Lecture 10 Part 1

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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?

<p>Their appearance on the face (D)</p> Signup and view all the answers

What happens to Diabetic Dermopathy lesions upon applying pressure?

<p>The finger sinks slightly into the skin (D)</p> Signup and view all the answers

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

<p>No definitive relationship has been established (B)</p> Signup and view all the answers

Where do Necrobiosis Lipoidica Diabeticorum plaques typically occur?

<p>Almost exclusively on the shins (C)</p> Signup and view all the answers

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

<p>To check for undiagnosed diabetes (D)</p> Signup and view all the answers

At what age do cherry angiomas typically begin to appear?

<p>20s (C)</p> Signup and view all the answers

Which characteristic is NOT associated with cherry angiomas?

<p>Easily removed with fingernail (C)</p> Signup and view all the answers

What is a common treatment option for seborrheic keratosis?

<p>Electrocautery (C)</p> Signup and view all the answers

Seborrheic keratosis lesions primarily develop after which age?

<p>30 (A)</p> Signup and view all the answers

Which feature is characteristic of chondrodermatitis nodularis helicis?

<p>Tender papule on the ear (A)</p> Signup and view all the answers

What is the underlying cause of chondrodermatitis nodularis helicis?

<p>Pressure from sleeping (D)</p> Signup and view all the answers

What does seborrheic keratosis commonly resemble?

<p>Atypical nevus (B)</p> Signup and view all the answers

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

<p>Hyperkeratosis (B)</p> Signup and view all the answers

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

<p>Morpheaform BCC (C)</p> Signup and view all the answers

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

<p>Squamous Cell Carcinoma (SCC) (C)</p> Signup and view all the answers

What is the primary focus of treatment for dermatoheliosis?

<p>Aggressive use of sun protection (D)</p> Signup and view all the answers

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

<p>Indolent plaques with sharp borders (C)</p> Signup and view all the answers

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

<p>Normalizing the maturation of epidermal keratinocytes (C)</p> Signup and view all the answers

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

<p>Keratoacanthoma (C)</p> Signup and view all the answers

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

<p>Actinic Keratosis (D)</p> Signup and view all the answers

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

<p>Skin redness, dryness, and irritation (D)</p> Signup and view all the answers

What is the most common type of basal cell carcinoma?

<p>Nodular BCC (B)</p> Signup and view all the answers

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

<p>PTCH gene dysregulation (C)</p> Signup and view all the answers

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

<p>Chemical peels (B)</p> Signup and view all the answers

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

<p>Marjolin’s ulcer (B)</p> Signup and view all the answers

What characterizes rhinophyma?

<p>It involves chronic enlargement of the nose skin. (B)</p> Signup and view all the answers

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

<p>Organ transplant recipients (D)</p> Signup and view all the answers

What characteristic is typical of nodular basal cell carcinoma?

<p>Pearly appearance and dome shape (C)</p> Signup and view all the answers

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

<p>Slightly pink, scaly patches (B)</p> Signup and view all the answers

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

<p>Erythematous plaque with a dense scale (A)</p> Signup and view all the answers

What causes rhinophyma to develop in individuals?

<p>Underlying rosacea condition (B)</p> Signup and view all the answers

What is the main treatment for rhinophyma?

<p>Surgical removal of excess skin (D)</p> Signup and view all the answers

Which statement about basal cell carcinoma is correct?

<p>The ratio of BCCs to squamous cell carcinomas is approximately 4:1. (B)</p> Signup and view all the answers

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

<p>Mutation in a single copy of the PTCH gene (B)</p> Signup and view all the answers

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

<p>Normal skin texture after complete healing (B)</p> Signup and view all the answers

What is a characteristic feature of morpheaform basal cell carcinoma?

<p>Ill-defined firm plaques (C)</p> Signup and view all the answers

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

<p>Lesion excision (A)</p> Signup and view all the answers

What distinguishes invasive SCC from SCC-in-situ?

<p>Invasive SCC invades through the basement membrane into the dermis. (C)</p> Signup and view all the answers

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

<p>Mutations in the p53 gene (B)</p> Signup and view all the answers

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

<p>Ultraviolet radiation (B)</p> Signup and view all the answers

Which statement about the characteristics of dermatoheliosis is true?

<p>It causes pigmentation abnormalities and altered texture. (A)</p> Signup and view all the answers

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

<p>SCC borders are less obvious. (A)</p> Signup and view all the answers

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

<p>SCCs located on the lip and ear (B)</p> Signup and view all the answers

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

<p>UVB affects only the epidermis while UVA penetrates deeper. (C)</p> Signup and view all the answers

At what age is dermatoheliosis least likely to become apparent?

<p>In individuals in their 20s (A)</p> Signup and view all the answers

Flashcards

Nodular Basal Cell Carcinoma (BCC)

A common skin cancer characterized by a pearly appearance, dome-shaped structure, and sharp borders. Often found on sun-exposed areas like the head and neck.

Superficial Basal Cell Carcinoma (BCC)

A less common type of BCC appearing as flat, scaly patches or plaques. Usually found on the trunk.

Basal Cell Carcinoma (BCC)

The most common type of skin cancer, often linked to sun exposure.

Cyst-like Nodular Hyperplasia (CNH)

A common skin condition that often resembles BCC but is less severe.

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PTCH Gene

A gene whose dysfunction plays a crucial role in the development of BCC. Its product, 'patched', normally deactivates a protein called 'smoothened'.

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Basal Cell Nevus Syndrome

A genetic disorder characterized by the development of numerous BCCs throughout the body.

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p53 Gene

A tumor suppressor gene, mutations in which are common in sporadic BCCs.

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Morpheaform BCC

A type of BCC that can be difficult to diagnose clinically due to its ill-defined borders.

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Cherry Angiomas

Small, bright red papules that are often found on the skin of people over 60. They are usually harmless and do not require treatment.

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Seborrheic Keratosis (SK)

Common skin lesions that appear as waxy, brown-to-black plaques or papules. They are mostly found on the trunk, arms, and face and typically appear after age 30.

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Chondrodermatitis Nodularis Helicis (CNH)

A painful nodule appearing on the outer rim of the ear (helix), often seen in those over 50.

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What are cherry angiomas caused by?

Condition in which blood vessels proliferate in the skin, resulting in the characteristic small, red bumps.

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What is one characteristic of seborrheic keratoses?

They are often a familial trait, meaning they tend to run in families.

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How are seborrheic keratoses treated?

They are harmless and don't require treatment. They can be removed using liquid nitrogen, or by scraping them off with electrocautery.

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What is the likely cause of Chondrodermatitis Nodularis Helicis (CNH)?

CNH usually occurs on the ear that the patient sleeps on. This is because of pressure and irritation from sleeping.

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How is Chondrodermatitis Nodularis Helicis (CNH) treated?

CNH is often treated by surgically shaving the papule flat with the surrounding skin.

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Dermatoheliosis Treatment

The most effective treatment for Dermatoheliosis (sun damage) focuses on preventing further damage by rigorously using sun protection.

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Tretinoin for Dermatoheliosis

Tretinoin is a topical medication used to treat Dermatoheliosis. It works by regulating the growth of skin cells, reducing wrinkles, and potentially lowering the risk of skin cancer.

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Tretinoin Side Effects

Tretinoin can cause side effects like redness, dryness, and irritation. These side effects are usually temporary and decrease after several months of use.

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Skin Resurfacing for Dermatoheliosis

Skin resurfacing techniques like lasers, peels, and dermabrasion are more effective treatments than Tretinoin for Dermatoheliosis but are also more risky, expensive, and painful.

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Rhinophyma

Rhinophyma is a condition characterized by chronic enlargement of the nose, mainly due to enlarged sebaceous glands and skin fibrosis.

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Rhinophyma Occurrence

Rhinophyma typically occurs in men over 50 years old and ONLY in patients with rosacea. It may be related to the repeated flushing associated with rosacea.

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Rhinophyma Treatment

The only effective treatment for Rhinophyma is surgical removal of the excess skin.

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Rosacea

Rosacea is a common skin disorder that causes redness, bumps, and visible blood vessels on the face. Rhinophyma is a severe form of rosacea.

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Actinic Keratosis (AK)

A precancerous skin lesion characterized by abnormal keratinocyte growth in the deeper layers of the epidermis. It's a precursor to squamous cell carcinoma (SCC).

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Squamous Cell Carcinoma (SCC)

A type of skin cancer that originates from the epidermis. It's slower growing than melanoma but can metastasize (spread).

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p53 gene mutation

The most common genetic alteration found in both AKs and SCCs. It's a gene involved in cell growth and repair.

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Dermatoheliosis

The process of skin aging caused primarily by sun exposure. It manifests as wrinkles, pigmentation changes, texture alterations, and increased risk of skin cancer.

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Ultraviolet (UV) radiation

UV radiation that reaches the earth after passing through the ozone layer. It's responsible for skin damage and tanning.

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Ultraviolet A (UVA)

A type of UV radiation that can penetrate into the dermis. It contributes to the deeper damage associated with dermatoheliosis.

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Ultraviolet B (UVB)

A type of UV radiation that is predominantly absorbed by the epidermis. It primarily causes sunburn and superficial skin damage.

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Wrinkles

A key characteristic of dermatoheliosis resulting from alterations in dermal collagen. They are a sign of skin aging and sun damage.

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SCC-in-situ

A type of SCC that remains confined to the epidermis and does not invade deeper tissues. It is typically slow-growing and can stay in-situ for years.

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Erythroplasia of Queyrat

A specific type of SCC-in-situ that occurs on the penis. It has a higher risk of becoming invasive than other forms of SCC-in-situ.

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Invasive SCC

The most common type of SCC, where the tumor cells have invaded deeper layers of the skin.

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Keratoacanthoma (KA)

A type of SCC that grows rapidly in the form of a dome-shaped nodule. Most KAs will spontaneously regress.

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Marjolin's Ulcer

A chronic ulcer that develops in a scar, often as a result of SCC. It can be a sign of SCC in the scar tissue.

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Actinic Keratoses

Precancerous lesions that can develop into SCC. They are often characterized by rough, scaly patches on the skin.

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What is Necrobiosis Lipoidica Diabeticorum (NLD)?

A rare skin condition that appears as yellow-brown, hard, shiny plaques, mainly on the shins, and is associated with diabetes.

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What is Diabetic Dermopathy (DD)?

A common skin condition that appears as small brown patches, mainly on the shins, and is linked to diabetes.

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What is the link between NLD and DD and diabetes?

Both occur mainly in people with diabetes, but can also occur in those without diabetes.

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How does NLD affect the skin?

It involves damage to the skin's collagen due to poor blood flow, leading to inflammation.

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How does DD affect the skin?

It involves damage to the skin due to poor blood flow, but without significant inflammation.

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What are xanthelasma?

They are raised, yellow-white deposits of fat in the skin near the inner corners of the eyes.

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What is the link between xanthelasma and high cholesterol?

Xanthelasma are often associated with high cholesterol levels.

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How are xanthelasma treated?

They can be surgically removed for cosmetic reasons.

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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.

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