question

This type of nevus is congenital or acquired and is composed of melanocytes

answer

Melanocytic nevus

question

This type of nevus is <1 cm., evenly colored, tan to brown, and can exhibit elevation

answer

Melanocytic nevus

question

Treatment for melanocytic nevus

answer

No treatment necessary

question

Three reasons to remove nevi

answer

1. Clinically atypical 2. Irritated or bothersome 3. Cosmetic

question

ABCDE's for skin cancer detection

answer

Asymmetrical, borders, color, diameter, elevation

question

A 40 year-old male presents with a bothersome lesion on his neck. Upon inspection, you see that the lesion is less than 1 cm., is evenly colored (tan), and slightly elevated. What is your diagnosis?

answer

Melanocytic nevus

question

This type of nevus exhibits ABCDE criteria, appears most frequently on sun exposed areas, irregular borders, deeply pigmented, clinically different from other moles present

answer

Dysplastic nevus

question

Patients presenting with this type of nevus have a personal and family history of melanoma and prolonged sun exposure.

answer

Dysplastic nevus

question

Treatment for dysplastic nevus

answer

full body skin exam, counseling, watch progression, shave biopsy, excision with margins

question

A 60 year-old farmer presents with an irregular lesion on his arm. The lesion is darkly pigmented and does not resemble any other nevi on the skin. While taking the history, the patient informs you that he rarely uses sunscreen and melanoma runs in his family. What is your diagnosis?

answer

Dysplastic nevus

question

Most common benign tumor after age 40

answer

Seborrheic keratosis

question

Characrteristic "stuck on" appearance, can vary in color from pale brown to sark black, velvety or verrucous surface, can be several centimeters

answer

Seborrheic keratosis

question

Abrupt eruption of seborrheic keratoses associated with adenocarcinoma of the GI tract, lymphoma, and leukemia

answer

Sign of Leser-Trelat

question

Treatment for seborrheic keratoses

answer

alpha hydroxy acid, retinoids, shave removal, cryosurgery, excision

question

A 45 year-old housewife complains of multiple lesions around her neck that often gets caught on her jewelry and sometimes fall off after taking a shower. She wants them removed because it makes her feel old, as her mother developed similar lesions as she aged. Upon inspection, the lesions appear "stuck on," are green-brown in color, and vary in size. What is your diagnosis?

answer

Seborrheic keratosis

question

Occur from breakdown in skin barrier; spread by direct or indirect contact and autoinnoculation

answer

Verruca vulgaris

question

Found most commonly on hands and knees

answer

Verruca vulgaris

question

Treatment is difficult because lesions are often resistent; start with less painful treatments

answer

Verruca vulgaris

question

Treatments include: salicylic acid, Veregen, imiquimod, cryosurgery, or laser surgery

answer

Verruca vulgaris

question

A 5 year-old boy presents with numerous, small lesions around the mouth. He says the lesions to do itch, but are "stupid and annoying." Upon inspection, you see that the boy also has similar lesions on his hands. The lesions have a rough texture. Additionally, you notice the boy keep putting his hands in his mouth. What is your diagnosis?

answer

Verruca vulgaris

question

Most common cutaneous cyst; proliferation of epidermal cells inside dermis

answer

Epidermal inclusion cyst

question

Flesh colored nodule, firm, central pore, erythmatous if inflamed

answer

Epidermal inclusion cyst

question

Usually asymptomatic; can discharge foul smelling cheese-like material

answer

Epidermal inclusion cyst

question

Treatments include: Antibiotics, I&D, excision, or no treatment if not symptomatic

answer

Epidermal inclusion cyst

question

A 30 year old women presents with a flesh colored nodule on the back of her neck. She states she's had it for one month and hasn't bothered her until recently when it became red and inflamed. On closer inspection, you notice a discharge coming from the lesion that has an unpleasant odor. What is your diagnosis?

answer

Epidermal inclusion cyst

question

Most common cutaneous vascular proliferation; increase in presence with age

answer

Cherry hemangioma

question

Small red macules to papules, often bright red, can be violet

answer

Cherry hemangioma

question

Treatments: No treatments necessary if not bothersome, electrodissection, punch removal favored due to vascular nature

answer

Cherry hemangioma

question

A 57 year-old business man presents with red-colored papules on the top of his head and arms. The patient states that the lesions cause no pain and are not itchy, but they are bothersome and cause self-confidence issues when presenting to clients. What is your diagnosis?

answer

Cherry hemangioma

question

Often found in obese, diabetics, intertriginous areas (neck, axillae, groin)

answer

Acrochordon

question

Small, soft, pedunculated flesh colored papules; can spontaneously fall off

answer

Acrochordon

question

Treatments: Generally cosmetic reasons, cryosurgery, removal with scissors, excision if large

answer

Acrochordon

question

A 25 year-old man, who is morbidly obese and diabetic presents with numerous small, soft, flesh-colored papules around his neck and axillae. The patient complains that the lesions rub against his clothing. What is your diagnosis?

answer

Acrochordon

question

Overgrowth of sebaceous gland, most common in middle and older age, can be associated with oily skin

answer

Sebaceous hyperplasia

question

Yellowish, soft papules, most common on the nose, cheeks, and forehead; central umbilication present

answer

Sebaceous hyperplasia

question

Treatments: Biopsy to rule out Basal Cell CA is unsure, shave removal, laser, electrodissection

answer

Sebaceous hyperplasia

question

A 43 year-old male complains of large, yellowish papules on the surface of his nose. Upon inspection, you notice the lesions have a central umbilication. The patient is concerned and even thinks it may be some kind of cancer. What is your diagnosis?

answer

Sebaceous hyperplasia

question

Rough, scaly patches or plaques commonly on the scalp, face, ears, dorsal hands and arms. May be tender on palpation.

answer

Actinic Keratoses

question

Approximately 60% of squamous cell cancers arise from these. Also a strong clinical marker for developing future NMSC.

answer

Actinic Keratoses

question

Treatments: prevention (sunscreen, hats), cryosurgery, topical fluorouracil cream, Imiquimod cream, Diclofenac 3% gel, chemical peel, photodynamic therapy.

answer

Actinic Keratoses

question

A 64 year old man presents with a scaly plaque on his scalp. He tells you he is a roof tiler and often spends up to 8 hours a day out in the sun. When questioned about sunscreen use, he shrugs and says it's for the sunbathers. As he speaks, you notice he also has the scaly plaques on his dorsal hands. What is your diagnosis?

answer

Actinic Keratoses

question

Conical projection composed of impacted keratin. Most common on the face, ears, and dorsal hands and may be several millimeters. Usually affects sun exposed areas in patients >60 years of age.

answer

Cutaneous Horns

question

Conical projection that rapidly grows, may be tender due to size and inflammation at base of lesion.

answer

Cutaneous Horns

question

Treatment: biopsy to rule out malignant changes, excision, electrodessication and curettage.

answer

Cutaneous Horns

question

Three different kinds of squamous cell carcinomas

answer

Keratoacanthoma, In Situ, Invasive SCC

question

Two different kinds of In Situ squamous cell carcinoma

answer

Supefical (SCCIS), also called Bowen's Disease

question

A 66 year old woman presents with a growth on the top of her right ear. The projection is tan in color and is hard like a fingernail. The skin is inflamed at the base. She tells you she grew up in Southern California and worked as a lifeguard through high school and college. What is your diagnosis?

answer

Cutaneous Horns

question

Dome shaped lesion with a centrally plugged keratotic nodule, sometimes with ulceration. Common on the face, forearms, and hands. Can rapidly enlarge within weeks.

answer

Keractoacanthoma

question

Treatment: surgical excision (most common), intralesional chemotherapeutic agents (5 FU, bleomycin, interferon), Imiquimod

answer

Keractoacanthoma

question

A 75 year old male presents with a dome-shaped lesion on the bridge of his nose. The outer edges are erythematous while the center is keratotic. He proceeds to tell you that he first noticed it one month ago, but it had been at least 2 cm smaller. What is your diagnosis?

answer

Keractoacanthoma

question

A discrete slowly enlarging thin plaque with irregular borders often with scale or crust. An easily treatable early stage of SCC. It is rarely seen before the age of 30 and slightly more common in women.

answer

Squamous Cell Carcinoma In Situ (Bowen's Disease)

question

Treatment: topical chemotherapy, electrodessication and curettage, PDT, excision, cryotherapy.

answer

Squamous Cell Carcinoma In Situ (Bowen's Disease)

question

A 45 year old female presents with a erythematous plaque on the back of her right hand. The border is irregular. She has light skin and blue eyes. Upon interview, she says she often spends time working in her garden. What is your diagnosis?

answer

Squamous Cell Carcinoma In Situ (Bowen's Disease)

question

A solitary keratotic nodule (most commonly), can be ulcerated or eroded. A majority arise in sun exposed areas. Can be highly differentiated or poorly differentiated. In women, it is most often found on the legs.

answer

Invasive SCC

question

excision, MOHS, radiation

answer

Invasive SCC

question

A 57 year old man presents with an ulcerated lesion on his cheek. The nodule also appears to be keratotic. The man tells you he received a kidney transplant one month ago. What is your diagnosis?

answer

Invasive SCC

question

The five types of Basal Cell Carcinoma

answer

Superficial, Sclerosing (Morpheaform), Nodular, Pigmented, Ulcerating

question

The most common skin malignancy in humans

answer

Basal Cell Carcinoma

question

A Pearly papule/ nodule, smooth , rolled borders, translucent, telangiectasia. Most common subtype.

answer

Nodular BCC

question

Treatment: surgical excision, MOHS, topical imiquimod, 5 FU, Erivedge

answer

BCC

question

An erythematous, pink plaque with well demarcated border, scaling bleeds when scratched. Only kind to exhibit considerable scaling.

answer

Superficial BCC

question

Brown, blue, or black colored lesion, smooth with translucence, can be eroded, increased melanization. Easily confused with melanoma. A biopsy is needed for definitive diagnosis

answer

Pigmented BCC

question

Crusted lesion with ulceration, rolled border similar features to nodular.

answer

Ulcerating BCC

question

Lesion with an ivory white appearance, may resemble scar, can progress to nodular or invasive BCC. An aggressive growth variant.

answer

Sclerosing (Morpheaform) BCC

question

Risk factors of Basal Cell Carcinoma

answer

Over 40 years, male, sun exposure, (beach vacations as youth)

question

A 52 year old male presents with a nodule on the left side of his nose. Little red veins are seen through the skin of the nodule. It has a smooth pearly appearance. What is your diagnosis?

answer

Nodular BCC

question

A 54 year old woman presents with a red plaque on her forehead. The plaque is scaly with a well demarcated border. She had frequent trips to the beach as a child and notices the plaque bleeds when scratched. What is your diagnosis?

answer

Superficial BCC

question

A 61 year old man presents with a dark pigmented lesion on his right temple. It is smooth in appearance. The man is worried it might be melanoma because it looks similar to the pictures he viewed online. What is your diagnosis?

answer

Pigmented BCC with biopsy

question

A 56 year old woman presents with an erythematous nodule on the bridge of her nose. When interviewed, she said it had started out as a scar-like lesion that matched her skin tone. She said unless she ran her hand over it, it was hard to tell it was even there. The recent change caused her to schedule the appointment. What is your diagnosis?

answer

Sclerosing (Morpheaform) BCC that progressed to Nodular BCC

question

What is the follow up procedure for SCC and BCC?

answer

Regular follow up at 3, 6, 12 months for full body exam, including lymph nodes. Patient education on reduction of risk factors, especially sun protection

question

Lesion with unknown etiology, occurs most commonly in women on lower legs

answer

Dermatofibroma

question

Pea-like nodule in the skin, range in color from flesh toned, brown pigment; can become traumatized and painful, especially with shaving

answer

Dermatofibroma

question

Treatments: If unsure of diagnosis, biopsy lesion; excision if bothersome; carbon dioxide laser

answer

Dermatofibroma

question

Common keratin filled cysts most commonly seen in infants; common after dermabrasion procedures where there is trauma to the pilosebaceous unit

answer

Milia

question

Superficial, pearly white to yellowish, domed; most commonly on the face, periorbital area; rarely symptomatic

answer

Milia

question

Treatments: topical retinoid to soften lesions and exfoliate skin, I&D, scissor excision, electrodissection

answer

Milia

question

Neoplasm of eccrine origin, most often appear at puberty but can form later in life

answer

Syringoma

question

Skin colored dermal papules, may appear translucent, usually in multiples on the cheeks and eyelids; may become pruritic with perspiration

answer

Syringoma

question

Treatments: Cosmetic reasons, surgical excision with sutures is best due to recurrent nature, electrodissection, cryotherapy

answer

Syringoma

question

Keratotic papule due to thickening of the epidermis, more common in men, appear after age 40

answer

Stucco keratosis

question

Most common on the lower extremities, characteristic "stuck on" appearance, white to yellowish crusted papule; asymptomatic, often unnoticed by the patient

answer

Stucco keratosis

question

Treatments: Topical moisturizers, salicylic acids, cryosurgery

answer

Stucco keratosis

question

Occurs most common the face; dome-shaped lesions with shiny, skin-colored appearance; firm; range in size from 1-5 mm; most common on the nose and chin

answer

Fibrous papule

question

Treatments: Mainly cosmetic, shave removal, electrodissection; often recurrent

answer

Fibrous papule

question

Extends beyond original wound, often recur after excision, do not regress spontaneously

answer

Keloid scar

question

Pruritic, do not extend beyond original wound, may regress spontaneously

answer

Hypertrophic scar

question

Presents on earlobes, face, chest, back, and shoulders; erythematous, highly vascularized, can be hard to soft in consistency, no hair follicles

answer

Scar

question

Treatments: Requires multiple modalities, compression, silicon sheeting, injection, laser therapy

answer

Scar

question

Benign tumors composed of adipose tissue, onset usually in early adulthood, most common on trunk

answer

Lipoma

question

Soft, rubbery on palpation, easily movable, skin overlying tumor is normal, encapsulated; rarely painful

answer

Lipoma

question

Treatments: No treatment necessary if not bothersome, excision, liposuction

answer

Lipoma

question

Most common skin biopsy; can control depth and width with blade, must make sure t get adequate tissue for pathologist

answer

Shave biopsy

question

Best biopsy for rashes where pathology lies in dermis, cosmetically sensitive areas such as face, skin folds where healing time is longer

answer

Punch biopsy

question

Best biopsy for large lesions where pathologist must have adequate tissue for diagnosis

answer

Excisional biopsy

question

Scissor biopsy; good for warts, skin tags, papillomas

answer

Tangential biopsy

question

Precise method of treating skin cancer that results in the highest cure rate with maximal tissue conservation

answer

MOHS Microscopic Surgery

question

Treatments for superficial BCCA and AK lesions

answer

Effudex cream and Imiquimod cream

question

Topical chemotherapy, indicated for tx of AK, also used for Bowens disease

answer

Topical Fluorouracil

question

60 % of skin cancers arise from these lesiosn

answer

Actinic keratoses

question

Pathogenesis: Prolonged sun exposure leads to damage of keratinocytes

answer

Actinic keratoses

question

Risk factors: males, fair skinned, outdoor workers, outdoor sportsman

answer

Actinic kertoses

question

Rough scaly patches or plaques, may be tender on palpation, most commonly on the scalp, face, ears, dorsal hands and arma

answer

Actinic keratoses

question

Treatments for AK's

answer

Protective clothing, cryosurgery, 5FU, Imiquimod cream, chemical peels, photodynamic therapy

question

What is the most common form of cancer in young adults?

answer

Melanoma

question

What are the mortality rates in men and women for melanoma?

answer

Decrease in women, increase in men

question

What is the main way to detect melanoma early?

answer

ABCDE'S

question

What are some risk factors of melanoma?

answer

Fair skinned individuals with light hair/eyes, UV radiation and sun damage, increased number of nevi/freckles, residence along the equator

question

What does the A in the ABCDE'S stand for?

answer

Asymmetry

question

What does the B in the ABCDE'S stand for?

answer

Border

question

What does the C in the ABCDE'S stand for?

answer

Color

question

What does the D in the ABCDE'S stand for?

answer

Diameter

question

What does the E in the ABCDE'S stand for?

answer

Evolution

question

What does the S in the ABCDE'S stand for?

answer

Symptoms

question

What are the four subtypes of melanoma?

answer

Superficial spreading, nodular, Lentigo maligna, Acral lentiginous

question

Lesion begins in nevus or can arise de novo, black / brown macule exhibits ABCDE's, most common subtype

answer

Superficial spreading melanoma

question

This subtype most commonly occurs on the trunks of men and the legs of women

answer

Superficial spreading melanoma

question

A 35 year old woman presents with a darkened nevi on her right calf. She said she noticed it had gotten darker after a recent sunburn. The border is also irregular. What is your diagnosis?

answer

Superficial spreading melanoma

question

If you are not sure of a diagnosis by appearance, what should you do?

answer

Biopsy

question

Blue, black, red nodule , ulceration, bleeding

answer

Nodular melanoma

question

A 62 year old man presents with a black nodule on his left cheek. It is circular and is raised from the skin. You measure it and find it is about 2 cm in diameter. What is your diagnosis?

answer

Nodular melanoma

question

Slowly enlarging, asymmetric brown or black patch. Most commonly on the face, nose, and cheek.

answer

Lentigo maligna melanoma

question

A 56 year old women presents with a large brown patch on her right cheek. The borders are irregular and the color isn't consistent throughout the patch. Some portions are darker than others. What is your diagnosis?

answer

Lentigo maligna melanoma

question

An uncommon melanoma subtype that occurs on the palms, soles, and nails. It is a darkly pigmented lesion.

answer

Acral lentiginous melanoma

question

A 40 year old man presents with a dark pigmented lesion on the bottom of his left foot. It has an irregular border. When measured, it is 3mm. What is your diagnosis?

answer

Acral lentiginous melanoma

question

What is the name of the melanoma variant that lacks pigment?

answer

Amelanotic melanoma

question

Lesion lacks pigment and can occur as any of the melanoma subtypes.

answer

Amelanotic melanoma

question

Treatment: must biopsy if suspicious, excision, MOHS, Chemotherapy for advanced stages, patient education

answer

Melanoma

question

When should individuals perform a self skin exam?

answer

Every month

question

T/F: Melanoma isn't very aggressive unlike other skin cancers and doesn't usually metastasize to other regions of the body

answer

False

question

What are three ways melanoma might disseminate?

answer

Direct extension from the primary site, lymphatic spread to regional or distant lymph nodes, hematogenous route

question

T/F: If there is any doubt to a lesion, you should always biopsy it

answer

True

question

A 36 year-old businesswomen complains of lesions on her lower legs. The patient also complains that the lesions often times are painful after shaving. Upon inspection, the lesions are the size of a pea and are flesh toned. What is your diagnosis?

answer

Dermatofibroma

question

A twelve-month female presents with superficial, pearly white, domed lesions around the eyes. The patient's mother said that the infant has not been itching the lesions. Therefore, you deduce that the lesions must be asymptomatic. Upon inspection, the lesions are uniform in size and shape. What is your diagnosis?

answer

Milia

question

A 46 year-old male football coach presents with numerous yellowish-white papules on his lower legs and feet. The papules also spear to be crusted and "stuck on." The patient did not even notice the papules until his wife pointed them out while on their beach vacation. What is your diagnosis?

answer

Stucco keratosis

question

A 24 year-old female model complains of a "mole-like lesion" on her chin. Upon inspection, the lesion appears shiny, skin-colored. Upon palpation, the lesion is firm. The patient also informs you that after a face-plant in a recent fashion show, the lesion began bleeding. What is your diagnosis?

answer

Fibrous papule

question

A 55 year-old male minister presents with a large bump under his skin in the left upper quadrant. He is afraid that he is developing some kind of malignancy. Upon palpation, the lesion is soft and rubbery feeling. It is also easily movable. When asked if the lesion caused him any pain, the patient said no, but he is worried because the lesion has gotten progressively larger with time. What is your diagnosis?

answer

Lipoma

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