Studied by 10 people
What is another name for Acquired Melanocytic Nevi?
Nevo melanocytic nevus (moles)
What are the clinical features of Acquired Melanocytic Nevi?
Asx, well-circumscribed, pigmented macules, papules or nodules, can arise anywhere, can disappear, may itch during growth
What are the features of Junctional melanocytic NMN?
at the level of DEJ, macular or minimally raised, preserved skin markings, brown/black in color
What are the features of Compound melanocytic NMN?
DEJ and Intradermal, pigmented papules, tan/brown, smooth, dome-shaped or papillomatous
What are the features of Dermal melanocytic NMN?
grows or remains intradermal, gradual fibrosis, skin colored/speckled brown, papules are dome shaped/pedunculated, soft rubbery texture
When is a biopsy of a NMN indicated?
if any of the melanoma ABCDE criteria is met; concern for melanoma
What is another name for Atypical Nevi?
dysplastic nevi or atypical melanocytic nevi
What are Atypical Nevi?
benign acquired melanocytic nevi, precursor of malignant melanoma
What are the clinical features of Atypical Nevi?
> 5mm, asymmetrical, variegated color, prominent macular component, papular center (“fried egg”), w/ notched, irregular, or ill-defined borders
A family hx of FAMMM syndrome increases risk of developing what?
Atypical Nevi
How do you dx Atypical Nevi?
clinical, refer to derm, biopsy
When would you refer an Atypical Nevi to derm?
assymmetry, > 6mm, irregular borders, abnormal color
What is a Halo Melanocytic Nevus?
melanocytic nevus surround by a round/oval, symmetric , halo of depigmentation
What increases your risk of developing a Halo Melanocytic Nevus?
hx/Fmhx of vitiligo
What are the 4 stages of a Halo Melanocytic Nevus?
stage 1: pigmented nevus surrounded by a halo
stage 2: pink nevus surrounded by halo
stage 3: disappearance of nevus w/ circular area of depigmentation
stage 4: normal skin w/ repigmentation
Where do Halo Melanocytic Nevus typically appear?
back and trunk
What is a Blue Nevus?
benign proliferations of dendritic dermal melanocytes that actively produce melanin; tindle effect influences color
What are the clinical features of a Common Blue Nevus?
< 1 cm, firm, blue/black, sharply defined papule or nodule; found on dorsal hands and feet
What are the clinical features of a Cellular Blue Nevus?
> 1 cm, congential/acquired, elevated nodule or plaque, slightly irregular border; found on scalp, buttocks, sacrum, face
What is the tx for a Blue Nevus?
common: observe, typically benign
cellular: excised; may progress to melanoma
What is a Spitz Nevus?
uncommon melanocytic lesion composed of large epithelioid or spindled cells
What are the clinical features of a Spitz Nevus?
rapid initial growth, dome-shaped, reddish/brown/tan nodule or papule, symmetric, sharply circumscribed, 1-2 cm
Who is most likely to develop a Spitz Nevus?
children, adolescents, and young adults < 20
What would you see in the dermatoscopy of a Spitz Nevus?
starburst or globular pattern of pigmentation, prominent punctate or rounded blood vessels, regularly distributed dotted vascular pattern
What is a Becker Nevus?
common cutaneous hamartoma w/ epidermal or dermal elements
What are the clinical features of a Becker Nevus?
well-defined unilateral brown patch w/ sharply demarcated borders, macular w/ papular/verrucous surface, hypertrichosis
What is the tx for a Becker Nevus?
Laser therapy
Q-switch Nd:YAG
Pulse dye laser
Fractional laser resurfacing
What are vascular tumors?
neoplastic, grow independently, due to increased proliferation rates of endothelial and vascular cells
What are vascular malformations?
non-neoplastic structural abnormalitites, normal endothelial cell growth, includes capillary, lymphatic, venous, arteriovenous malformations
What is another name for Pyogenic Granuloma?
lobular capillary hemangioma
What is a Pyogenic Granuloma?
benign vascular tumor of the skin or mucous membranes
What are the clinical features of a Pyogenic Granuloma?
starts as small, red papule that grows rapidly, friable and bleeds, ± collarette scale at the base of the lesion
What would you see on a dermoscopy of a Pyogenic Granuloma?
pink homogenous papule w/ white septa
What is the tx for Pyogenic Granuloma?
topical
Imiquimod or Timolol
procedural
cryotherapy, laser, excision
avoid trauma
table salt
What is an Infantile Hemangioma?
most common vascular tumor characterized by a growth phase and an involution phase
What are clinical features of a superficial Infantile Hemangioma?
soft bright red papule or nodule
What are clinical features of a deep Infantile Hemangioma?
not visible to the naked eye; may cause proptosis, strabismus, decreased VA in compressing the optic nerve
What are clinical features of a mixed Infantile Hemangioma?
combination of superficial and deep components
What is the proliferative growth pattern of Infantile Hemangioma?
3-9 mo; rapid growth and enlargement during the first year
What is the involution growth of Infantile Hemangioma?
2-6 yr; regresses and completely resolves by age 4
What is the tx for Infantile Hemangioma?
1st line
uncomplicated: topical timolol
complicated: propranolol
2nd line
pulsed dye laser
excisional surgery
What is another name for a Cherry Angioma?
Campbell de Morgan spots
Who are more likely to get Cherry Angioma?
middle-age and older populations
What are the clinical features of a Cherry Angioma?
dome shaped, 1-4 mm red, purple, blue/black papule; may bleed w/ trauma
What would you see on the dermoscopy of a Cherry Angioma?
red, purple, or blue-black lagoons
What are the tx options for a Cherry Angioma?
electrocautery, laser therapy, shave excision, cryotherapy
What are the clinical features of a Port Wine Stain?
irregulary shaped, painless red or violaceous pathces, present at birth, never disappear spontaneously, blanchable, thicken and darken w/ age
What is a Port Wine Stain?
congenital low-flow vascular malformations of dermal capillaries and post-capillary venules; follows the trigeminal nerve
What syndromes are associated w/ a Port Wine Stain?
Sturge Weber Syndrome, Klippel-Trenaunay Syndrome, CLOVES syndrome
What is needed in diagnostic workup of a Port Wine Stain?
US w/ doppler & MRI
What is the tx for a Port Wine Stain?
Pulse Dye Laser
What is the classic triad for Sturge-Weber Syndrome?
facial port wine stain, leptomeningeal angiomatosis, ocular involvement
What is another name for a Spider Angioma?
spider naevus or spider telangiectasia
What are the clinical features of a Spider Angioma?
central red papule w/ fine red line that extend radially, solitary lesions, diascopy- radiating telangiectasisa blanch and centeral arteriole may pulsate
What are the clinical features of a Venous Lake?
dark blue/violaceous, Asx, soft papule, blanching w/ diascopy, bleed easily
What are Acrochordon?
skin tags
What are the clinical features of Acrochordon?
.1-1 cm soft flesh colored or tan/brown, round or oval, pedunculated lesions (polyp)
What can skin tags + Acanthosis nigrcans indicate?
insulin resistance is present (metabolic syndrome)
What is another name for a Dermatofibroma?
benign fibrous histiocytomas
What are the clinical features of a Dermatofibroma?
solitary, firm, mobile, hyperpigmented nodule, Asx, positive dimple or pinch sign; common on LE
What are the clinical features of a Seborrheic Keratosis?
well demarcated round lesions, dull verrucous surface, typical “stuck on appearance”, slow growing
What is a Seborrheic Keratosis?
common epidermal tumor caused by benign proliferation of immature keratinocytes
What would you see in a biopsy of a Seborrheic Keratosis?
well-demarcated proliferation of keratinocytes w/ characteristic small keratin-filled cysts
What is the most common benign soft-tissue neoplasm?
Lipomas
What must you remove in order to completely get rid of a lipoma and ensure it doesn’t grown back?
must remove the fibrous capsule it is enclosed in
What are the clinical features of a lipoma?
soft, painless subcutaneous nodule consisting of mature fat cells; can be round, oval, or multilobulated
What is a unique feature of angiolipomas?
vascular component that may be tender in cold ambient temperatures and with compression
What are the clinical features of an angiolipoma?
soft subcutaneous tumor of adipocytes and vessels; usually on chest and forearms, occurs in multiples, painful and tender
What are the clincial features of Sebaceous hyperplasia?
2-6 mm enlargement of sebaceous glands, umbilicated yellow/brown papules on the forehead, nose, and cheeks
What are the risk factors for developing Sebaceous Hyperplasia?
elderly, medications -cyclosporine
What are Calluses?
diffuse thickening of the outermost layer of the skin (stratum corneum) in response to repeated friction or pressure
What are corns?
occur at pressure points secondary to ill-fitting shoes, an underlying bony spur, or an abnormal gait; has a central core that is hyperkeratotic and painful
What are the clincial features of Calluses/Corns?
hyperkeratosis, skin ridges or “toe prints” are present w/in the hyperkeratosis
What is the tx for Calluses/Corns?
salicyclic acid plaster/ointment, better shoes, pumice stone, urea or lactic acid creams
What are hypertrophic scars?
do NOT extend beyond the margin of the original wound
What are keloids?
continuous growth and invasion into adjacent skin beyond the original wound
What is the pathophysiology behind Keloids and Hypertrophic scars?
dysregulation of would healing process, local tissue factors, pt related factors
What are the clinical features of Keloids?
disfiguring, painful/pruritc, recur after surgical excision, can form 1 mo-1 yr post injury, do NOT spontaneously regress
Where are keloids more common?
upper chest and back, shoulders, head and neck, ears
Where are Hypertrophic scars more common?
extensor surfaces
What are the clinical features of hypertrophic scars?
more common, usually form 6-8 wks post injury, plateau around 6 mo, regression may occur in 12-18 months
What is the tx for Keloids and Hypertrophic scars?
1st line
Silicone cream or gel
intralesional steroids (triamcinolone)
2nd line
intralesional 5-Fluorouracil
cryotherapy + laser + intralesional steroid
surgical excision + intralesional steroid
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