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Derm Quiz 3
Terms in this set (76)
Nevomelanocytic nevus (NVM)
"Mole" - Brown discolored dark skin lesion
What differentiates nevomelanocytic nevus from one another?
The location of melanocytes (melanin) within the skin layers
A Junctional Nevus is located (1) .This type of lesion is called (2) .
1. Above the basement membrane (dermal/epidermal junction)
2. Macule: flat, non-palpable
A Compound Nevus is located 1 . This type of lesion develops into a 2 .
1. at the junction of the papillary dermis and basal layer of epidermis
2. Papule/small nodules: elevated
When melanin travels vertically deeper into the dermal tissue layer the lesion becomes _____.
A dermal nevus is located 1 . This type of lesion develops into a 2 .
1. Solely within the dermal layer
Acquired Nevomelanocytic Nevi typical onset in _____.
Childhood (1st 3 decades of life)
Clinical distinctions of Atypical Melanocytic Nevi compared to Acquired Nevomelanocytic Nevi:
- Color variation w/ in lesion
- Asymmetric in outline
Risk of melanoma is directly related to the
number of normal melanocytic nevi compared to atypical melanocytic nevi
Greater than ____ atypical melanocytic nevi increases the risk of melanoma
Greater than ____ normal melanocytic nevi increases the risk of melanoma
Blue Nevus caused by melanin distributed in ____ tissue layer.
Spitz Nevus occurs primarily in ___1__. It mimics other vascular tumors such as ___2___.
2. Melanoma, Hemangioma, Dermatofibroma
A benign firm papule dark-blue-gray in color
Subtype of melanocytic nevus: Dome-shaped, hairless, <1 cm nodule, pink/tan in color often occurring in children
Lesion caused by acute/chronic sunlight exposure that leads to hyperproliferation of melanocytic active
Seborrheic Keratoses only involve ___1__ tissue layer. Do not appear until __2___ years of age.
Histological hallmark of Seborrheic Keratoses
Horn Cyst --> continuous w/ external surface
Appearance of Seborrheic Keratoses under dermoscopy exam:
Keratin pseudocyst - small white spots
"Yellowish Waxy Center"
Signs of Leser-Trelat:
Sudden onset of multiple Seborrheic keratoses or increase in size indicative of internal malignancy
Tan to white papules with flat hyperkeratotic surface 1-3 mm in size on the LE or dorsum of the foot with stuck on appearance in older demographics
Medical term for skin tags:
Wide distribution of acrochordons could be a marker for ______
Epidermal inclusion cyst is caused by:
Traumatic implantation of epidermis into the dermis accumulation of degenerating keratin within cyst cavity
Multiple wide spread of epidermal cysts at a younger age increases clinical suspicion for internal malignancy
Clinical exam used to evaluate for dermatofibroma
Dimple sign: depression of lesion with lateral pressure
Targetoid lesion with central necrosis, "bulls-eye appearance" on palms and soles caused by reaction to new medication
Minor vs Major Erythema Multiforme
Major has 2 or more mucosal sites involved and has widespread skin lesions along the trunk
Maximum variant of erythema multiforme is called ______. It has _____ % of epidermal detachment.
Maximum variant of Stevens-Johnsons syndrome is called _____. It has _____ % of epidermal detachment.
Toxic Epidermal Necrolysis
Stevens-Johnson syndrome/Toxic epidermal necrolysis have a _____ % overlap of epidermal detachment
Hard conical projection of keratin
Must always excise cutaneous horn due to the risk of _____.
Invasive squamous cell carcinoma at the base of the lesion
Histologically what is the difference between in-situ squamous cell carcinoma and invasive squamous cell carcinoma
In-situ squamous cell carcinoma confined to epidermis whereas invasive squamous cell carcinoma involves the dermis
Formation of excessive fibrous tissue repair following cutaneous trauma
Keloids and Hypertrophic scars
Difference between a hypertrophic scar and a keloid
- hypertrophic scar: remains within boarders of original wound site
- keloid: extends beyond the borders of the original wound site
An important distinction between squamous cell carcinoma and basal cell carcinomas is that squamous cell carcinoma origin is...
Identifiable dysplastic in situ lesion.
Basal cells >> dysplastic keratinocytes >>SCCIS >> SCC
Actinic keratosis, a premalignant lesion, has the potential to become malignant by transforming into _____.
In Situ Squamous Cell Carcinoma (Bowen's Disease)
Sun damaged skin that increases the chance of a premalignant lesion to progress into malignant one:
Which Fitzpatrick skin phototypes have a higher risk of chronic UV radiation?
I,II, and III
Describe the malignant progression of Actinic Keratosis to Squamous Cell Carcinoma
UV induced p53 tumor suppressor gene mutation leads to
1) Suppress skin's immune system
2) Induce melanocyte cell division & free radical production
3) Damage melanocyte DNA
Coarse sandpaper lesion diagnosed by palpation
Actinic Keratosis treatment
Liquid nitrogen cryotherapy
Other treatment: 5- fluorouracil, Imiquimod, NSAID: Diclofenac.
The formation of _____ suggests conversions of In situ to invasive squamous cell carcinoma
Dermatopathology of In Situ Squamous Cell Carcinoma
-Basement membrane intact
- Keratinocyte polymorphism
-Increased mitotic rate of cells
A rapidly growing benign pseudo-cancer epithelial tumor that mimic Squamous cell carcinoma
Clark's level of invasion I-V
2. Papillary dermis
3. Papillary-Reticular Dermis
4. Reticular dermis
5. Subcutaneous tissue
Measurements that indicate a higher potential for metastatic squamous cell carcinoma
Diamater >2 cm
Breslow's Depth > 4mm
Clark level IV and V
Chronic (10-15 yrs), non-healing wounds that are malignant degeneration to squamous cell carcinoma
Basal Cell Carcinoma have limited ability to metastasize because _______ do not disseminate w/ tumor cells into vessels required for tumor growth distant from initial site
Most common type of basal cell carcinoma
Basal cell carcinoma that is ill defined, translucent, morphea (hardened skin), scar like:
Basal Cell carcinoma that is pink/red scaly with a thread-like boarder and sometimes ulcerative, often seen in younger patients:
Superficial multicentric BCC
Oval shaped Basal Cell Carcinoma dark in colors with depressed center
Lesion the mimics basal cell carcinoma with telangiectasia that go around oil glands:
Autosomal dominant inheritance of multiple basal cell carcinomas by age 35 with palmoplantar pits, bifids ribs, macrocephaly
Gorlin Syndrome - Basal cell nevus syndrome
Type of biopsy used for basal cell carcinoma
Shave and punch
Curability rate of a patient is directly related to _____ in terms of melanomas
depth of invasion and size of lesion
Cell of origin in melanomas
Melanocytes that reside in the basal layer of the epidermis
Melanomas have an initial _____ growth phase followed by a ____ growth phase
Why is it important to catch melanomas during radial growth phase?
Still confined to epidermis - avascular tissue, will not metastasize
Common dermoscopic pattern in melanoma
Melanoma associated with genetic predisposition in non-Caucasian individuals not associated w/ UV accumulation often seen in the foot:
Acral Lentiginous Melanoma
Acral lentiginous melanoma of the nail are found in:
subungually to the nail matrix (location of melanocytes)
Hutchinson's sign in acral lentiginous melanoma
spread of pidmentation to epynicum proximal or lateral nail fold
What is the biopsy procedure of choice for longitudinal melanonychia?
Punch biopsy through the nail plate at the level of the matrix
Lesion that occurs following a arthropod bite (bug bite):
Non-pigmented tumor nodules
Melanoma that begins in the vertical growth phase that arises rapidly from normal skin presents as elevated thick plaque or dome shaped:
Slowest growing melanoma with a prolonged radial phase often occurring in older patients that presents with papules in lesions from radial to vertical growth:
Lentigo Maligna Melanoma
Treatment for lentigo maligna melanoma
-Excise 1 cm margin
- if lesion >1.0 mm in thickness/Clark's IV --> sentinel node biopsy
When is a sentinel lymph node biopsy performed?
Breslow depth >1.0 mm
How is Breslow depth measured?
Granular layer of epidermis to deepest portion of tumor
Signature Nevus or ugly duckling sign:
Melanoma often has a different pattern than the other nevi.
How to calculate sun protection factor:
amount of time to produce erythema on sun protected skin / amount of time to produce erythema on skin without sunscreen.
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