Dermatology

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BCC Mimickers

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Nevus

Sebaceous hyperplasia

Sebborheic keratosis

Angiofibroma

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Pigmented/skin-coloured

Should not grow

No rolled border or ulceration

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Intradermal nevus

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Yellowish papule +/- telangiectasia and central dimple

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sebaceous hyperplasia (oil gland overgrowth)

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flesh-coloured or pink firm papule (mostly on nose); doesn't grow

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angiofibroma

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rough, irregular surface; stuck-on appearance; not pearly

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Seborrheic keratosis (benign overgrowth of keratinocytes; mimicker for melanoma)

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Pearly papule or nodule with rolled border and telangiectasis

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nodular BCC

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Thin scaly plaque that is well-defined and pink/translucent; +/- telangiectasia and rolled border

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superficial BCC

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White, bound-down/scar-like areas +/- pink colour, telangiectasia, rolled border

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sclerosing BCC

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Treatments for BCC

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usually surgical:

curettage and electrodessication

excision with wide margins

Mohs micrographic surgery

field therapy (for superficial BCC)

Topical chemo

cryosurgery (for pre-SCC)

radiation therapy (if you can't have surgery, since it can lead to secondary carcinogenesis)

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Higher risk of metastasis: BCC or SCC?

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SCC

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SCC in non-sun-exposed areas could be related to...

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chemical carcinogens (arsenic)

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Higher incidence of SCC

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immunocompromised patients

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friable (bleeds with trauma) erythematous indurated hyperkeratotic lesion with crusting

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SCC

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higher risk of metastasis in SCC if:

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immunosuppression

large, deep, or recurrent lesion

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spectrum leading to SCC

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photodamaged skin -> actinic keratosis-> bowen's disease (SCC in situ)->SCC

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Circumscribed, pink-red patch or thin plaque with scaly or rough surface

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Bowen's disease (SCC that does not invade the dermis)

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rough, scaly, thin, red-pink papules and plaques

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actinic keratosis

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risk factors for AK

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cumulative and prolonged UV exposure

age

fair skin

immunosuppression

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erythematous patch with rough, gritty scale on lips

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actinic cheilitis

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AK treatments

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localized (usually liquid nitrogen cryotherapy)

field (if there's many in one area; topical or photodynamic)

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volcano-like erythematous nodule with central keratinous core; rapid growth and sharp demarcation

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keratoacanthoma (often spontaneously involutes)

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melanoma risk factors

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personal/family history

fitzpatrick skin type 1-3

intermittent sun exposure with sunburns

tanning beds

immunosuppression

>50 common nevi, any dysplastic nevi, or 1 large congenital nevus

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ABCDEs of melanoma

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Asymmetry

Border irregularity

Colour variation

Diameter > 6mm

Evolution

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types of melanoma

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-superficial spreading (most common, younger)

-nodular (thicker=poor prognosis)

-lentigo maligna melanoma (elderly, chronic sun-exposed sites, slow-growing)

-Acral lentiginous (bottom of feet)

-Amelanotic

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Management of melanoma

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excisional biopsy to assess Breslow depth

re-excision with wide margins

follow-up skin exams

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progression of benign melanocytic nevi

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junctional->compound->dermal

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flat brown maccule confined to epidermis

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junctional nevus

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raised, coloured papule in epidermis and dermis

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compound nevus

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raised, skin-coloured papule (that used to be flat and brown for a long time)

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dermal nevus

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round, firm papule secondary to insect bite/trauma; dimples when squeezed

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dermatofibroma (scar tissue)

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forms of psoriasis

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guttate

chronic plaque

erythrodermic

pustular

palmoplantar

inverse

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Treatment of psoriasis

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Topical: steroids, vitamin d derivatives, calcineurin inhibitos

phototherapy

Systemic medications

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mildly pruritic pink scaly plaques, with herald patch, in christmas tree pattern on trunk and on peripheral extremities

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pityriasis rosea

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treatment for pityriasis rosea?

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spontaneous resolution over 6-8 weeks, so treatment is symptomatic (topical steroids, emollients, cool compresses)

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6 P's of lichen planus

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purple

pruritic

peripheral

polygonal

penile

papules

(idiopathic inflammatory disease)

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location of lichen planus

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skin (flexural surfaces), mucous membranes (white, lacy reticular lesions in mouth), and nails

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treatment of lichen planus

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steroids (topical, intralesional, or oral depending on location and severity)

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forms of cutaneous lupus

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acute

subacute (psoriasiform and annular)

chronic (discoid and panniculitis)

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Chronic, pruritic, ill-defined, scaly, erythematous rash

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atopic dermatitis

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scaling, oozing, blistering, pruritic, dermatitic rash under belly button

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allergic contact dermatitis (likely to nickel of belt buckle)

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treatment of allergic contact dermatitis

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topical steroids

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bilateral swollen lower legs with ulceration, oozing, and crusting (diagnosis and treatment)

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stasis dermatitis, a cutaneous sign of venous hypertension and insufficiency

treat with compression stockings and elevation, topical steroids, and wound care (oral antibiotic if needed)

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a drug rash that has no internal involvement

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simple rash (exanthem (maculopapular) or urticarial (very itchy))

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drug reaction leading to widespread, symmetrical, slightly raised rash and fever, fatigue, organ inflammation

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complex exanthem

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blistering complex drug rash with mucosal involvement, skin necrosis

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steven-johnson syndrome-->toxic epidermal necrolysis

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complex urticarial rash

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serum sickness-like reaction

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potential drug causes for psoriasis

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lithium, some beta-blockers, anti-TNF drugs

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phenytoin and carbamazepine can cause...

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severe, complex reactions fatal in 10% of cases

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allopurinol-related rashes

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hard to treat, may cause SJS/TEN

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treatment for drug-related rashes

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stop the drug

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what is the highest class of potency for a topical corticosteroid?

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class 1 (7 (hydrocortisones) is least potent)

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best vehicle for delivery of corticosteroids?

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ointment

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location for lowest potency of corticosteroid application? highest?

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lowest: face, folds, genitals

highest: palms, soles, scalp

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what immunosuppressant would you consider for psoriasis, atopic dermatitis, and morphea?

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methotrexate (except in pregnancy and livery disease)

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treatment for genital herpes?

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oral antivirals (acyclovir, valciclovir, famciclovir)

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treatment for zoster?

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oral antivirals within 72h of rash onset

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treatment for genital warts?

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destructive methods, topical creams (does not reduce transmission)

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treatment for molluscum contagiosum?

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self-resolve, or topical treatment/cryotherapy

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treatment for tinea capitis?

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oral antifungals (topical won't penetrate hair follicles)

antifungal shampoo for family members

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treatment for onychomycosis (tinea unguium)?

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oral antifungal (terbinafine) or topical (low efficacy)