Skin Cancer and Neoplasms Quiz

Inflammatory Reactions of the Skin

• Psoriasis: A chronic, non-contagious, inflammatory autoimmune disease characterized by hyper-proliferation of skin cells.
  • Etiology: Autoimmune, idiopathic in origin, possibly related to genetics, smoking, obesity, alcohol use, and infections (bacterial and viral).
  • Epidemiology: More common in certain age ranges, with increased prevalence in Caucasians.
  • Signs & Symptoms: Erythematous papules and plaques covered with silvery scales, extremely pruritic (itchy). Auspitz's sign (punctate bleeding upon scraping) and Koebner phenomenon (new psoriasis at sites of skin trauma) are commonly observed. Scalp, extensor surfaces of elbows and knees, back, chest, groin, and armpits are common affected areas.
  • Common Comorbidities: Psoriatic arthritis (5-30% of psoriasis patients; characterized by joint pain, stiffness, swelling, and tenderness). Nail bed involvement (pitting, discoloration, separation) is common in 1/3 of psoriasis cases.
  • Diagnosis: Clinical examination, skin biopsy (for ambiguous cases).
  • Treatment: Topical corticosteroids, over-the-counter moisturizers, controlled UV light/sunbathing (avoid overexposure to prevent skin cancer), antihistamines for pruritus. Massage is a local contraindication if broken skin is present, otherwise light massage can be applied.
• Rosacea: A chronic, progressive, inflammatory skin condition causing facial redness.
  • Etiology: Idiopathic, possibly related to genetics and/or an overactive immune system.
  • Epidemiology: Most common in individuals aged 30-50, more prevalent in females and those with fair complexions.
  • Signs & Symptoms: Persistent facial erythema, dryness, warmth, swelling, and tiny pustules. Telangiectasia (spider veins) and thickened skin can develop. Rhinophyma (erythematous, bulbous nose) is a possible complication from sebaceous gland hypertrophy. Facial redness is often the primary manifestation.
  • Rosacea Phases:
    • Phase I: Pre-rosacea phase (redness).
    • Phase II: Vascular stage (spider veins).
    • Phase III: Inflammatory phase (acne).
    • Phase IV: Late stage (rhinophyma).
  • Treatment: Avoid triggers (e.g., sunlight, strenuous exercise, extreme temperatures, spicy foods, alcohol), topical antibiotics for the inflammatory phase. No cure exists.
  • Prognosis: Potential for migraines, and link with IBD, celiac disease, and SIBO/IBS. Massage may be contraindicated depending on severity and areas, avoiding pus-containing areas.
• Hidradenitis Suppurativa: A chronic, scarring, inflammatory process akin to acne; primarily affects axillae, groin, and around nipples and anus.
  • Etiology: Idiopathic; likely related to blocked hair follicles, possible connections to hormones, genetics, smoking, or excess weight.
  • Symptoms: Small, painful nodules under the skin that ultimately drain pus. Chronic cases can form cord-like fibrotic bands and produce a foul odor. Absence of pruritus.
  • Treatment & Prognosis: Topical antibiotics, steroids, warm compresses, surgical excision (for severe cases), laser hair removal; recurrence and scarring are typical outcomes. Massage is a local contraindication over any pustules
  • Prognosis: Often leads to significant scarring.

Drug Eruptions and Reactions

• Erythema Multiforme: An inflammatory reaction (type IV hypersensitivity) characterized by target-shaped skin lesions, and oral mucosa involvement, possibly triggered by drugs or infections (particularly herpes simplex virus).
  • Signs & Symptoms: Mildly itchy, symmetrically distributed patches of red, raised skin with target-like lesions, blistering, and mucous membrane involvement. Systemic symptoms like fatigue, joint pain, and fever can occur.
  • Treatment: Self-limiting condition (2-4 weeks). Antivirals may be given if HSV is the cause. Massage contraindicated while lesions are present.
• Stevens-Johnson Syndrome (SJS): A life-threatening hypersensitivity reaction (type IV) causing separation of the dermis from the epidermis (necrosis) with mucous membrane involvement.
  • Etiology: Primarily caused by medications (sulfa drugs most common) or infections.
  • Symptoms: Severe blistering, pain in mouth/eyes and during eating, drooling, difficulty swallowing. Possible systemic symptoms (fever, fatigue, sore throat).
  • Treatment: Supportive care (analgesics, IV fluids, nutritional support). Massage is a contraindication until lesions have fully healed.
• Urticaria (Hives): An inflammatory disorder usually associated with allergic reactions (type I hypersensitivity).
  • Etiology: Allergen triggers a histamine-mediated response. Triggers include medications, insect bites, foods, and idiopathic cases.
  • Signs & Symptoms: Itching followed by wheals and flare response. Wheals are small, smooth, elevated skin lesions; flares are the surrounding redness. Severe cases can include angioedema (edema of deeper tissues) which could be life-threatening if affecting the mouth or throat.
  • Treatment: Oral antihistamines, topical corticosteroids. Monitor for lesions around the mouth. EpiPen for anaphylaxis (life-threatening reaction). Massage is contraindicated during acute episodes and if skin is broken.
• Decubitus Ulcers (Bed Sores/Pressure Sores): Breakdown of skin integrity due to prolonged pressure and decreased blood flow.
  • Etiology: Prolonged pressure on skin, reduced blood flow. Causes include immobility (bedridden, wheelchair-bound), paralysis, coma, and diabetes.
  • Stages:
    • Stage I: Non-blanchable erythema (redness) of intact skin.
    • Stage II: Partial thickness skin loss.
    • Stage III: Full-thickness skin loss, down to, but not including, muscle.
    • Stage IV: Full-thickness skin loss with muscle or bone exposure.
  • Treatment: Repositioning, wound care, antibiotics (to avoid infection). Massage is a local contraindication over ulcers of any stage, particularly if infected.
• Dermatitis: Superficial inflammation of skin, often presenting with pruritus, redness, edema, oozing, crusting, and scaling. Divided into acute, subacute, and chronic types.

Dermatitides: Specific Types

• Atopic Dermatitis (Eczema): Chronic, itchy inflammation of skin, often linked to genetics and a predisposition to allergies (asthma and rhinitis). Triggers include food/environmental allergies, emotional stress, humidity, clothing friction. Common on flexor surfaces.
  • Treatment: Identifying and avoiding triggers, OTC moisturizers, topical corticosteroids. Massage is a local contraindication if broken skin is present; caution and client consent is required for intact skin.
• Primary Irritant Contact Dermatitis: Inflammation due to direct contact with an irritant (not an allergic reaction). Causes include cleaning products, chemicals, dyes, metals in jewelry.
  • Treatment: Removing irritant, antihistamines, corticosteroids. Massage is a local contraindication.
• Allergic Contact Dermatitis: Type IV hypersensitivity reaction due to contact with allergens. Triggers include cosmetics, metals (nickel), plants (poison ivy), and various chemicals.
  • Treatment: Avoiding allergen, antihistamines, topical or oral corticosteroids. Massage a local contraindication
• Phototoxic Dermatitis: Cutaneous reaction within minutes to hours of sun exposure. Underlying drug or topical substance triggers over-exposure to UV light, resulting in inflammation.
  • Treatment: Avoiding exposure, and any substance or chemical/topical causing the interaction with the radiation. Massage a local contraindication.
• Photoallergic Dermatitis: Type IV hypersensitivity reaction 1-3 days after sun exposure. Light absorption alters an agent and allows it to bind to tissue proteins, becoming antigens.
  • Treatment: Avoiding triggering agents. Massage a local contraindication.
• Stasis Dermatitis: Inflammation of lower legs due to chronic venous insufficiency (venous fluid pooling). Causes include deep vein thrombosis (DVTs), varicose veins, obesity, pregnancy, lack of activity, and smoking.
  • Treatment: Addressing underlying cause; massage is a local contraindication, especially over ulcers as avoiding clots is important.
• Neurodermatitis (Localized Scratch Dermatitis/Lichen Simplex Chronicus): Chronic, itchy inflammation leading to skin thickening, likely linked to psychological factors such as anxiety. A vicious scratch-itch cycle often develops.
  • Treatment: Manage underlying psychological issues, patient education (regarding scratching), topical corticosteroids, antihistamines. Massage is a local contraindication.
• Seborrheic Dermatitis: Chronic inflammatory condition in areas with sebaceous glands. Possibly linked to yeast (Malassezia Furfur), immune system weaknesses, stress, and climate.
  • Treatment: Anti-inflammatory shampoos and topical antifungals. Massage is possible in this case.
• Perioral Dermatitis: Inflammation around the mouth, potentially misdiagnosed as acne or rosacea; often linked to topical steroid use.
  • Treatment: Removing potential triggers, antibiotics, and anti-inflammatory creams. Massage is possible, but sensitivity should first be checked.

Neoplasms of the Skin

• Melanocytic Nevi (Moles): Benign skin growths; atypical or dysplastic moles can be concerning (ABCDEs of moles).
• Malignant Melanoma: Highly dangerous. UV exposure is a common cause. Early detection is crucial for a high survival rate.
• Basal Cell Carcinoma (BCC): Most common skin cancer; rarely metastasizes. Typically appears as a pearly, translucent nodule.
• Basosquamous Carcinoma (BSC): Rare, aggressive cancer resembling a mutated BCC.
• Sebaceous Neoplasms: Mostly benign; some can be malignant.
• Cutaneous Papilloma (Skin Tags): Extremely common, benign growths in areas where skin rubs together.
  • Treatment: Surgery for certain types. Massage is a local contraindication.

Ichthyosis:

• A group of over 30 genetic conditions with similar presentations (red, itchy, flaky skin).
  • Treatment: Hydrating creams tailored to the specific type. Massage is not contraindicated but skin sensitivity should be assessed.

Test your knowledge on skin cancer types and their characteristics with this quiz. Questions cover malignant melanoma, basal cell carcinoma, and common skin growths. Perfect for students and professionals in dermatology or health sciences.