-
seborrheic keratosis
- stuck-on, warty, crust
- very variable appearance
- benign
-
why do people confuse SK with skin cancer
- because it changes...it starts out skin color, then gets darker then crustier.
- it is benign
-
where does SK mostly happen
- lower legs, feet
- it is benign
-
acrochordon
- skin tags, skin folds, high friction, snip cryo dessication
- it is benign
-
dermatofibroma
- dimple sign
- circular
- legs
- from shaving
- excision
- benign
-
chavus
- corn.
- specially shaped callus of dead skin
- benign
-
long name for pink-red papule on helical ear cartilage than can mimic SCC and BCC
- chondrodermatitis nodularis helicis
- (cartilage skin nodule helix)
- benign
-
treatment chondrodermatitis nodularis helicis
- relieve pressure, inject kenalog, excision, C&D
- benign
-
epidermal cyst
- subQ keratin filled cyst hair follicle
- central punctum like open comedone
- benign
-
where epidermal cyst?
- trunk, posterior neck, postauricular
- benign
-
what is the one thing about epidermal cysts that is easy to remember
they are STINKY inside
-
pilar cyst, patients will sometimes call it a
-
where are pilar cysts?
- scalp. develops from hair follicle
- no punctum!
- i think these are dad's
- family inheritance, multiple, after puberty
- benign
-
sebaceous hyperplasia
- enlargement of sebaceous gland on FACE
- forehead nose cheeks
- umbilicated
- benign
-
sebaceous hyperplasia treatment
-
hemangiomas of infancy
- red-blue-purple in year one
- girls more than boys
- head neck more than others
- usually one
- one in year one
- benign
-
treatment hemangiomas of infancy
- laser, roids, excise, aldara (offlabel) propanolol (off label)
- benign
-
angiokeratoma 4 kinds--most common one is
- angiokeratoma of Fordyce
- scrotum, vulva
- [they look like purple angiomas]
- benign
-
pyogenic granuloma also called
lobular capillary hemangioma
-
pyogenic granuloma what do they DO
- grow rapidly and bleed easily
- looks like the indian dot
- benign
-
pyogenic granuloma recurs especially in these people
-
lipoma and ages
- soft movable
- painless
- 40-60 yrs
- benign
-
-
solar lentigo also called
-
solar lentigo appearance and how/when
- tan brown
- associated with agina
- 40+ yrs
- increased number of melanocytes and melanin
- benign
-
junctional nevus
flat mole, benign
-
compound nevus
- what people usually think of as moles
- squishy brown or flesh
- benign
-
intradermal nevus
- firmer, slightly elevated, can't wiggle it
- benign
-
nevus spilus
- birthmark, grows with you
- benign
-
blue nevus
- "tricky"
- these can be flat or papule
- bluish black symmetrical
- benign
-
spitz nevus
- could be precursor, do clear margins
- benign
-
halo nevus
- white ring around it that doesn't tan
- you can leave the halo
- if the mole looks normal, you can just watch it
- benign
-
recurrent nevus
- if you've had one removed and it starts coming back
- if benign? leave it
- if you think precancerous, you need to go back and take more out
-
actinic keratosis
- pre-malignant
- sun exposed areas
- treat all as SCC
- 40yrs+ (or younger if sun)
-
actinic keratosis treatments
- cryo
- efudex
- imiquimod
- levulan/blue light (less irritating than efudex)
-
Bowen's disease
- squamous cell carcinoma (SCC) in situ
- superficial variant of SCC
- pre-malignant
-
bowen's disease (SCC in situ) causes
- sun
- radiation/chemicals
- hpv
-
bowen's disease appearance
faint inflammation, raised, red plaque, dry appearance
-
bowen's disease looks like
wart. crustier and wartier looking eczema
-
erythroplasia of Queyrat (SCC in situ)
Bowen's disease of the penis, under foreskin
-
Bowen's disease of the penis (under the foreskin)
Erythroplasia of Queyrat (SCC in situ)
-
nevus sebaceous
- premalignant
- usually on head/scalp
- linear-oval yellow-flesh colored plaque
- 3 stages
- tx: excision
-
nevus sebaceous 3 stages
- 1. childhood, barely noted, velvety, no sx
- 2. puberty, more verrucous-like, sxs possible
- 3. adulthood, 20% neoplastic changes--7% can turn into BCC
- TREATMENT EXCISION
- pre-malignant
-
nevus sebaceous appearance
- orangey yellowish irregular plaque
- scalp
-
atypical nevi syndrome (ANS)
- multiple clinically atypical moles, increased risk melanoma
- moles continue to form into adulthood
-
most with atypical nevi syndrome (ANS) have more than this many moles
more than 50
-
atypical nevi:
- larger
- border irregular
- color variation
- surface irregular
-
ABCDE skin lesions
- A asymmetry, fold in half
- B borders notching or irregular
- C more than one color
- D diameter bigger than pencil eraser
-
-
BCC most common type of malignancy
- over 40 yrs
- only sun exposed areas
- mets rare
- fair skin and sun exposure before 14 yrs
(mom)
-
BCC appearance
- pink/red shiny pearly papule with superficial telangiectasias
- rolled translucent borders
- ulcerated center
- firm to palpation
- non healing
-
BCC treatments
- complete excision with primary closure
- MOHS
- C&D
-
SCC
squamous cell carcinoma
-
-
SCC risk
outdoor occupations, industrial, HPV, arsenic ingestion
-
keratocanthoma
- variant of SCC
- volcano/crater-like
-
SCC treatments
- complete excision with primary closure
- MOHS
- C&D
-
-
malignant melanoma
- 4% of all skin CA
- #1 25-29yrs, #2 30-35yrs
-
who's at risk for MM: MMRISK
- MMRISK
- M atypical nevi more than 5-10
- M moles more than 50 on the body
- R red hair and freckling
- I inability to tan
- S severe sunburns before 14 yrs
- K kindred (any 1st degree relative with melanoma)
-
ABCDE
- Asymmetry
- Borders
- Color
- Diameter
- *Evolution
-
how to bx MM
take punches in different places, one from lighter, one from darker, for example
-
MM: superficial spreading MM, most common
- laterally before vertical growth
- trunk/extremities
- whites, females
-
2. nodular MM
- grows vertically
- extremities
- raised
-
3. lentigo maligna
laterally in epidermis but if left untreated can grow into dermis and becomes LMM lentigo maligna melanoma
-
4. acral lentiginous melanoma
- dark skinned people
- palms, soles, subungual
-
Amelanotic MM
- non pigmented melanoma
- bx and tx often delayed because it appears innocent
-
treatments for MM
- wide excition with 1cm margin
- 2cm margin for bigger
Stage 1B and II: sentinel node bx
upper stages--high dose interferon-2a (chemo)
-
CTCL cutaneous T cell lymphoma aka MF mycosis fungoides
helper T cell lymphoma
-
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