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244 Cards in this Set
- Front
- Back
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A circumscribed, flat discoloration that may be brown, blue, red, or hypopigmented
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macule
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A large macule, 1cm or greater in diameter
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patch
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An elevated solid lesion with no visible fluid
Up to 0.5 cm in diameter ** |
Papule
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Circumscribed, elevated, superficial, solid lesions
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Plaques
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Circumscribed, elevated, solid lesion
Greater than 0.5 cm in diameter |
Nodule
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Circumscribed epidermal elevation that contains free fluid
Up to 0.5 cm in diameter |
VESICLES
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Rounded or irregularly shaped blisters containing serous or seropurulent fluid
Differ from vesicles only in size Greater than 0.5 cm in diameter |
BULLA
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Evanescent, edematous, plateau-like elevations of various sizes
Tend to be oval or arcuate and surrounded by a “flare” of macular erythema |
wheals
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Circumscribed collection of necrotic inflammatory cells and free fluid
Tend to have an inflammatory areola |
PUSTULES
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primary lesions
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Macules/ Patches
Papules/ Plaques Nodules Tumors Wheals Vesicles/ Bullae Pustules |
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Secondary Lesions
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Scale
Crusts Erosions Ulcers Fissures Atrophy Scars |
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Dry or greasy laminated masses of keratin
Vary in size from fine to coarse |
SCALES
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aka: scabs
Collection of dried serum, pus or blood |
CRUSTS
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A focal loss of epidermis
Do NOT penetrate below the dermoepidermal junction |
EROSIONS
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A focal loss of epidermis and dermis
Heals with scarring |
ULCERS
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do erosions cause scarring?
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hell nah
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aka: Cracks
A linear cleft through the epidermis or into the dermis |
FISSURES
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A depression in the skin resulting from thinning of the epidermis or dermis
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ATROPHY
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New connective tissue that replaces lost substance in the dermis or deeper parts as the result of injury or disease
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SCARS
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SPECIAL SKIN LESIONS
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Excoriations
Comedones Milia Cysts Burrow Lichenification Telangectasia Petechia Purpura |
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Erosions caused by scratching
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EXCORIATIONS
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Plug of sebaceous and keratinous material in the opening of a hair follicle
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COMEDONES
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Small, superficial keratin cyst with no visible opening
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MILIA
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Small, circumscribed lesions with a wall and a lumen containing either fluid or solid matter
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CYSTS
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Narrow, elevated, tortuous channel
Usually the result of a parasitic infection |
BURROW
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Area of thickened epidermis induced by scratching
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LICHENIFICATION
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Dilated superficial blood vessels
Can be multiple or single |
TELANGECTASIA
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Circumscribed deposit of blood
Less than 0.5 cm in diameter |
PETECHIAE
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Circumscribed deposit of blood
Greater than 0.5 cm in diameter |
PURPURA
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of the skin is determined by the melanin, oxyhemaglobin, reduced hemaglobin and carotene
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color
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(T-F) color alone should note be used to make a diagnosis
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True
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Forming a Ring/Circle
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Annular
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Part of a circle
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Arcuate
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Several intersecting portions of circles
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Polycyclic
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Snake like – curving line
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Serpiginous
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Small round lesions
“Drop like” |
Guttate
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Coin-like
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Nummular
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An infection of the upper portion of the hair follicle
Characterized by a follicular papule, pustule, erosion or crust |
Folliculitis
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Pink
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Erythematous
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Purple/Blue
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Violaceous
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Disease of pilosebaceous unit
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acne
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non inflammatory acne
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open & closed comedones
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inflammatory acne
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Papules, pustules, nodules
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Noninflammatory
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Open comedones
Closed comedones |
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Normal skin resident
Generates components that create inflammation |
p. acne
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Reverse the abnormal pattern of keratinization – reduce follicular plugging
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Retinoids
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Antibacterial – effectively reduced P. acnes counts
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Benzoyl Peroxide
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Reduction of P. Acnes
Antiinflammatory activity |
oral antibiotics
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Erythema, telangiectasias, papules, pustules
No comedones |
Rosacea
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Caused by Poxvirus (dsDNA virus)
Discrete 2-5mm umbilicated papules |
Molluscum Contagiosum
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Mite
Spread by contact with infected people Fomites |
scabies
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Nummular
Dyshidrotic Atopic Dermatitis Lichen Simplex Chronicus Many others |
Eczema
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Symmetric vesicular hand and foot dermatitis
Itching precedes the appearance of vesicles |
Eczema
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Excessive washing may exacerbate this condition
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Asteatotic Eczema
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Acute, subacute, or chronic relapsing skin disorder
Often begins in infancy |
Atopic Dermatitis
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Waxy brown “stuck on” plaques
Unknown origin No malignant transformation |
Seborrheic Keratosis
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Common pedunculated papules and tumors
Frequently located in the axilla, neck and inguinal area |
Skin Tags
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Usually found on the lower legs
Fibrous reaction to trauma, insect bite, or an infection |
Dermatofibroma
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Multiple itching nodules
Pruritus is intermittent and severe Relieved only by scratching to the point of damaging the skin |
Prurigo Nodularis
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Benign neoplasms resulting from rapid proliferation of endothelial cells
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Hemangiomas
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Most common vascular lesion
Common on the trunk Appear with increasing age |
Cherry angiomas
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Dark blue
Commonly on sun exposed areas of the lip, face, or ears. |
Venous lake
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Hyperpigmentation – usually on the face
Found almost exclusively in women 10:1 |
Melasma
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Can be an incidental benign finding
Can be associated with neurofibromatosis |
Café au lait spots
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Epidermal Inclusion Cyst treatment
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Excision
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Keratosis Pilaris treatment
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Moisturization, avoid abrasive cleansers, urea based creams
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Vitiligo treatment
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Topical steroids, UVR
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Rare autoimmune blistering disease involving skin and mucous membranes
Can be associated with internal malignancy Flacid, easily ruptured bullae Postive Nikolsky sign |
Pemphigus
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Autoimmune subepidermal blistering disease
Disease of the elderly Large, tense bullae Negative Nikolsky’s |
Pemphigoid
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Prodrome of
Cough, Coryza (Nose and eyes run continuously), Conjunctivits, Photophobia and Fever Rash presents 3-4 days afterward |
Measles
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Fifth disease
Parvovirus B19 Facial erythema, “slapped cheek” Spread by respiratory droplets or blood transfusions |
Erythema Infectiosum
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Red papules
Fiery red plaques Symmetric – both cheeks Spares nasolabial folds Fades within 4 days |
Erythema Infectiosum
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NET-LIKE pattern erythema
Begins on extremities 2 days after facial rash Extends to trunk & buttocks Fades in 6 – 14 d |
Erythema Infectiosum
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Sixth disease
Herpes virus 6 80% of kids infected by 1st year of life Infects infants through saliva In adults – severe infectious mononucleosis-like syndrome if primary infection |
Roseola Infantum
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Suddenly develop high fever – 103-106 of several days duration
Few symptoms Febrile seizures Usually there is mild lymphadenopathy |
Roseola Infantum
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Historically caused by Coxsackie A16
Vesicular palmoplantar eruption Erosive stomatitis Mild associated symptoms – low grade fever Spread by respiratory, fecal-oral route Children can continue to shed the virus in the stool for up to 6 weeks |
Hand Foot and Mouth Disease
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Tends to be at the proximal nail fold
Usually asymptomatic Usually due to candidiasis Often the cuticle may be missing Treatment: Oral anti-yeast medications (i.e. Diflucan) Topical anti-fungals |
Chronic Paronychia
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Green discoloration of the nail
Often asymptomatic |
Pseudomonas infection
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Auto-immune hair loss
Often the areas will spontaneously re-grow |
Alopecia Areata
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Hormone related hair loss
Men & Woman Treatments |
Androgenic Hair Loss
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Emotional based cause
Hair is often of different lengths Patches tend to be irregularly shaped |
Trichotillomania
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Very common
Present in 1% of all newborns and increase in incidence with age Size and pigmentation changes occur with growth and pregnancy Very low malignant potential Tend to remain uniform in color and shape |
Melanocytic Nevi
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nevus cells remain at DE junction
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Junctional
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nevus cells found at DE junction and in the dermis
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Compound
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nevus cells found in the dermis
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Dermal
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Tend to be flat or slightly elevated
Light brown to brown-black Melanocytes at the dermal-epidermal junction |
Junctional
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Slightly elevated, dome shaped, papules
Flesh colored or brown Hair may be present Nevus cells at dermo-epidermal junction and upper dermis |
Compound
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Dome shaped, verrucous, or pedunculated papules
Brown or black but may become flesh colored with age Nevus cells in dermis |
dermal
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Extremely low malignant potential
<1.5 cm in diameter Clinical observation usually recommended |
Small Congenital Nevus
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Malignant potential controversial
1.5 cm – 19.9 cm Lifelong observation versus biopsy versus prophylactic excision |
Medium-sized congenital nevus
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5% or greater body surface; usually on trunk (>20 cm)
Malignant transformation occurs |
Large Congenital Nevus
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Brown pigment absorbs longer wavelengths of light and scatters blue light
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Tyndall Effect of blue nevi
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Marker for increased risk of melanoma
NOT a true “pre-cancer” May have “fried egg” appearance Irregular and dark pigmentation Irregular borders |
Dysplastic Nevi
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Hairless, oval or irregularly shaped brown lesion that is dotted with darker brown-black spots
May appear at any age Transformation into MM is rare |
Speckled Letiginous Nevus
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Lacks nevus cells
Hamartomatous growth of smooth muscle fibers Can consist of a brown macule, a patch of hair, or both |
Becker’s Nevus
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A compound or dermal nevus that develops a white border
Incidence is about 1% Found most commonly on children Due to an immune reaction toward the nevus |
Halo Nevus
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Lumbosacral steel- blue patch present at birth or early childhood
More common in pigmented races |
Mongolian Spots
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Blue-brown unilateral facial patch
More common in darkly pigmented races Present either at birth/before age one or around puberty (onset after age 20 is rare) Follows the first two branches of the trigeminal nerve |
Nevus of Ota
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Most common in children
Hairless red papules/nodules with a smooth surface Usually solitary |
Spitz Nevus
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2nd most common melanoma
More common in men (2:1) Occasionally amelanotic Resemble blood blisters, hemangiomas, dermal nevi, seborrheic keratoses, or dermatofibroma |
Nodular Type mm
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Commonly found in sun-damaged skin
Radial growth phase is quite long and the vertical growth phase may never develop |
Lentigo maligna type mm
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Occurs on the palms, soles, phalanges, and mucous membranes
Most frequent in African Americans and Asians |
Acral lentiginous type
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Appearance of a pigmented band with extension into the proximal or lateral nail fold
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Hutchinson’s sign
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ABCDE’s of mm
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Asymmetry
Border Color Diameter Evolving |
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What to do when you suspect Melanoma
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Biopsy is paramount
Recommend excisional biopsy down to fascial plane |
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Most important histologic determinant of prognosis
Measured from the granular layer to the deepest portion of malignant cells |
Breslow Depth
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(Breslow Depth) When greater than 1mm
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higher risk for metastasis
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Describe the emphases of Offensive Information Warfare?
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Offensive Information Warfare (IW) emphasizes the manipulation of electronic information systems to influence an adversary's perceptions and behavior. This might, for example, involve disabling military and civilian telecommunication systems through computer viruses or electromagnetic pulse devices. Infiltration is, however, the "maneuver of choice" since an enemy, unaware that his information sources have been compromised, will continue to trust them, creating opportunities for deception. Offensive Information Warefare (IW) also emphasizes the use of direct broadcast satellites, the commercial media, and "visual stimulus and illusion" technologies such as holography to conduct propaganda and subversion.
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Relatively common
Acute, often recurrent inflammatory disease Associated with preceding herpes simplex or mycoplasma infection |
Erythema multiforme
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Self limited recurrent disease
no prodrome lasts 1-4 weeks spring and fall young adults |
Erythema multiforme
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Targetoid lesions
Central dusky purpura Ring of pale edema Ring of macular erythema Sharply marginated |
Erythema multiforme
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Drugs are the most common cause
Occurs most often in those treated for seizure disorders |
SJS / TEN
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Severe hypersensitivity reaction
Very rare Incidence: 0.8/1,000,000 Drug induced more severe than infection induced Tends to have a prolonged course lasting 3 or more weeks |
SJS / TEN
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< 10% BSA
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SJS
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10% - 30%
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SJS / TEN
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> 30%
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TEN
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Differentiation based upon (SJS / TEN)
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the percent of tissue detachment
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Start with fever and flu-like symptoms
1 – 14 days later there is abrupt onset of symmetric red macules Skin lesions appear on the face & trunk and spread quickly to maximum extent |
Stevens-Johnson Syndrome
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The oral mucosa is ALWAYS involved
Two or more mucosal sites are ALWAYS involved |
sjs
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Lips tend to form hemorrhagic crusts
Eyes develop severe conjunctival erosions and exudate |
sjs
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Diagnosis: Made by the characteristic prodrome followed by the abrupt onsest of mucocutaneous necrosis with at least TWO mucosal sites involved
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sjs
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Begins initially as SJS like changes but progresses to involve full-thickness loss of the epidermis involving a large percent of BSA
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Toxic Epidermal Necrolysis
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Epidermal detachment reproduced by mechanical pressure on an area of erythematous skin
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NIKOLSKY’S SIGN Positive (TEN)
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Pain, erythema, heat, over wide area of skin
Nikolsky’s sign Bullae Erosion of mucous membranes Eye |
ten
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If patient presents with diffuse erythema and painful skin
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ten
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TEN vs. Staph scalded skin syndrome (TEN)
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has full thickness skin involvement
Split at dermal epidermal junction |
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TEN vs. Staph scalded skin syndrome (SSSS)
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SSSS has loss of superficial layer
Split at granular layer of epidermis |
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Nodular erythematous eruption that is usually limited to the extensor aspects of the extremities.
In USA most commonly caused by Oral Birth Control Pills Lesions begin as red, nodule-like swellings over the shins |
Erythema Nodosum
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Never suppurate
Color changes from bright red to bluish or livid Probably a delayed hypersensitivity rxn to a variety of antigens |
Erythema Nodosum
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is the most common cause of EN in the west and southwest USA.
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Coccidiodomycosis
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Inflammation & necrosis of the vessel wall.
Classified as small, medium, and large vessel vasculitis |
Vasculitis
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Characteristic lesion is PALPABLE PURPURA
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Vasculitis
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the most common form of small-vessel necrotizing vasculitis
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Hypersensitivity vasculitis
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Acute vasculitis of small to medium sized vessels
Seen in young patients Usually follows upper respiratory tract infection |
Henoch-Schonlein Purpura
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Typically associated with abdominal pain (63%)
Blood in stool (GI bleed – 33%) Blood in urine (nephritis – 40%) Chronic renal failure in a few patients |
Henoch-Schonlein Purpura
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Wheals
Itchy Acute Chronic Last less than 24 hours No scale Leave without a trace |
Urticaria
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Scratching skin results in urticarial wheals / lines
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Dermatographism
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IgE and complement mediated
(Urticaria) |
Immunologic
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Opiates, polymyxin, ASA, NSAIDS, ACE-inhibitors, Contrast dye
(Urticaria) |
Nonimmunologic
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Self limited, lasting few days
Commonly caused by allergic reaction to food or meds In children may be associated with viral illness Urticaria (Acute vs. Chronic) |
Acute
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> 6 weeks
Most idiopathic Autoimmune cause often suspected Histology shows non necrotizing perivascular infiltrate (no vasculitis) Urticaria (Acute vs. Chronic) |
Chronic
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Group of disorders characterized by scaly papules and plaques
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Papulosquamous diseases
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Chronic, inflammatory disease
Pityrosporum ovale Oily complexion; “seborrheic diathesis” |
Seborrheic Dermatitis
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Seborrhea in newborn
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Cradle Cap
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rare, chronic disease of unknown etiology.
Occurs in childhood, or in the 50-60’s Scalp, palms, & soles Red-orange plaques Follicular papules Islands of sparing |
Pityriasis Rubra Pilaris
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a 2-10cm round-to-oval lesion most often found on the trunk and preceding the other lesions (pts think they have ringworm),
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Herald Patch
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Lesions are salmon pink in whites and hyperpigmented in blacks.
Collarette scale can help with diagnosis |
Pityriasis Rosea
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Lesions are oriented along skin lines giving the appearance of a Christmas tree.
Lesions asymptomatic or mildly itchy |
Pityriasis Rosea
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Five P’s of Lichen Planus
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pruritic, planar, polyangular, purple, papules.
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Small, pink or ivory papules with follicular plugs
With time – oval plaques with a dull, atrophic, wrinkled surface |
Lichen Sclerosis et Atrophicus
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Treponema Pallidum
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Syphilis
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Chancre develops at the site of inoculation
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Syphilis
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1º Syphilis
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Chancre: Painless erosion
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6 - 8 weeks after onset of 1º chancre
Results from hematogenous spread of T. pallidum Systemic symptoms may be present |
2º Syphilis
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Generalized nonpruritic macular erythematous eruption
Arises on trunk, spreads to shoulders and extremities, spares face, palms, soles Resolves in 2 weeks |
Macular Syphilid
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Predilecton for palms and soles
sharply demarcated margins Copper colored oval papules and plaques Thin ring of scale |
2º Syphilis Macular Papular Rash
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Can occur on the mouth, lips, pharynx, genitalia, anus
Highly infectious Macerated grey oval lesions with raised border, central erosions and grey membranous covering |
Mucous Patches
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Most infectious lesions
Ooze fluid filled with spirochetes Flesh colored smooth, papillated, cauliflower like vegetations Occur on genital and perianal areas |
Condyloma Lata
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Asymptomatic state
Only manifestation is reactive serologic testing Diagnosis of exclusion |
Latent Syphilis
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Presents many years after inoculation
May have mucocutaneous, osseous, visceral, and neural manifestations Characteristic skin lesion is the gumma |
3º Syphilis
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Painless pink nodules with ulceration
heal with scarring may cause massive destruction of tissue rarely contagious rarely heal |
3º Syphilis Gumma
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Autoimmune in nature
Serum autoantibodies directed at cellular components (typically nuclear antigens) are found in these diseases are important in the development of clinical manifestations Auto-antibodies are not organ specific Presence of auto-antibodies is not enough to equal clinical disease |
Connective Tissue Diseases
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Multisystem disease of unknown origin characterized by the production of autoantibodies that lead to immune mediated tissue damage
Common: 1 in1,000 High morbidity and significant mortality Often has episodes of flaring, remission, and relapsing |
Lupus Erythematosus
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Strongest risk factor = Gender
Female: 6:1 ratio Most commonly occurs during childbearing years Believed that hormonal factors influence suseptibility |
Lupus Erythematosus
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Usually seen in young to middle-aged females
80% of patients will have cutaneous involvement Most organs can be involved |
Systemic Lupus Erythematosus
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fixed erythema over malar area
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Malar rash-
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red, raised patches with adherent keratotic scaling
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Discoid rash-
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Classification Criteria – Mneumonic “MD Soap Brain”
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M – Malar Rash
D – Discoid Lesions S – Serositis O – Oral Ulcers A – ANA P – Photosensitivity B – Blood (Hematologic abnormalities) R – Renal abnormalities A – Arthritis I – Immunologic (other autoantibodies) N – Neurologic |
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More common in females in the 4th decade of life
ANA tends to be negative Diagnosis usually made by biopsy of lesional skin DIF (Direct Immunofluorescence) will be positive in lesional skin ONLY |
Discoid Lupus Erythematosus
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Discoid lesions are the most common manifestation
Face and scalp are the most common locations |
Discoid Lupus Erythematosus
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Begin as asymptomatic 1-2 cm plaques with firmly adherent scale
The scale penetrates down into the follicular orifices creating a “carpet tack” appearance |
Discoid Lesions
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Later there is atrophy, hypopigmentation and scarring
May cause scarring alopecia with scalp involvement |
Discoid Lesions
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Mostly seen in Caucasian females (15-40 years old)
Usually in sun-exposed surfaces Tends to be chronic and recurrent May be drug induced (NOT the same as drug induced lupus erythematosus) Hydrochlorothiazide and Calcium channel blockers |
Subacute Cutaneous Lupus Erythematosus
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ANA is positive in about 63%
SS-A (Ro) is usually positive SS-B (La) may be positive 75% have arthralgias or arthritis 20% have leukopenia |
Subacute Lupus Erythematosus
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Lesions occur most often on the trunk and one morphologic types tends to predominate
Spares the knuckles, inner aspects of the arms, axillae and lateral parts of the trunk Don’t tend to see atrophy or scarring |
Subacute Lupus Erythematosus
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Two Distinct Morphologic Catagories with SCLE
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Papulosquamous Pattern
Annular Polycyclic Pattern |
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Systemic symptoms predominate
Arthralgias, arthritis (small joints) myalgia, fever, serositis No CNS involvement Often no cutaneous findings ANA positive Anti-histone antibodies |
Drug Induced Lupus Erythematosus
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Procainamide is the most common cause in US
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Drug Induced Lupus Erythematosus
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Rare condition caused by transplacental autoantibodies from the mother to fetus
Annular and polycyclic lesions Associated congenital heart block, cardiomyopathy, cholestatic hepatitis, and thrombocytopenia |
Neonatoal LE
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Rare inflammatory muscle disease with cutaneous findings
Polymyositis – same disease without cutaneous manifestations |
Dermatomyositis
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Believed to be a vasculopathy that is mediated by complement deposition with lysis of endomysial capillaries and resulting in muscle ischemia
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Dermatomyositis
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Pathognomonic for DM
Violaceous discoloration and edema of eyelids |
Heliotrope erythema of eyelids
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Pathognomonic sign of DM
Round, smooth, violaceous/red, flat-topped papules that occur over the knuckles and lateral aspects of the digits |
Gottron’s papules
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Most prominent at the proximal nail fold
Irregular, red, linear streaks |
Periungual erythema and telangietasia
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Localized or diffuse eruption over bony prominences
Often in a “shawl” distribution Photosensitivity is common |
Violaceous scaling patches
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Most important diagnostic feature of DM
Mottled white areas with brown pigmentation, telangiectasia, and atrophy |
Poikiloderma
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Erythematous, scaly, atrophic scalp lesions
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Scaly red scalp
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Creatinine kinase- elevated in most cases
Aldolase, lactic dehydrogenase, and transaminase elevations may indicate active disease |
Dermatomyositis
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Positive anti-Jo-1 antibody
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Dermatomyositis
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Systemic form (Scleroderma) and a Localized form (Morphea)
Characterized by circumscribed or diffuse, hard, smooth, ivory-colored immobile areas of skin |
Systemic Sclerosis
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Generalized disorder of connective tissue resulting in thickening of dermal collagen, fibrosis, and vascular abnormalities in internal organs
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Progressive Systemic Sclerosis
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Involves changes in skin and internal organs
Female Predominance 15:1 |
Scleroderma
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Vasospastic disorder precipitated by temperature changes
More common in women WhiteBlueRed discoloration. Corresponds to vasoconstriction, relaxation of vasoconstriction, and hyperemia |
Raynaud’s phenomenon
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variant of systemic scleroderma with the most favorable prognosis (limited systemic involvement)
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CREST syndrome
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CREST syndrome
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Calcinosis cutis
Raynaud’s phenomenon Esophageal dysmotility Sclerodactyly Telangiectasia |
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Anticentromere antibodies are highly specific for
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CREST syndrome
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One or more circumscribed areas of purple discoloration progresses to a thickened, firm, hairless, ivory patch
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Morphea
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Primarily effects cartilage
Autoantibody to Type II collagen Redness, swelling and pain of cartilaginous portion of the ear – spares the lobe |
Relapsing Polychondritis
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Autoimmune disorder that primarily affects secretory glands
Most common features are xerostomia, xerophthalmia, and arthritis Skin manifestations include xerosis, palpable purpura, urticarial vasculitis and annular erythema |
Sjogren’s Syndrome
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Most patients have ant-U1 RNP antibodies
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Mixed Connective Tissue Disease
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Rare, chronic, intensely, burning, pruritic vesicular skin disease with frequent recurrences
Associated with subclinical gluten-sensitive enteropathy IgA deposits in the upper dermis |
Dermatitis Herpetiformis
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Begins with a few itchy papules and evolves to intensely burning urticarial papules, vesicles, and rarely, bullae
Distributed on elbows, knees, scalp, nuchal area, shoulders, and buttocks |
Dermatitis Herpetiformis
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Rare, potentially lethal, autoimmune, intraepidermal, blistering disease involving the skin and mucous membranes
IgG autoantibodies directed against the cell surface of keratinocytes destroy the adhesion between epidermal cells |
Pemphigus
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Mucosal erosions, thin-walled and flaccid bullae that appear on normal skin and mucous membranes.
Heal with hyperpigmentation and no scarring. |
Pemphigus Vulgaris
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Elicited by slight pressure, twisting, or rubbing of the skin.
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Nikolsky sign-Positive
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Elicited by direct pressure on an intact bullae.
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Asboe-Hansen Sign- Positive
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Characterized by flaccid bullae and localized/generalized exfoliation
Adherent scale crusts may resemble corn flakes Nikolsky sign positive |
Pemphigus Foliaceus
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Acantholysis in the upper epidermis (usually the granular layer)
Absence of the stratum corneum may be seen DIF demostrates IgG throughout the epidermis |
Pemphigus Foliaceus
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Rare, autoimmune subepidermal blistering disease with circulating IgG and basement membrane zone bound IgG antibodies and C3
Disease of the elderly Antibodies bind to antigens (BP230 and BP180) component of hemidesmosomes in basal keratinocytes) |
Bullous Pemphigoid
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the most common type of skin cancer in Caucasians
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bcc
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Ionizing radiation
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SCC=BCC
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Arsenic
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SCC>BCC
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HPV
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SCC
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Cigarette smoking
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SCC
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Second most common type of skin cancer
Has the potential to metastasize |
Squamous Cell Carcinoma
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are the earliest lesion in the development in scc
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Actinic Keratosis
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Tend to be slow growing
Rarely progress to invasive carcinoma Most commonly occur in sun-exposed areas Tend to be solitary, sharply demarcated, pink to fiery red scaly plaques that can resemble other common skin lesions |
Squamous Cell Carcinoma in situ
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Historically these were considered benign
Now considered a variant of SCC with potential for local destruction and metastasis Rapidly enlarging nodules with a crater-like center |
Keratoaconthoma
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Most appropriate for superficial lesions – superficial BCC’s
Simple, cost effective No surgical repair needed Leaves significant scarring |
ED & C
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Appropriate for all types except morpheaform BCC’s
Use 2-4mm margins More costly but better cosmetic outcome Time consuming |
Excisional Surgery
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Appropriate for all types that are in either high risk locations or cosmetically important locations.
Best choice for morpheaform BCC’s |
Mohs Micrographic Surgery
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Recommended for any stage III SCC or higher (positive lymph nodes)
Can be an option for facial lesions when surgery is not recommended |
Radiation Therapy
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Not widely used
Painful Inexpensive Can be effective therapy for well-marginated NMSC’s |
Cryosurgery
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Most appropriate for superficial lesions
Currently recommended for superficial BCC’s and AK’s Expensive for patients if they have to pay for medications out-of-pocket Cosmetically superior to surgery |
Aldara
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Encompasses a group of distinct lymphomatous neoplasms of helper T Cells that present in skin
Later involve lymph nodes, peripheral blood cells, and the viscera. |
Cutaneous T-Cell Lymphoma
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Slowly progressive disorder
has 3 cutaneous stages patch plaque tumor erythroderma |
Mycosis Fungoides
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< 10% body surface involved
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T1
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>10% body surface involved
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T2
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tumors present
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T3
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Erythrodermic
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T4
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no palp nodes no histo
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No
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palp nodes no histo
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N1
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no palp nodes positive histo
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N2
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clinical and pathological involvement
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N3
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Lymphadenopathy, tumors, or cutaneous ulceration are cardinal progostic factors
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Mycosis Fungoides
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Generalized exfoliative process with universal redness
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MF erythroderma
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Malignant neoplasm of T lymphocytes
Affects all races Blacks > whites males > females Elderly slowly progressive disorder |
Mycosis Fungoides
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Can get full thickness skin biopsy including small amount of subcutaneous fat
Good for diagnosis of most tumors or inflammatory skin conditions Should avoid in malignant melanoma |
Punch biopsy
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Good for elevated lesions
Use only if full thickness of tissue is not important Results in a superficial piece of tissue for biopsy |
Shave biopsy
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Biopsy of entire lesion down to and including some subcutaneous fat
Most useful for biopsy of malignant melanoma |
Excisional Biopsy
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Length to width needs to be 3:1 to avoid dog ears
Resulting scar should follow normal skin lines |
Elliptical Excision
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Used to treat superficial nonmalignant lesions
Warts, Actinic keratosis, seborreic keratoses, molluscum contagiosum |
Cryosurgery
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Electrode contacts the skin (must be dry)
Char occurs in immediate surrounding tissue Care must be taken as high settings can lead to deeper tissue damage |
Electrodesiccation
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Scraping technique used to remove soft tumors
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Curettage
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