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Acrochordon [pic] [dermis]tags of redundant skin in armpits, neck, groin / common in fat people / Treatment: scissors Hemangiomas (mostly benign) [pic] [dermis] Cherry small, red papules on trunks of over 30 yr olds Strawberry congenital, neonatal / may grow to huge size / often regress spontaneously Nevus flammeous macular, red-purple lesion / congenital or neonatal / some regress spontaneously, (port wine stain) persistent ones may be treated with laser therapy [dermis] Spider angioma common in females, estrogen therapy, liver disease / can be zapped with laser [pic][dermis] Pyogenic granuloma granulation tissue / weeping, red, juicy nodules [pic] / fingers, mouth / common in pregnancy / grows rapidly / resection [dermis] Kaposi’s sarcoma (malignant) purplish/blue dermal plaques (violaceous plaques) /oval nodules [pic] / common in AIDS patients (more aggressive) affecting various organs (skin, lungs, GI tract) Pathology: may not be obvious to detect / endothelial cell proliferation (spindle cells), vascularity CXR: peribronchiolar cuffing, patchy infiltrates, effusions Note: do not forget that these can cause internal organ damage with NO skin findings Treatment: radiotherapy or vinblastine in non-AIDS patients Other Dermal Business Sweet’s Syndrome (Acute Febrile Neutrophilic Dermatosis) [pic][dermis] Neutrophilic inflammatory disease, red/juicy plaques/nodules/bullae on face/extremities Biopsy: neutrophils in dermis (not vasculitis) / neutrophilia, fever Exhibits pathergy – not only contiguous, but if you do sterile pin-prick somewhere else on the skin, it should create a similar lesion Associations: AML, AMML, CML, CLL, acute lymphoblastic, hairy cell, myelodysplastic syndrome, multiple myeloma, solid tumor (rarely)
Like an ulcerated version of Sweet’s syndrome / solitary/multiple, inflammatory purple border, necrotic base Diagnosis: non-specific cultures and biopsy / diagnose by excluding bacterial/mycobacterial infection (must not confuse this with cellulitis) / pathergy trauma to lesions begets more lesions (i.e. DO NOT surgically debride lesions) Associations: IBD, arthritis, gammopathy, malignancy, hepatitis, biliary cirrhosis, SLE Treatment: steroids (systemic and intra-lesional), dapsone (or cyclosporin A, FK506), sulfapyridine, azulfidine Dermatofibrosarcoma protuberans (DFSP) [dermis] special kind of dermatofibroma / CD34 / requires Moh’s surgery Microcystic adenoid carcinoma (MAC) lips, local invasion, neuronal invasion / requires Moh’s surgery Sebaceous gland carcinoma (SGC) requires Moh’s surgery Melanocytic tumors Benign Melanocytic nevi junctional (brown), intradermal (raised, skin color), compound / may be congenital or acquired / more than 25 moles by age 20 years is marker for increased risk of melanoma (either from nevi in question or future nevi) [pic][pic] Ephelis (freckle) normal number of melanocytes, overproducing melanin / darken on exposure Solar lentigo brown macules from sun-exposure Lentigo simplex childhood / diffuse proliferation / NOT due to sun-exposure Cafe-au-lait spot brown macules [dermis] / more than 6 big ones correlated with neurofibromatosis Nevus spilus flat, tan patch with dark spots [dermis] / mistaken for melanoma (excised) Blue nevus so deep it looks blue Mongolian spot black babies’ bottoms (sacral regions) / resolve by age 3 yrs Spitz nevus pink [dermis] / young adults / looks like melanoma / benign course halo nevus children and adults / white halo around residual nevus [dermis] / lymphocytic infiltration Pre-malignant Lentigo maligna Hutchinson’s freckle / melanoma in situ / sun-damaged skin / elderly, blacks macule with notched border / epidermal atrophy, atypical melanocytes Treatment: excision
5% of skin CA / 3% of all CA / 50% mortality (different depending on stage) ⅓ arise from nevi, ⅔ de novo / incidence increasing (ozone depletion?)
Note: may not be pigmented (amelanotic melanoma) [pic] Treatment: wide excision [.5 to > 2-3 cm margins, based on size] Chemo/Adjuvant: IFN-a2B (Intron A) Aldesleukin (Proleukin) Temozolomide (Temodar) Dacarbazine (DTIC-Dome) Uninvolved nodal basin selective lymphadenectomy Get sentinel node – blue dye (given right at surgery) and colloid radioactive (given 1 hr pre-surgery) – false negative rate of only 5% (80% of which are actually positive using better histological stains and pathologists) SLN technique smaller incision, visual confirmation, rescan later, identifies in transit mets PCR has too many false positives but does detect all would be recurrences
most superficial Ddx: basal cell carcinoma, light skin color (especially people who have red hair), history of severe sunburn, porphyria cutanea tarda, Werner syndrome, tyrosine-positive oculocutaneous albinism, xeroderma pigmentosa Superficial spreading malignant melanoma - medium prognosis [dermis] most common / non sun-exposed regions Acral lentiginous melanoma - medium prognosis occurs distally (fingers and toes, near nails) / most common malignant melanoma in blacks Nodular melanoma - worst prognosis [dermis] solid nodule (no macular component), vertical growth [pic] Acne vulgaris [dermis] increased sebum, abnormal keratinization (comedome), bacteria produce FFA (inflammation), hormones (androgens promote, estrogens inhibit androgen production, some have increased androgen sensitivity) comedomes topical retinoids mild inflammatory topical or, if needed, oral antibiotics severe inflammatory oral antibiotics or, if needed, oral isoretinoin
oral antibiotics tetracycline, doxycycline, erythromycin, minocycline topical antibiotics clindamycin, erythromycin, sulfur, benzoyl peroxidase (water based less irritating than alcohol based) topical retinoids adapalene, tazarotene (in microsphere delivery system) oral isoretinoin (13-cis-retinoic acid or accutane) for recalcitrant nodulocystic acne / very teratogenic; no pregnancy at least 30 days after stopping / very expensive medication / monitor lab values during therapy other azaleic acid / acne surgery / intralesional triamcinolone (100ul) / chemical peels (glycolic acid, trichloroacetic acid) Avoid: thick, oil based makeups / dial, safeguard 2-3 x day, consider oil-free acne wash or salac if comedomes present / agents that worsen acne: Dilantin, lithium, steroids, kelp (iodides), bromides / recommend normal diet
middle-aged, fair-skinned, sun-damaged areas / exacerbation by stress, alcohol, heat Presentation: central facial erythema, may have papules, pustules / clinical diagnosis but can be distinguished from SLE, DM with routine skin biopsy (rosacea will not have interface change) / may get rhinophyma [dermis] Treatment: avoid triggers / rapid cooling of oral cavity (e.g. ice) can abort flushing that follows drinking hot beverages / alcohol, caffeine, sun exposure, spicy food have been implicated but may vary on individual basis oral tetracycline, erythromycin, metronidazole (all effective) topical erythromycin, metronidazole Follicular occlusion triad (acne inversa, acne triad, tetrad)[dermis] acne conglobata [dermis], cellulitis of scalp, hidradenitis suppurativa Solar acne (Favre-Rachouchout) Neonatal acne Steroid acne Cutting oil acne Pomade acne (petroleum hygiene products) Gram negative folliculitis (see Pseudomonas) pustular lesions with line of demarcation, 8-48 hrs after soaking in hot tub or other Vesiculobullous skin diseases Bullous disease in diabetes SLE Download 3.95 Mb. Share with your friends:
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