• Junctional melanocytic nevi: cells in DE junction
• Compound melanocytic nevi:combo of junctional & dermal.
• Dermal melanocytic Nevi:cells exclusively in the dermis.
• Halo nevomelanocytic nevi:nevus encircled by halo leukoderma
• Blue nevi: localized proliferation of melanin-producing dermal melanocytes "tindle effect"

• uniform, round, regular, tan/brown macules.
• >1cm, the mole is congenital nevus or dysplastic nevus
• Predilection for sun-exposured areas

• unform, round, dome-shaped, skin-clored tan/brown in papule or nodule +/- telangiectasia or hair.
• face, neck, trunk, extremity
• do not disappear spontaneously.
• found in 2nd or 3rd decades of life.

• Combination of Junctional and dermal nevus.
• Darkly pigmented, round, dome-shaped, smooth
• Distribution: face, trunk, extremities, scalp.

• Sutton's leukoderma acquisitum centrifugum
• nevus encircled by halo of leukoderma
• onset fist 3 decades
• associated with vitiligo or metastatic melanoma.

• benign, blue/gray color. dark may be confused with melanoma.
• Proliferation melanocyte in dermis give color. "tidle effect".
• Three variants (can only distinguish by biopsy): common blue nevus, cellular nevus, combine blue nevus-nevomelanocytic nevus.
• TX: most remain unchanged; cellular blue nevi are usually excised to R/O mm

• asymptomatic, smooth-topped, hairless, vary in color. benign.
• age onset: all age
• >90% acquired.
• Px and Tx: full excision with a border.

Nevus Spilus

• The histology of this lesion is a combination of lentigo and a nevus.
• distinctive feature dark brown small macules or papules scattered through the pigmented background.

• gray-blue coalescing patches on lumbosacral area.
• common in 99% nfrant of asiatic or amerindian origin.

• mottled mixture of blue/brown hyperpigmentation of skin
• pigmentation usually affect the 1st/2nd branch of trigeminal nerves.

• Tx: excision if suspicious, otherwise monitor clinically w/ skin exams

• AD inheritance.
• asymptomatic, classcally stuck on greesy warty.
• The most common benign epithelial tumor.
• sign of Leser Trelat.
• PE: discrete, "stuck-on," "greasy", "warty" brown, grey, tan papules and plaques, face, trunk and upper extremities.
• tx: light electrocautery, cryosurgery curettage (scrape off)

• It is pseudocancer
• treat as a squamous cell because histologically hard to distinguish.
• dome-shaped nodule with central keratin plug.
• mimic squamous cell carcinoma.
• rapod growth over 6 weeks, spontaneously involute.

• developmental normal
• compromised of pigmentation, hair growth, elevated verrucous surface.
• develop around puperty
• common on shoulder and back.

• Benign appendage tumors
• occur at puperty
• common on face
• pink to skin colored papules. peraly shinny in multiples.
• similar to basal cell carcinoma.

• Sweat duct tumor-benign adenoma.
• 1-2mm flesh colored papules.
• multiple, lower lids, face, axilla
• Tx: ED, cryo, TCA

• Tumors of enlarge sebaceous glands
• Pale, yellow, dome, umbilicated papules
• Forehead, cheeks, lower lid, nose.
• tumor of sebaceous gland, donut shaped appearance. Umbilicated-yellow, indented on face.

• congenital malformation of sebaceous differentiation
• most common scalp.
• hairless orange tinged plaque
• may develop basal cell carcinoma in lesion sto excision at puperty is recommended.

• developmental disorder characterized by hyperplasia of epidermal structures
• several variants: ILVEN-inflammatory linear verrucous epidermal nevus
  

• Benign subcutanoeus tumors
• a collection of fat cells
• soft, round, movable
• mc neck, trunk, extremities

• commo button-like dermal nodule
• fibrous reaction to trauma or bite
• "dimple sign"-lateral compression with thumb and index finger produces a depression or dimple.
• Tx: cryo, surgery (not favorable)

• excessive scarring, fibrous repair
• Tx: prevention, IL steroids, excision, silicone cream
  

• syn: skin tags, cutaneous papilloma, soft fibroma.
• excessive piece of skin common in body fold, intiginous area, common on neck.
  
• soft, skin-clored, oval, sessile
• txL scissor excision, electrodessication
  

what's capillary hemangioma of infancy?

• disorders of blood vessle, self-ressolve.
• AKA strawberry nevus
• avascular tumor. pale patch first , elarge rapidly to red, soft to firl, nodule or palque
• Kasabach-Merritt syndrome: Cavernous type with platelet entrapment, thrombocytopenia. (vascular tumor entrapps platelet causng drop in blood platelet)
  

• a type of blood vessel disorder
• capillary malformations that do not undergo spontanoeus involution
• irregularly shaped red to violaceous patch present at birth
• do not cross midline; dermatomal
• usually confined to skin but may affect eyes and leptomeninges.
• Tx: pulse dye laser.
• unlike strawberry nevus, port wine stain do not go away.

What are some variants of port wine stain (disorders of blood vessels)??

• Sturge-Weber synd: port wine stain, vascular malformations of eye & leptomeninges
• nevus flammeus nuchae ("stock bite") neck, eyeslids, glabella, unlike other port wine stains, may invoute
• Klippel-Trenaunay-Weber synd: port wine with enlargement of extremity
• Port Wine Stain on midline may be associated with arteriovenous malformation of spinal cord.

• deep, vascular malformation composed of capillary, lymphatic and venous tissues
• soft, compressible blue-tinged, erythematous nodules.
• varints: Klippel-Trenaunay-Weber syndrome local overgrowth of soft tissue with enlargement of extremity. Blue Rubber Bled Nevus-painful, compressible soft blue swelling. Mafucci's syndrome-associated with dyschondroplasia (hard nodules on fingers, toes, boney deformities.
  

• dark blue to violaceous, soft papule
• common to lower limb
• face, lip, ear of patient over 50
• tx: electrosurgery, excision, laser.

• bright, red papule on trunk. increase with age.
• asymptomatic, bright red dome papules.
• tx: electrocautery or laser.

• red, focal telangiectatic network of dilated capillaries radiating from a central arteriold (puctum)-like a spider.
• face, forearms, hands
• F>M a/w hypeestrogen state in pregnancy, liver dx
• Tx:laser, electrocautery.
  

• rapid development of blood under skin site of trauma, rapidly developing hemangioma arising at site of minor trauma.

• Angiokeratoma of Fordyce-dilated venules of scrotum and vulca. little blood vessel of scrotum that look like cherry angioma.
• Angiokeratoma of Mibelli- pink/red papules on elbows, knees,
  
• Angiokeratoma Corporis Diffusum (Fabry's dz)- x-linked inborn error of metabolism in males.
  

• tumor of glomus body which fx as AV shunt linking venules to arterioles. painful. common on fingers and toes.

• Lymphatic malformation.
• multiple small vesicles filled with fluid
• usually present at birth or childhood.

• Wen-most common cutanoeus cyst
• epidermis enclosed keratin
• tx: excision

• occurs secondary to traumatic implantation of epidermis within the dermis.
• Accumulation of keratin within cystic cavity
  

• 1-2 mm superficial white to yellow keratin containing epidermal cyst.
• located on eyeslids, cheek, forehead, and sites of trauma.

• calcified cyst on the scalp.
• second most common
  

• digital (finger) cyst
• pseudocyst over DIP and base of nail.
• Extrudes gelatinous material.
  

• cutaneous horn
• radiation dermatitis
• actinic keratosis
• basal cell carcinoma
• squamous cell carcinoma

• actinic keratosis, squamous cell carcinoma, seborrheic keratoses, or wart
  
• appearance of animal horn

• Skin changes from exposure to ionizing radiation.
• erythema, pigmentation, scarring, atrophy of skin, telangiectasias, necrosis and ulceration, leathery skin.
• skin cancers may develop in these areas.

• precancerous, developed into squamous cell carcinoma.
• premaliganct potential
• tx: cryotherapy. topical 5-FU (usage of topic 5-FU will cause inflammation at spot of sun damage. precancerous spot will go away when inflammation is resolved)
  

• Most common type of skin cancer
• locally invasive and aggressive, limited capacity to metastasize.
• 7 clinical types: superficial, nodular, pigmented, ulcerative, sclerosis, cystic, basosquamous
• cm on head, neck, medial and later canthi (eyelids), nasolabial fold.
  

1. basal cell carcinoma
2. squamous
3. melanoma (deadliest)

red scaly plaque, pearly white border, resembles eczema, psoriasis, least aggressive, no rleation to sun exposure

this doesnt get better with cortisole cream, need to do a biopsy.

• excision
• electrodessication and curettage, cryotx
• mohs-surgery: cut layer to layer, to make sure the whole cancer is removed
• topical immunomodulators
• radiation therapy

• autosomal dominant
• multiple BCC's, palmoplnatar pits
• skeletal malformations (mandibular "keratocyst") 
• internal neoplasm
• eyes, cns, endocrine abnormality.
  

• rare malignant tumor derved from merkel's cells
• solidary or multiple firm nodules
• mc. head, extremities
• can disseminate to lymph nodes viscera and CNS

• second most common malignancy of the keratinocyte
• UV, HPV, Actinin keratosis
• indurated erythematous, hyperkeratotic, scaly papule, plaque, nodules, +/- erosion
• occur on face, tips of ears, preauricular area, scalp, dorsal hands.
  
• tx: cryotherapy, mohs, surgery
  

congenital nevus

clar's (dysplastic nevus)

lentigo maligna

melanoma risk factors?

M-moles, atypical (dysplasia)

M-moles, common >50

R-Red hair, frekcling

I-inability to tan, skin type I and II

S-Sunburn,

K-Kindred, family hx of melanoma.

• proliferations of atypical melanocytes
• arises de novo from a compound nevus
• variegated in color
• asymmetric in outline
• irregular borders
• unusual histologic features
• potential precursors of melanoma. (superficial spreading type)
  

30% preexisiting melanocytic lesion

70% normal skin

• lentigo maligna: a melanoma in situ, a macular intraepidermal neoplasm and a precursor to LMM, slowly evolves over 20 years.
• letigo maligna melanoma: the least common of the principle melanomas of white person.
• risk factors: occurs in older person on sun exposed area.
• Nodular melanoma: occurs in mid-aged person on unexposed area, this tumor begins in the vertical growth phase and is aggressive. risk factors-dysplastic nevi, family hx
• Superficial spreading melanoma:occurs as slow growing, remains in radial growth phase for mth-yrs. contained mixed colored, arised in upper back. same risk as nodular MM.
• acral lentiginous melanoma: arise on the sole, palm, finger/toe nails bed or mucocutanoeus skin of mouth. Hutchinson's sign: pigmentation frok nail spread to normal skin.

• spread is usually from primary site local recurrence to regional metastsis (lymph nodes) to distant metastasis (viscera)
• sentinelnode biopsy can detect regional metastasis to lymph nodes
• visceral metastasis can occur in lung, liver, brain and bone
• sentinel node status and breslow thickness of the melanoma are strong preductors of reccurenct survival.

Malignant melanoma

the five cardinal features of MM

A. Asymmetry

B. Irregular Borders

C. Colors changes

D. Diameters

E. Elevation

Dx: clinal suspicious, dematopathology

Tx: excision +/- elective lymph node dissection