Quick Review: Malignant Skin Lesions

by Stephen Holt, MD, MS

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    00:02 With that, let's do a quick review.

    00:04 Again, I'll ask some questions.

    00:06 I'll pause after each question to allow you to reflect on the answer and then we'll go and give the answers.

    00:13 First one, a 52-year-old, fair-skinned woman presents with a skin lesion on her forehead.

    00:19 She has multiple rough, sandpapery patches on the forehead and dorsum of the hands.

    00:25 One of those scaly patches on the forehead is associated with a firm hyperkeratotic papule.

    00:32 What's the diagnosis? Great. The answer is there are multiple actinic keratoses shown here.

    00:45 Again, those rough, sandpapery patches on the forehead and the dorsum of the hands, classic location for those with a single squamous cell carcinoma in situ lesion and that's that lesion that has that firm hyperkeratotic papule.

    00:59 This is something which has a 3% chance of progressing to squamous cell carcinoma if we don't treat it potentially with 5-FU or imiquimod cream or cryotherapy.

    01:12 Next question.

    01:13 All of the following is true of a keratoacanthoma except: Number one, grows rapidly and may resolve spontaneously.

    01:29 Well, we know that's true.

    01:30 That's one of the classic features of a keratoacanthoma.

    01:33 Number two, it is considered a pseudocancer or a low-grade malignancy.

    01:39 That's also true.

    01:39 The nomenclature has changed and gone back and forth but ultimately, it's clearly not an aggressive cancer.

    01:46 Number three, it is nodular or dome-shaped.

    01:49 That's also true.

    01:50 Oftentimes, it will have that central hyperkeratotic plug that I described.

    01:55 Number four, most commonly appears on the face.

    01:58 That's also true.

    01:59 Ninety percent of the time, you'll see them there.

    02:02 Five, most important risk factor is HIV.

    02:06 That's not true.

    02:07 HIV is not really linked with keratoacanthomas at all.

    02:10 The answer in this case is number five.

    02:12 Okay, next question.

    02:14 A 61-year-old Caucasian man presents with a flesh-colored papular lesion with multiple telangiectasias and rolled borders on his left cheek.

    02:25 What's the diagnosis? Great. I want to make sure you come up with the right subtype here as well and it's a basal cell carcinoma specifically, the nodular subtype, similar to what our prior patient had.

    02:46 One last question.

    02:48 All of the following is true of a seborrheic keratosis except: Great. Number one, they're often hereditary and increase with age.

    03:04 That's true.

    03:06 Number two, they occur mainly in sun-exposed areas.

    03:10 I don't think that's true.

    03:12 They're oftentimes in areas like the chest, the upper back even on the axilla, all over the place but they don't tend to go with a predilection for sun-exposed areas.

    03:23 Just to round things out though, number three, described as waxy and stuck-on.

    03:28 That's a classic sort of descriptive terminology used to describe seborrheic keratosis so that part is true.

    03:33 Lastly and importantly, the lesions are almost universally benign and that's true as well.

    03:39 The answer to this question is number two.

    03:41 They don't really occur in sun-exposed areas or at least they don't have a predilection for those areas.

    03:47 With that, I think we've come to the end.

    About the Lecture

    The lecture Quick Review: Malignant Skin Lesions by Stephen Holt, MD, MS is from the course Neoplasms of the Skin (Quiz Coming Soon).

    Author of lecture Quick Review: Malignant Skin Lesions

     Stephen Holt, MD, MS

    Stephen Holt, MD, MS

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