USMLE Step 1 Web Prep Skin

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DISORDERS OF PIGMENTATION
Vitiligo

Irregular areas of complete depigmentation African Americans- apparent Caucasians- apparent when suntanned icro o !e"oid of melanoc#tes

elasma $atches of h#perpigmentation %ace &e#es' (C$s ) pregnanc#

*egress after pregnanc# ) withdrawal of (C$s

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DISORDERS OF PIGMENTATION CONT

%rec-les %air-s-inned -ids .ight /rown macules Varia/le presentation0 dependent on season icro o 1ormal 2 of melanoc#tes o Increased melanin deposition 3enign lentigo elanoc#tic h#perplasia icro o .inear proliferation of melanoc#tes
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MELANOCYTIC TUMORS
Congenital ne"i $resent at /irth

5iant congenital ne"i ma#

melanoma

1e"ocellular ne"us 3enign melanoc#tic tumors 6un e7posure 4 t#pes- 8unctional0 compound ) intradermal 5ross o 9ell-circumscri/ed /orders o :niform tan;/rown o 6ta/le si<e ) shape alignant transformation uncommon
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MELANOCYTIC TUMORS CONT

!#splastic ne"i Irregular /order ) pigmentation If > 1 0 ma# ha"e !#splastic ne"us s#ndrome o Increased ris- of melanoma
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MELANOCYTIC TUMORS CONT

A.I51A1> ?.A1( A Incidence *apidl# increasing 40- =0 #ears of age *is- factors @ids with lots of sun e7posure ) sun/urn %air- s-inned !#splastic ne"us s#ndrome
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MALIGNANT MELANOMA CONT

5ross

As#mmetric Irregular /orders Variegated color .arge diameter ?nlarging ales- upper /ac%emales- /ac- ) legs
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Clinical

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MALIGNANT MELANOMA CONT

4 >A$?6 (% A.I51A1> ?.A1( A .entigo maligna %ace of older indi"iduals 3est prognosis 6uperficial spreading ost common t#pe Bori<ontal growth pattern Acral- lentiginous African Americans ?7tremities- palms ) soles 1odular

Vertical growth 9orst prognosis

"ascular structures

metastases

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MALIGNANT MELANOMA CONT

$rognosis 6taging /# depth of in"asion o 3reslowDs thic-ness- greater prognostic "alue o Clar-Ds le"els >reatment 9ide e7cision 6#stemic disease- chemo ) immunotherap#
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BENIGN EPIDERMAL

DERMAL LESIONS

Acanthosis nigricans B#perpigmented0 thic-ened s-in o A7illa ) groin

Associated with internal malignanc#

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BENIGN EPIDERMAL

DERMAL LESIONS CONT

6e/orrheic -eratosis 3enign sEuamoproliferati"e neoplasm iddle-aged ) elderl# %ace ) trun 5ross o Coin- shaped plaEues ) nodules o 3rown0 greas#; granular o Fstuc--onG icro o 3asaloid epidermal h#perplasia o FBorn c#stsG >reatment o *emo"e if irritated or cosmeticall# unsightl#

6ign of .eser- >relat

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BENIGN EPIDERMAL
$6(*IA6I6 ?pidemiolog# 1H of population

DERMAL LESIONS CONT

$soriasis "ulgaris 5enetic component Associated with arthritis0 enteropath# ) m#opath#

5ross- image ?l/ow0 -nees ) scalp ?r#thematous plaEues with sil"er# scales

Auspit< sign
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PSORIASIS CONT
$athogenesis Increased epidermal turno"er icro

?pidermal h#perplasia $ara-eratosis ?longation ) thic-ening of rete ridges I unroDs microa/scesses

>reatment 6teroids ) :V irradiation ethotre7ate

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MALIGNANT TUMORS
6Euamous cell carcinoma Incidence ?lderl# *is- factors 6un e7posure J:V-3 %air comple7ion 6-in ulcers ) sinus tracts Arsenic ) h#drocar/ons 3urns ) radiation Immunosuppression Keroderma pigmentosa $recursor Actinic -eratosis
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S"UAMOUS CELL CARCINOMA CONT

icro

1ests of at#pical -eratinoc#tes in"ade dermis @eratin pearls

Intercellular /ridges

$rognosis *arel# metastasi<e

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S"UAMOUS CELL CARCINOMA CONT

Variant: @?*A>(ACA1>B( A Bands Crater0 "olcano-li-e *apidl# growing

6pontaneous regression
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MALIGNANT TUMORS CONT

B#$#% &'%% &#(&)*o+# ?pidemiolog# ost common malignant tumor iddle-aged ) elderl# *is- factors Chronic sun e7posure %air comple7ion Immunosuppresion Keroderma pigmentosa
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BASAL CELL CARCINOMA CONT

5ross

6un- e7posed areas $earl# papules >elangectasia F*odent ulcerG

icro

3asal cell proliferation

palisading pattern

$rognosis .ocall# aggressi"e *arel# metastasi<e >reatment .ocal e7cision

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MALIGNANT TUMORS CONT

BI6>I(CA>(6I6 K $roliferation of .anghans cells 4 clinical "ariants o eosinophilic granuloma o Band- 6chuller- Christian disease o .etterer- 6iwe s#ndrome .anghans cells- stains with C!1a ? - 3ir/ec- granules in c#toplasm
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MALIGNANT TUMORS CONT

AC(6I6 %:15(I!?6 ales > 40 #ears of age >run-0 e7tremities ) face 5rosso ?"ol"e- ulcerate0 nodules ) plaEues icro o $roliferation of > l#mphoc#tes in dermis o ?pidermotropism o $autrierDs microa/scesses- > l#mphoc#tes

6e<ar#Ds s#ndrome