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Benign and Malignant Skin Tumors
Study Guide
31
Science
Graduate
01/20/2015

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Term
Seborrheic Keratosis
Definition
benign plaques of epidermis, beige to brown/black; 3-20 mm; velvety or warty; non-cancerous growths of the epidermis; are rapidly growing skin cells that mix with oil and produce a raised (papule or plaque )
  1. Stuck or pasted onto skin; scale; m/c chest or back
  2. Extremely common, esp. elderly
  3. May resemble melanoma
  4. Generally asx
  5. Tx only if bothersome (liquid N, curettage, shave bx)
Term
Skin Tags
Definition
  • AKA polyp
  • Overgrowth of skin cells
  • Genetically related
  • Are very common.  Affect 25 % of population
  • Found in skin folds such as neck
  • Commonly seen in overweight individuals
Term
Skin Tags: Signs and Symptoms
Definition

  • Soft, skin colored, brown or tan, round, pedunculated papule
  • Constricted at base
  • Asymptomatic, unless it gets caught on clothes or jewelry
  • Most common on neck
  • Commonly seen in intertriginous(fold) areas
Term
Skin Tags: Treatment
Definition
  • Scissor Excision
  • Cryosurgery
  • Electrodessication - burning the base, to kill the blood supply
  • No treatment is necessary.  Only if becomes a problem for patient
Term
Dermatofibromas
Definition
  • Scar tissue
  • Very common, hard round pink or brown nodule,  usually occurring on the extremities
    • Been there for many years
  • “Dimple Sign” - push the sides together will cause an indentation in the middle
    • Scar tissue is deeper than what you see
  • Probably caused by minor trauma or bug bite or shaving
    • But not sure about exact cause
  • Women> Men
  • May be tender
  • Pts are worried about these!
    • Looks different than others but not a big deal
Term
Dermatofibromas: Diagnosis & Treatment
Definition

 

  • Physical Exam
    • Discrete, firm, pink papules
    • Look for dimpling or puckering of the lesion  
    • Has persisted for many years without change
  • Treatment
    • Kenalog injections (steroids) - ?
    • Shave biopsy - ?
    • Full excision
Term
Lipomas
Definition
  • Benign neoplasm of fat cells  
  • Are generally asymptomatic
    • Unless develops around nerve root
  • Round, moveable and soft
  • May sometimes occur in area of constant irritation (ie belt line)
  • Complete excision if becomes bothersome
    • Large , so when removed will see indent
  • Lipoma vs Cyst
    • Lipomas are soft
    • Cyst will have a punctate and are hard
Term
Epidermal Inclusion Cysts
Definition
  • AKA Sebaceous cyst
  • Oil producing gland gets clogged and fills with sebum and keratin
  • May get infected or rupture
  • Round, hard, mobile papule, nodule
  • Overlying punctum
  • Malodorous  
Term
Epidermal Inclusion Cysts : Treatment
Definition
    • If the lesion is non inflamed
      • Do excision
      • I & D can lead to return of EIC
    • If inflamed
      • I & D
      • Intralesional steroid
    • Topical and Oral Antibiotics – if infected
Term
Actinic Keratosis
Definition
  • Single or multiple scaly lesions on sun exposed skin of adults
  • AKA pre skin cancers
  • Have potential to become Squamous cell carcinoma
Term
Actinic Keratosis: Signs and Symptoms
Definition
 
  • Generally appear on ears, nose, face, back of hands
  • Feel like sand paper
  • Pink scale
  • Some spots may be tender.
  • History is of scaly spot that comes and goes
  • If people have one, they will generally develop more.
Term
Actinic Keratosis: Treatment
Definition
  • Liquid nitrogen  
  • 5-Fluorouracil Cream  (ie Effudex, Carac)
    • Causes irritation,
    • Will bring up the pre skin cancers that havent been brought up yet
  • Other creams; Picato (ingenol mebutate) Soloraze (diclofenac sodium), Aldara (imiquimod) for areas with numerous AK’s
  • Electrodessication & Curettage
  • Shave biopsy
    • Hard to differentiate a Actinic Keratosis and pre-skin cancer spot
Term
Benign Nevi
Definition
  • Melanocytic Nevus 
  • Halo Nevus 
  • Congential Nevus 
  • Blue Nevus 
  • Atypical or Dysplastic Nevus 
Term
Melanocytic Nevus
Definition
  • Normal mole
  • Small, well circumscribed, with a well defined border
  • May be flat or elevated
  • Single shade of pigment from beige or pink to dark brown
  • Junctional nevus
    • Moles at junction of epidermis and dermis
    • Often appear at a very early age
  • Compound nevus
    • Moles can get bigger and get a dermal component
Term
Halo Nevus
Definition
  • An ordinary common nevus with a hypo-pigmented “halo” around it
  • Occurs when the immune cells (which normally fight off infection) attack a mole for reasons unknown
  • Will generally undergo spontaneous involution
  • May be associated with vitiligo
Term
Congenital Nevus
Definition
  • A Nevus that is present at or near birth and remain throughout life
  • Generally are large
  • Many are associated with hair growth
  • Risk of developing into melanoma
Term
Blue Nevus
Definition
  • Dark blue to black sharply defined papule
  • Deeper pigment due to large amounts of melanin pigment within the deeper dermis.
  • Commonly seen in Asian decent
  • If it is a new lesion, should be evaluated to rule
Term
Dysplastic Nevus or Atypical Nevus
Definition
  • Moles with an abnormality that can transform to a melanoma
  • Tend to be larger than .5 cm with ill defined borders and irregular pigmentation
  • Risk factors
    • Many moles on the body
    • Family history of melanoma
    • Other documented dysplastic nevi
    • Fair skin
    • History of sun exposure
    • Increase risk of melanoma
Term
Benign Tumors
Definition
  • Seborrheic Keratosis
  • Skin tags
  • Dermatofibromas
  • Lipomas
  • Epidermal inclusion cysts
  • Actinic Keratoses
  • Nevi
Term
Malignant Tumors
Definition
  • BCC
  • Squamous Cell Carcinoma 
  • Malignant Melanoma 
Term
Basal Cell Carcinoma
Definition
  • Most common type of skin cancer
  • Grows at a very slow rate
  • Locally invasive and destructive, but rarely metastasizes
  • Malignancy from epidermal basal cells
  • Etiology and Epidemiology of BCC
    • Most often > 50 y/o
    • Caucasian
    • Fair skinned with light hair and light eyes
    • Develop after  years of extensive sun exposure
Term
BCC: S&S
Definition
  • Generally asymptomatic
  • May bleed, become crusty, ulcerate
  • Generally small, shiny, “pearly”  papule.   Usually will see telangiectasia
  • On the back and chest – may be red and shiny
  • Located most frequently on face, ears, dorsum of hands
Term
BCC: Treatment
Definition
  • First do shave or punch biopsy
  • When confirm diagnosis
    • Excision
    • Electrodessication and curettage (NOT on FACE)
      • When basal cell is superficial or when pt. is older
    • MOHS surgery
      • All day procedure
      • Tissue sparing - just takes the skin cancer cells
      • Most common esp when face or back of hand
    • Topical immune modulators for superficial BCC
    • Radiotherapy
Term
Squamous Cell Carcinoma
Definition
  • Malignant tumor of keratinizing epidermal cells that builds up over time
  • May arise from actinic keratosis
  • Can destroy normal tissue and has the potential to metastasize
  • Can see in pts s/p organ transplants
Term
Squamous Cell Carcinom: S&S
Definition
  • Generally asymptomatic
  • Pink papule or plaque with thick scale  Generally with erosion or ulceration
  • Sun exposed areas (ie face, ears, lips, back of hands)
Term
Squamous Cell Carcinoma : treatment
Definition
  • Excision 
  • Electrodessication and curettage (not on face)
  • MOHS surgery 
Term
Malignant Melanoma
Definition
  • Malignancy of melanocytes
  • Most serious form of skin cancer
  • Frequently metastasize to regional lymph nodes, lung, liver or the brain
  • Features of Melanoma
    • A – asymmetry
    • B – border
    • C – color
    • D- diameter
    • E - evolution
    • Females- most common on legs
    • Males – most common on upper back
    • If a mole, itches, burns, bleeds or changes in anyway, a biopsy needs to be done
    • “Ugly duckling sign”
      • One abnormal mole compared to the rest of the moles of the body
Term
Malignant Melanoma: Risk factors
Definition
  • Fair Skin - m.c
    • Can develop with any skin
  • Atypical nevi in sun exposed and sun protected areas
    • Fair skin - more sun exposed
    • Darker skin - sun protected areas such as  heel of foot
  • PMH of Melanoma
  • Hx of blistering sunburn
Term
Malignant Melanoma: Prognosis
Definition
  • Tumor thickness is single most important prognostic factor
  • A melanoma within epidermis holds a good prognosis *
  • A melanoma on extremity has more favorable prognosis than those found on head, neck *
  • Tumor thickness is most important
Term
Malignant Melanoma: Treatment
Definition
  • EARLY detection
  • Wide excision
    • Do not want to do a shave biopsy
      • Cutting through the depth of the melanoma

    • Do excisional or punch biopsy
      • Get it of the whole lesion in order to get the whole depth
  • Surgical Oncologist (Sentinel LN biopsy)
  • Chest x-ray
  • CBC, Liver function
  • Frequent skin exams
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