion(sessile)
Asymptomatic, excision if desired

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14
Q

Verruca vulgaris:

A

Wart. Common, benign
HPV infection via contact/formites > viral proliferation of keratinocytes > thickening of stratum corneum (keratinised skin)
Small, skin col. Painless papules, w/scaly hyperkeratinisation > finger projections.
Viral shedding > pap conjuntivitis / keratitis
Self limiting, otherwise cryo w/excision

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15
Q

Actinic (solar) keratosis patho:

A

Epithelial, pre-malignant slow growth. 40% ^40y, 60% ^60y
UV/cauc. > genetic damage/immunosuppression > p53/16 TS protein alteration > irregular squam. Epith. Proliferation > abnormal (nuclear atypia) keratinocyte tumor at basal epidermis > growth w/o superficial layer involvement.

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15
Q

Keratoacanthoma:

A

Rare, rapid nodule. With ^age
UV > p53 alteration < proliferation of acanthotic squam. Epith.
Small papule > tender red nodule with keratin cap > keratotic horn > receding epidermis/horn loss > resoultion from 6-12w
No biopsy (false positive for SCC)
Cryo excision if possible

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15
Basal cell papilloma:
80% 26-50y > 100% ^50y UV/unknown origin (idiopathic) > elevation of squamous epith. Via basal cell proliferation Single/several round, brown plaques, appearing stuck on. w/ keratin horn. Benign, cryo excision (cosmetic) Known as Seborrheic keratosis/senile verruca
15
Actinic keratosis symptoms and management:
Well defined macules of variable colour (from brown>pink), w/ hyperkeratosis (plaque/horn), non-tender w/stinging May regress/unchange/progress through basement (SCC) Requires biopsy > cryo excision
16
Melanocytic naevi presentation and management:
Junctional naevus: uniform brown macule in kids, at junction of dermis and epidermis Compound neavus: junctional neavus cells move into dermis > raised papule w/uniform colour Intradermal naevus: increased epidermal cells in dermis > larger colourless lesion Asymptomatic, excision (cosmetic)
16
Freckle:
Common benign area of pigmentation UVB radiation > melanocytic hyperactivity > melanin production > hyperpigmentation of basal cells Well-defined flat macule/papule w/variable colour Requires follow-ups, UV protection to avoid darkening
16
Melanocytic neavi patho:
UV/genetics/idiopathic > melanocyte aggregation/proliferation Acquired neavi grow/change with time, low malignancy, congenital neavi have 25% melanoma development
17
Capillary hemangioma:
Proliferation of vascular endoth. Within dermis and subcutaneous tissue 1% neonates, 1/3 present at birth, 2/3 develop by 6m, resolve by 7y Superficial lesion > raised red strawberry nodule on brow Subcutaneous lesion > spongy blue mass Deep lesion > proptosis/globe displacement Corticosteroid injection if lesion alters globe/muscle function
17
Pyogenic granuloma:
Rapid vasular growth (neither pyogenic or granulomatous) Red nodule w/bleeding Requires excision, otherwise will atrophy > fibrosis > resolution
17
Syringoma:
Skin coloured papules from sweat glands on lid/adnexa, with females, may be unilateral Sporadic proliferation of intraepidermal cells in eccrine gland ducts > duct lining thickening Excision (cosmetic)
18
Portwine stain:
Benign BV malformation, doesn’t blanch w/pressure or regress like capilliary hemangioma Well demarcated soft, flat, pink skin Laser therapy for cosmetics
18
Neurofibroma
Neurofibromatosis (genetic disorder) > NF1 mutation > non-myelinated schwan cell proliferation Dermal > raised small round nodule (tender if subcutneous) Plexiform > Sup. Eyelid mass (cant be removed w/o lid damage)
19
Basal cell carcinoma discription:
Most common skin cancer from UV, Aus has greatest incidence 1% pop/year Arise from pluripotent stem cells, as they require less UV exposure than SCC
20
BCC patho:
UV > proliferation (^mutation) / gene alteration / immunosupression > tumor mutations* > unregulated proliferation of abmormal basal cells
20
Tumor mutations in BCC:
Patched mutations / Sonic hedgehog pathway: altered "patched/smoothend" genes > sonic signalling pathway upregulation > ^activation of genes for cell differentiation Mutations in detox proteins: altered genes for glutathione-S-peroxidase enzyme > decreased skin oxidation defence Mutation in p53 ts gene > unregulated abnormal cell growth (noted in 50%) Any of these mutations > basal tumors
21
BCC symptoms:
Superficial: well defined red patch. Slow growth, w/crusting and irritation Nodular: Pearly/translucent/skin c./pink papule/nodule. Growth > rolled edge w/central depression > ulceration w/bv Morphoeic/sclerosing: white/waxy patch from longstanding presence * Locally invasive, rarely metastatic
22
BCC management:
Biopsy as: Superficial/morphoeic BCC appear as eczema/scar, nodular appears as several lesions(SCC). Removed via radiotherapy
22
Squamous cell carcinoma discription:
2nd most common skin cancer, arise from actinic keratosis Risk increases with smoking (3.3x or 1.9x for former smokers) / immunosupression Related to UVA(320-400nm) and UVB (280-320nm) Metastasis risk <1%, increasing with size/depth
23
SCC patho:
UV > proliferation (^mutation) / gene alteration / immunosupression > p53 / melanocortin-1 receptor gene alteration > unregulated proliferation of squamous epith. w/o apoptosis > dermis invading tumor
24
SCC presentation:
Erythematous, tender papule/nodule. Commonly presents as ulcer with hyperkeratosis/horn. Lesion expansion > recurrent culceration/bleeding
25
SCC management:
Cryo to differentiate from actinic keratosis > persisting lesions are excised vis +/- Moh's technique Excision > 90% cure rate Risk decreased via sun protection, antioxidants and NSAIDs
26
Sebaceous gland carcinoma description:
Rare, very malignant neoplasm from seb. Glands on lids. ^from 60y, 60% on sup. lids UV > meibomian/zeiss Proliferation (or brow/caruncle) > neoplasm of lipid cells
26
SGC presentation and management:
Nodular: yellow nodule in tarsal place (like chalazion) Spreading: thickened tarsal plate w/annilation of meibomian gland orifice > blepharitis appearance Pagetoid spread: neoplasm invasion of epith. > adnexa/conj. Lesion Biopsy to rule out bleph. Or chalazion > excision
27
Malignant melanoma patho:
Genetics/naevi/freckle/UV > malignant transformation of intraepidermal atypical melanocytes Lentigo: diffuse proliferation along basal layer Superficial spreading: nests throughout epidermis Pagetoid spread: invasion of superficial epidermis from below Nodular: large / poorly differentiated cells
28
Malignant melanoma presentation and treatment:
Lentigo maligna: flat macule, w/variable pigmentation / irregular margins. Slow progression Superficial spreading: small raised papule w/ irregular margins. Rapid progression Nodular: pigmented or amelanotic, symmetrical. Rapid progression w/bleeding ulcers Biopsy > Moh's technique excision
29
Differentiation between naevus and melanoma:
Asymmetry Boarders (irregular/poor definition) Color (variable pigmentation) Diameter (>6mm) Evolution
29
Pingueculum:
^ between 70-80y / UV exposure > p53 alteration > degeneration of stromal elsatin/collagen > nodular hyperplasia w/actinic keratosis / epith. Thinning /calcification No treatment > UV protection > lubricants (DED) > FML qid 7d (flare-up) > excision
30
Pterygium patho following UV:
^pro-inflammatory cytokines (IL/TNF-a) > inflammatory influx Epidermal GF / PDGF > cell proliferation / migration ^expression of pro-angiogenic factors (IL-6/8, VEGF, MMPs) > vascularisaion ^MMPs > ECM remodelling > Bowmans layer breakdown Lesion invades cornea following bowmans damage
30
UV factors in pterygium formation:
Fibrovascular proliferation of degenerative bulbar conj. UV > several causative factors: Endogenous photosensitiser activation > ^ROS > oxidation breaks ECM > altered collagen/elastin synthesis ^Expression of epidermal GFs > cytokine production (IL-6/8) and MMP-1 Genetic mutations (possible p53)
30
Pterygium symptoms:
Wing fibrovascular growth at 3/9o'clock, from limbus over cornea. Can form iron deposition at boarder (Stockers line) WTR astigmatism when on visual axis, can flare up
31
Pterygium management:
Monitor for growth > UV protection > lubricants (DED) > FML qid 1w (Flare-up) > excision w/conj. Autograft (visual effect) Surgery requires excision of growth and adjacent tenons capsule, with conj. Autograft. Heals in 7-14 days with strong pain for 1-2 weeks. Glasses can be used after 6w, commonly recurrs
32
Pseudopterygium:
Conj. Adherence to corneal stroma following inflammation > wedge shaped conj. Fold over cornea Can occur from any angle (not 3/9') Cannot be removed easily > lubricants > FML qid 1w (DED)
32
Conj. Inclusion cyst:
Inplantation of epith. Into conj. (trauma/surj) > proliferation > double epith. Cyst w/fluid Commonly transparent (can be opaque), blink disruption Requires opthal puncture
33
Conjunctival dermoid:
Foetal development with epidermal injection in dermis > epith. Fibrous growth w/dermal features Well-demarcated solid white mass (often w/hairs) Usually just observed > excision Associated with goldenhar's syndrome
34
Conj. Papilloma:
HPV infection of conj. Squamous epith. > viral transformation and proliferation of keratinocytes Prolonged proliferation > squamous atypia > OSSN Pink vascular finger lesions (papilloma) with narrow base (pedunculated) or broad (sessile) Asymptomatic w/ slow spontaneous resolution > excision (irritating)
34
Conj. Actinic keratosis:
Benign proliferation, commonly over pterygium / pingueculum UV/age/smoking/caucasian > proliferation (^mutation)/gene alteration/ immunosuppresstion > p53/16 TS gene alteration > unregulated irrgular squam. Epith. Proliferation > hyperheratinised lesion Flat, white, plaque. Slow growth. Requires biopsy (similar to CIN)
34
conjunctival Pyogenic granuloma:
Rapid, benign fibrovascular lesion (neither pyogenic or greanulomatous) Conj. Damage > inflammation w/abnormal healing Red elevation w/ vascular supply Requires corticosteroid treatment
35
Conjunctival lymphangioma:
Proliferation of endothelial lymph channels > mass of dilated channels > clear channels can fill with blood > red raised channels Excision usually have incomplete removal
35
Capillary haemangioma:
2% neonates, 1/3 at birth, 2/3 develop by 6m Proliferation of vascular endothelial cells, forming highly vascularised red stromal mass. 75% Self resolves by 7y > corticosteroid injections
35
Types of ocular surface neoplasia:
Squamous neoplasia occurs on conj. As either localised in epith. (CIN) or as aggressive lesion through basement membrane invading stroma (SCC)
36
OSSN patho:
UV + HPV > reactivation of HPV > E7 HPV proteins promote proliferation / E6 proteins disable p53 gene > growth Risk increased with: HPV infection, UV, caucasian, age, smoking, immunosupression, AIDS, prior Skin SCC
36
OSSN symptoms:
Leukoplakic: localised thickening od stratifies squamous epith. W/ white keratotis plaque Papillomatous: vascularised mass, w/ BV corkscrews to supply metabolic proliferating cells Gelatinous: poorly defined, transparent thickening of squamous epith. All stain with NaFl due to irregular tight junctions of abnormal squamous cells
37
Squamous cell carcinoma:
Mass of dysplastic stratified squamous epith. Invading corneal stroma > likely metestasis to lymph
37
Conjunctival intraepithelial neoplasia:
Partial replacement of conj. Epith. With abnormal epith. Mild > lower third of epith. Replaced with dysplasic cells Moderate > middle third Severe > upper third Carcinoma in situ > full replacement
38
Conjunctival naevi:
UV/genetics/idiopathic > junctional naevi (melanocyte clum in basal epith.) > melanocyte migration into stroma > stromal pigmentation Well-defined boarders, raised, varied pigment on limbal conj. (elsewhere is suspicious), 1/2 w/ microcysts (not present on melanomas), mobile. Requires periodic measurement/photography > excision w/cryo
39
Signs of conj. Naevi developing into malignant melanoma:
Development post 20y Sudden onset / rapid growth / pigment change Abnormal location (fornices/palpebral conj.) Increased thickness w/feeder BVs
40
Primary acquired melanosis patho:
Proliferation of melanocytes in basal conj. ^with caucasion at 55y No Atypia > hyperpigmentation, low proliferation, low metastasis risk Atypia > ^melanocyte proliferation, w/abnormal cell structures. 50% metastasis by 5y
40
Conjuntival melanoma patho:
Develops usually at 60y 15% de novo, 75% PAM, 10% naevi > abnormal melanocyte proliferation through conj. Stroma > 25% metastasis to lymph/brain/liver/lung Risk increases w/ >2mm, caruncle/fornix involvement
40
Conjuntival melanoma presentation and management:
Raised dark lesion on conj. Fixed to episclera May have PAM, or amelanotic, BV feeders Biopsy > excision > radiation therapy Recurrance of 25% 5y > 65% 15y
41
PAM presentation and management:
Flat hyperpigmentation (brown/gold), mobile. Requires observation > biopsy > Atypia excision
42
Complexion related (racial) conjuntival melanosis:
Benign hyperpigmentation from excess melanocytes of basal conj. Epith. Diffuse, patchy, flat pigmentation Required observation
43
Lymphoid tumor:
Proliferation of T/B cells in conj. Smooth, elevated, diffuse mass in conj. Stroma w/ pink colour. Slow growth, w/malignant risk Requires biopsy (either benign or malignant) > systemic lymphoma check > chemotherapy
43
Ocular melanocytosis:
Bluish pigmentation of periocular skin/sclera Basically physiological, w/ low metastatic risk
44
Iris naevi:
Raised melanocyte proliferation in iris stroma. Metastasis risk 8%, increased with: age < 40, inferior location, feathery margins Requires observation Freckle is smaller and flat
44
Iris melanoma:
8% of all uveal melanomas with 5% metastasis by 10y following treatment Usually asymptomatic, >3mm diameter, >1mm depth, located inf. w/BV, cataracts/ectropion (uncommon). Requires iridetomy
45
Iridociliary epithelial cyst:
Cyst on iric/ciliary, arising from pigmented epith. Requires OCT to resolve sinister pathology
46
Choroidal neavus:
Benign pigment in 5-10% caucasians Proliferation of spindle cell melanocytes usually in younger years. Suspicious if older. Usually <5mm diameter, <1mm deep, w/yellow drusen. Requires monitoring
47
Signs of choroidal naevus forming malignancy:
Growth Blur, metamorphospia, VF loss, photopsia >5mm diameter, >1mm deep Presence of orange lipofuscin Near OD Associated serous RD
47
Choroidal melanoma:
80% of uveal melanomas, usually sporadic, otherwise from naevi. 1% have metastasis at time of detection, with 50% mortality at 10y. Commonly metastaise to liver, lungs, bone Causes blur/metamorphopsia, painless VF loss, floaters
48
Signs of choroidal melanoma:
Elevated nodular mass under RPE 60% near OD/fovea Clumps of orange pigment lipofuscin RPE atrophy/drusen/exudative RD
49
Choroidal metastasis:
Breast and lung cancer usually metastasise to choroid, with low mortality Fast growing elevation under RPE > serous RD w/pigment change
50
Congenital hypertrophy of the RPE:
Scattered pigment on fundus. Uncommonly atypical CHRPE have comma formation, related to FAP > colon cancer

OPTO3003 (18 decks)

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