Lecture 10 Part 1

Podcast

Play an AI-generated podcast conversation about this lesson

Questions and Answers

What is a characteristic feature of Necrobiosis Lipoidica Diabeticorum (NLD)?

Large, yellow-brown, hard, shiny plaques (correct)

Small, sunken, soft, brown patches

Red to violaceous inflamed patches

Scaly, itchy lesions on the scalp

Which patient demographic is more likely to develop Diabetic Dermopathy (DD)?

Middle-aged adults

Young children

Pregnant women

Older patients with diabetes (correct)

What type of treatment is primarily used for active lesions of Necrobiosis Lipoidica Diabeticorum?

Oral antibiotics

Anticoagulants or agents to improve microcirculation

Topical antifungals

Intra-lesional and systemic steroids (correct)

What is the main cosmetic concern regarding Xanthelasma?

Their appearance on the face Signup and view all the answers

What happens to Diabetic Dermopathy lesions upon applying pressure?

The finger sinks slightly into the skin Signup and view all the answers

What is known about the relationship between glucose control and the development of NLD or DD?

No definitive relationship has been established Signup and view all the answers

Where do Necrobiosis Lipoidica Diabeticorum plaques typically occur?

Almost exclusively on the shins Signup and view all the answers

Why might it be important to check HbA1C levels in patients suspected of having NLD or DD?

To check for undiagnosed diabetes Signup and view all the answers

At what age do cherry angiomas typically begin to appear?

20s Signup and view all the answers

Which characteristic is NOT associated with cherry angiomas?

Easily removed with fingernail Signup and view all the answers

What is a common treatment option for seborrheic keratosis?

Electrocautery Signup and view all the answers

Seborrheic keratosis lesions primarily develop after which age?

30 Signup and view all the answers

Which feature is characteristic of chondrodermatitis nodularis helicis?

Tender papule on the ear Signup and view all the answers

What is the underlying cause of chondrodermatitis nodularis helicis?

Pressure from sleeping Signup and view all the answers

What does seborrheic keratosis commonly resemble?

Atypical nevus Signup and view all the answers

What is typically observed in the central area of a CNH lesion?

Hyperkeratosis Signup and view all the answers

What is the most locally destructive form of basal cell carcinoma (BCC)?

Morpheaform BCC Signup and view all the answers

Which of the following conditions is known to be more prevalent in immunosuppressed patients?

Squamous Cell Carcinoma (SCC) Signup and view all the answers

What is the primary focus of treatment for dermatoheliosis?

Aggressive use of sun protection Signup and view all the answers

Which characteristic is typical of SCC-in-situ, also known as Bowen's Disease?

Indolent plaques with sharp borders Signup and view all the answers

What is the main action of tretinoin in the treatment of dermatoheliosis?

Normalizing the maturation of epidermal keratinocytes Signup and view all the answers

What histological subtype of SCC is characterized by sudden growth followed by spontaneous regression?

Keratoacanthoma Signup and view all the answers

What is a common precursor lesion to squamous cell carcinoma (SCC)?

Actinic Keratosis Signup and view all the answers

What are the side effects experienced during the first week of tretinoin use?

Skin redness, dryness, and irritation Signup and view all the answers

What is the most common type of basal cell carcinoma?

Nodular BCC Signup and view all the answers

Which genetic alteration is most important in the pathogenesis of basal cell carcinoma?

PTCH gene dysregulation Signup and view all the answers

Which treatment method for dermatoheliosis is considered more effective than tretinoin?

Chemical peels Signup and view all the answers

Which type of SCC may present as a chronic ulcer arising in a scar?

Marjolin’s ulcer Signup and view all the answers

What characterizes rhinophyma?

It involves chronic enlargement of the nose skin. Signup and view all the answers

Which patient demographic is at a greater risk for developing squamous cell carcinoma (SCC)?

Organ transplant recipients Signup and view all the answers

What characteristic is typical of nodular basal cell carcinoma?

Pearly appearance and dome shape Signup and view all the answers

What clinical presentation is most common for superficial basal cell carcinomas?

Slightly pink, scaly patches Signup and view all the answers

What is a typical presentation of an invasive squamous cell carcinoma (SCC)?

Erythematous plaque with a dense scale Signup and view all the answers

What causes rhinophyma to develop in individuals?

Underlying rosacea condition Signup and view all the answers

What is the main treatment for rhinophyma?

Surgical removal of excess skin Signup and view all the answers

Which statement about basal cell carcinoma is correct?

The ratio of BCCs to squamous cell carcinomas is approximately 4:1. Signup and view all the answers

In Basal Cell Nevus Syndrome, what leads to the development of hundreds of BCCs?

Mutation in a single copy of the PTCH gene Signup and view all the answers

What is a common outcome of skin resurfacing treatments for dermatoheliosis?

Normal skin texture after complete healing Signup and view all the answers

What is a characteristic feature of morpheaform basal cell carcinoma?

Ill-defined firm plaques Signup and view all the answers

What is the most accepted surgical treatment for basal cell carcinomas?

Lesion excision Signup and view all the answers

What distinguishes invasive SCC from SCC-in-situ?

Invasive SCC invades through the basement membrane into the dermis. Signup and view all the answers

Which of the following is a primary genetic alteration associated with SCC?

Mutations in the p53 gene Signup and view all the answers

What is the primary cause of the damage leading to dermatoheliosis?

Ultraviolet radiation Signup and view all the answers

Which statement about the characteristics of dermatoheliosis is true?

It causes pigmentation abnormalities and altered texture. Signup and view all the answers

Why must more tissue be removed when treating SCC compared to BCC?

SCC borders are less obvious. Signup and view all the answers

Which lesions are considered high risk for metastasizing when it comes to SCC?

SCCs located on the lip and ear Signup and view all the answers

What is the relation between UVB and UVA in terms of skin damage?

UVB affects only the epidermis while UVA penetrates deeper. Signup and view all the answers

At what age is dermatoheliosis least likely to become apparent?

In individuals in their 20s Signup and view all the answers

Study Notes

Cherry Angiomas

Common in individuals over 60, but can appear as early as the 20s.
More noticeable in lightly pigmented patients.
Small, bright red papules.
Early lesions can be flat, while larger ones may reach 5mm in diameter.
Partially compressible, often bleeding easily if traumatized.
Occasionally hormone responsive, showing increased growth in high estrogen states (pregnancy, OCP use).
Do not typically require treatment but can be electrocauterized if needed.

Seborrheic Keratosis (SK)

Common lesions developing after age 30.
Can range from 1-2mm to 5-6cm in size.
Familial trait; one person can have many SKs.
Waxy, "verrucous" brown-to-black plaques or papules.
Often slightly scaly.
Usually located on the trunk, proximal extremities, and face.
Commonly removed with fingernails, but recurrence is possible.
May require a biopsy if unsure whether the lesion is an atypical nevus.
Does not usually require treatment, though can be removed with liquid nitrogen or electrocautery.

Chondrodermatitis Nodularis Helicis (CNH)

Common in older individuals (rare before age 50).
Tender papule on the helix of the ear.
Typically skin-colored, but can be red.
Often located on the ear the patient sleeps on.
Likely due to ischemia of the skin and cartilage from pressure.
Typically treated surgically; shaving the papule flat with the surrounding skin is often curative.

Basal Cell Carcinoma (BCC)

Most common skin cancer.
Related to sun exposure, more prevalent in those with higher exposure and fair skin.
Approximately 4 BCCs per 1 SCC.
Approximately 10 BCCs per 1 melanoma
Types:
- Nodular, dome-shaped with pearly appearance and visible telangiectasias (typically on the head/neck).
- Superficial, scaly patches/plaques (frequently on the trunk).
- Morpheaform/infiltrating, firm plaques with ill-defined borders (difficult to diagnose clinically).
Most important genetic alteration is dysfunction of the PTCH gene.
Often treated surgically.
Rarely metastasizes.

Squamous Cell Carcinoma (SCC)

Less common than BCCs.
Related to chronic sun exposure.
More common in immunosuppressed individuals and smokers.
Present as keratotic papules, plaques, or nodules with a dense, adherent scale.
Subtypes:
- SCC-in-situ (Bowen's disease): erythematous plaques with moderate scale, sharp borders.
- Invasive SCC: most common, presenting as plaque, papule/nodule, or ulcer.
- Keratoacanthoma (KA): rapidly growing, dome-shaped nodules that regress spontaneously in most cases.
Often treated with surgery.
Can metastasize, particularly in lesions on the lip, ears, and those arising in scars or chronic ulcers.

Dermatoheliosis

Skin aging due to sun exposure.
Characterized by wrinkling, altered pigmentation, and texture changes.
Can affect epidermis and dermis.
Damage is due to ultraviolet radiation, with UVB causing more epidermal damage and UVA causing more dermal damage.
Often treated with sun protection and topical products like tretinoin.

Rhinophyma

Chronic enlargement of the nose, typically in men over 50 with rosacea.
Lumpy, nodular appearance with enlarged pores.
Caused by sebaceous gland enlargement and skin fibrosis.
Treated surgically.

Necrobiosis Lipoidica Diabeticorum (NLD) and Diabetic Dermopathy (DD)

Skin conditions associated with diabetes.
NLD: large, yellow-brown, sharply bordered, hard plaques on the shins (often with inflamed borders).
DD: small, sunken, soft, brown patches on the shins that sink slightly when pressed.
Treatment is often focused on better glucose control.

Xanthelasma

Deposits of lipid within macrophages.
Yellow-white papules near the medial canthi of the eyes.
Often a cosmetic concern.
May indicate hyperlipidemia requiring treatment with a lipid profile checkup.

Eruptive Xanthomas (EX)

Small, yellow to pink papules, often on extensor areas, associated with high levels of triglycerides.
Treatment involves normalizing serum triglycerides typically with drug therapy (gemfibrozil, niacin or statins).

Xerosis (Dry Skin)

Skin condition, becoming more common with age and frequently in winters.
Often itchy and can be a severe inconvenience, particularly in the elderly.
Treatment usually focuses on moisturizing approaches.

Studying That Suits You

Use AI to generate personalized quizzes and flashcards to suit your learning preferences.

Description

This quiz covers the characteristics and treatment options for cherry angiomas and seborrheic keratosis. Learn about the common appearance, demographics, and management of these skin lesions typically observed in adults. Assess your knowledge about their developmental traits, size variations, and clinical implications.