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jmnies's version from 2017-05-08 22:30

ABCDE EFGs for Melanoma

 

Question Answer
Afor Asymmetry of once side of mole compared to the other
Bfor irregular Borders, especially ragged, notched, or blurred
Cfor variation in color, especially blue and black mixed with white and red (white from scarring and regression; red from inflammatory reaction to abnormal cells)
Dfor Diameter ≥6 mm or different from others
Efor Evolution or change in size, symptoms, or morphology
Eelevated
Ffirm to touch
Ggrowing
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Skin colors

Question Answer
Slightly but uniformly pigmented macule or patch with somewhat irregular border, usually 0.5 to 1.5 cm in diameter; benignCafé-Au-Lait Spot
Hypo- or hyperpigmented, slightly scaly macules on the trunk, neck, and upper arms (short-sleeved shirt distribution)Tinea Versicolor
Depigmented macules on face, hands, feet, extensor surfaces, other regions, may coalesce into extensive areas that lack melaninVitiligo
The yellowish palm is compared with a normally pink palm, sometimes a subtle finding; The cause is a diet high in carrots and other yellow vegetables or fruitsCarotenemia
Violaceous patches over the eyelids in the collagen vascular disease dermatomyositisHeliotrope
What four pigments are responsible for skin color?melanin, carotene, oxyhemoglobin, and deoxyhemoglobin
A golden yellow pigment that exists in subcutaneous fat and in heavily keratinized areas such as the palms and solesCarotene
Brownish pigment of the skin, genetically determined and increased by exposure to sunlightmelanin
Two forms of circulating hemoglobinoxyhemoglobin and deoxyhemoglobin
oxyhemoglobin loses O2deoxyhemoglobin
Increased concentration in cutaneous blood vessels gives the skin a bluish cast known as cyanosisdeoxyhemoglobin
Two types of cyanosiscentral or peripheral
Overall level of oxyhemoglobin is low, bluish mouth/lips/tonguecentral cyanosis
Overall level of oxyhemoglobin is normal, focal issue; shunting of blood from the periphery can be response to anxiety or coldperipheral cyanosis
Brown/blackNevi, café au lait, melanoma, melasma, acanthosis nigricans, drug reaction
benign proliferations of a type of melanocyte known as a "nevus cell", aka a molenevi
Acquired hyperpigmentation of skin that typically affects sun-exposed areas of face, most common in women with darker complexions who live in areas of intense UV exposuremelasma
Common condition characterized by velvety, hyperpigmented plaques on skin. Intertriginous sites, such as the neck and axillae, are common sites for involvementAcanthosis nigricans
Acanthosis nigricans associated with what two disease?diabetes and obesity
BlueVenous pooling, nevi
benign tumors of vascular endotheliumHemangioma
have greatest concentration of eccrine glandsPalms, soles, axilla
Sweat glands are of two typeseccrine and apocrine
Excessive stretch with hypermobile joint flexibility is seeEhlers-Danlos syndrome
Yellow (Jaundice)Hyperbilirubinemia, hemolysis, protein deficiency, enzyme deficiency, liver disease, bile duct obstruction
Yellow-brown pigment, arises from the breakdown of heme in the red blood cellsbilirubin
Causes of central cyanosisadvanced lung disease, congenital heart disease, and hemoglobinopathies.
Cyanosis of heart failureis usually peripheral, reflecting deoxygenation or impaired circulation
dryness, coolness, rough texture of skin in thyroid conditionhypothyroidism skin changes
how quickly skin returns into placeturgor
how easily skin lifts upmobility
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Primary skin lesion

Question Answer
Small flat spot, up to 1.0 cm, non palpablemacule (Hemangioma, Vitiligo)
Flat spot, 1.0 cm or larger, non palpablepatch (Café-au-lait Spot)
Elevated lesion 1.0 cm or larger, often formed by coalescence of papules, palpableplaque (Psoriasis)
Elevated, solid skin lesion <1 cm in diameterpapule
Knot-like lesion larger than 0.5 cm, deeper and firmer than a papulenodule
Nodule filled with expressible material, either liquid or semisolidcyst
A somewhat irregular, relatively transient, superficial area of localized skin edemawheal, welt or hive
Often associated with an allergic reaction, making them pruriticwheal
Palpable elevations with fluid-filled cavity, up to 1.0 cm; filled with serous fluidvesicle
Palpable elevations with fluid-filled cavity, 1.0 cm or larger; filled with serous fluidbulla
Filled with pus (yellow proteinaceous fluid filled with neutrophils)pustule
Thin, elevated tortuous channel produced by a parasiteBurrow
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Secondary skin lesion

Question Answer
A flaking of the uppermost layer of skin, the stratum corneum, produced by abnormal keratinization and sheddingscale
The dried residue of skin exudates such as serum, pus, or blood, a scabcrust
Linear or punctate erosions caused by scratchingExcoriation
Increased connective tissue that arises from injury or diseasescar
Hypertrophic scarring that extends beyond the borders of the initiating injurykeloid
Nonscarring loss of the superficial epidermis; surface is moist but does not bleed, dermis intact, denuded blisterErosion
An erosion that involves the epidermis and dermisulcer (Stasis ulcer of venous insufficiency, pressure ulcer, basal cell carcinoma)
Pressure sores result whensustained compression obliterates arteriolar and capillary blood flow to the skin
A split in the skin that extends through the epidermis and dermisfissure
Visible and palpable thickening of the epidermis and roughening of the skin with increased visibility of the normal skin furrows (often from chronic rubbing)Lichenification (ezcema)
a thinning of skin that may include the subcutaneous layer. The skin may appear shiny, translucent, tight, or depressedatrophy
plug of sebaceous and keratinous material in the opening of the hair folliclecomedone
blackheadWhen the orifice is dilated (open comedone), Comedones are the skin-coloured, small bumps (papules) frequently found on the forehead and chin of those with acne
whiteheadWhen the orifice is narrowed (closed comedone)
Their absence is helpful when entertaining a diagnosis for rosaceaComedone
small, circumscribed, superficial keratin cysts with no visible opening, common in newbornsMilia
a condition caused by chronic moisture, which softens and makes the tissues opaque. Commonly seen in the corners of the mouth, between skin folds such as under the breasts, and between the toesMaceration
dilated blood vessels appearing within a lesion or on the surface of the skin. Commonly seen as a component of basal cell carcinoma or rosaceaTelangiectasia
a circumscribed deposit of blood Petechiae
a circumscribed deposit of blood >3 mm in diameterpurpura
bruises; reddish to purple lesions that are larger than petechiaeEcchymosis
Common, benign, whitish-yellowish to brown raised papules or plaques that feel slightly greasy and velvety or warty and have a “stuck on” appearanceSeborrheic Keratosis
Superficial, hyperkeratotic papules. Often multiple; can be round or irregular; pink, tan, or grayish. Appear on sun-exposed skin of older, fair-skinned people; precancerousActinic Keratosis
Three vascular lesions?spider angioma, spider vein, cherry angioma
significance of spider angioma?Liver disease, pregnancy, vitamin B deficiency; also occurs normally in some people
significance of spider vein?Often accompanies increased pressure in the superficial veins, as in varicose veins
Purpuric Lesions?Petechia/Purpura and Ecchymosis
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Skin lesions: shape and configuration

Question Answer
shape of the individual lesion?Oval, annular (round), arciform (arch-like), angulated
Questions?shape, symmetry, borders, lesions individual and scattered or do they form patterns, becoming linear, clustered, serpiginous, or coalesced
Koebner phenomenon development of skin disease in sites of skin trauma
Squamous cell carcinomas predilection forthe dorsum of the hand
Basal cell carcinomas predilection forthe face
What should be included in skin lesion description?Size, color, shape, texture, type, configuration
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Skin cancer

Question Answer
Most common type of skin cancerbasal cell carcinoma
basal cell carcinoma descriptiona dome-shaped lesion with translucent, pearly white borders and telangiectasias that frequently ulcerate, forming a central depression
basal cell carcinoma is more common inold men
Most common form of BCC isnodular
BCC arises from theepidermis
Second more common form of skin cancersquamous cell carcinoma
Presentation of SCCscaly, red papules or plaques
Rarest and most aggressive form of skin cancermelanoma
HARMM acronym for melanomaHx of previous melanoma, age > 50, regular dermatologist absent, mole changing, male gender
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Nails

Question Answer
Separation of the nail from the bedonycholysis
a bulbous swelling of the soft tissue at the nail base, with loss of the normal angle between the nail and the proximal nail fold; spoon-like curvature of nail bedclubbing
clubbing is most commonly associated with what?hypoxia, chronic lung/congenital heart disease
White, distal band of reddish-brown, obliteration of lunulaterrys nails
Seen in liver disease, usually cirrhosis, heart failure, and diabetesterrys nails
superficial infection of the proximal and lateral nail folds adjacent to the nail plate, folds are tender, swollen and red, infection of the handParonychia
Represents the most common infection of the hand, usually from Staphylococcus aureus or Streptococcus speciesParonychia
Whitening and opacification of the nail is the most common color change, can be result of traumaleukonychia
Transverse depressions of the nail plates, usually bilateral, resulting from temporary disruption of proximal nail growth from systemic illnessBeau’s lines
Local causes of onycholysis (T,P,FI, AR)trauma, psoriasis, fungal infection, and allergic reactions to nail cosmetics
Systemic causes of onycholysisdiabetes, anemia, photosensitive drug reactions, hyperthyroidism, peripheral ischemia, bronchiectasis, and syphilis
Follow the curve of the lunula and may occur after acute or severe illness; poisoning (M)mees lines
Thin, linear brownish-red or brown splinters caused by microinfarcts from endocarditis or vasculitisSplinter hemorrhages on nail bed
What to check for in nails?proximal nail fold (swelling, redness), nail plate (thickening, lines), nail bed color, nail thickness, length/hygiene, elongation, shape, cap refill
Pitting of the nails is usually associated with what?psoriasis
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Hair

Question Answer
Three things to check for hairquality, texture and distribution
Evaluation of hair loss should include what?localized/generalized, scarring/non-scarring, inflammatory/non-inflammatory, follicular plugging
Clearly demarcated round or oval patches of hair loss, usually affecting young adults and children. no visible scaling or inflammationAlopecia areata
Chronic immune-mediated disorder that targets anagen hair follicles and causes nonscarring hair lossAlopecia Areata
Hair loss from pulling, plucking, or twisting hair. Hair shafts are broken and of varying lengths. More common in children, often in settings of family or psychosocial stressTrichotillomania
Round scaling patches of alopecia. Hairs are broken off close to the surface of the scalp. Usually caused by fungal infection from Trichophyton tonsurans from humans, less commonly from microsporum canis from dogs or cats. Mimics seborrheic dermatitisTinea Capitis (“Ringworm”)
also known as male pattern hair loss and male baldingAndrogenic alopecia
Localized hair loss differentialAlopecia areata, hair loss associated with underlying skin disorders, hair loss from mechanical damage
Diffuse or generalized hair loss differentialAndrogenic alopecia, other hormone related causes, medications (anticoagulants, anticonvulsants, and beta blockers), systemic disease
Scarring hair loss differentialpermanent loss of hair, localized cutaneous disease (e.g., lichen planopilaris), part of a systemic disorder (e.g., lupus), trauma (e.g., burns, surgery, radiation, and injury), infections (e.g., chronic untreated dermatophyte infections), tumors (e.g., basal cell carcinoma)
loss of nearly all hair from the scalpAlopecia totalis
loss of hair from the entire body, can be associated with autoimmune disorders (lupus, vitiligo)Alopecia universalis
reversible condition usually occurring about three months following a major stress such as illness, surgery, psychological trauma, severe weight loss, or pregnancyTelogen effluvium
results from an alteration in follicular cycling that leads to the excessive shedding of telogen hairsTelogen effluvium
defined as excessive male-pattern hair growth in a woman/Excessive terminal hair growth or growth of hair in unusual placesHirsutism
Hirsutism causesAbnormal androgen production (Polycystic ovary syndrome, adrenal hyperplasia, and ovarian and adrenal tumors) or severe insulin resistance
infestation of head and scalp with licePediculosis capitis
Infestation by crab louse in groin and eyelashesPediculosis pubis (pubic) and ciliaris (eyelashes)
patients on bimatoprost ophthalmic (Lumigan) for glaucoma will have what side effect?Hypertrichosis
(thyroid) characterized by the hair becoming coarseHypothyroidism
(thyroid) associated with thinning of the hairhyperthyroidism
Alopecia Hair Pull TestFirmly grasp about 50–60 hairs from the side of the scalp above the ear and exert slow, constant traction to slightly tent the scalp skin while slowly sliding the fingers up the hair shaft
In hair pull test, what hairs should come outAnagen growing hairs should remain rooted while telogen hairs should easily come out, should be fewer than six hairs that come out
excessive number of telogen hairstelogen effluvium
short, fine, less pigmentedvellus hair
coarser, pigmented (scalp, eyebrows)terminal hair
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