Snapshot A 60-year-old man with multiple "sun spots," or solar lentigos, comes to the dermatologist for his annual skin exam. He complains of several rough patches on his cheeks that has been there for a year. They feel like sandpaper. He is a gardener and often spent hours under the sun. Introduction Keratotic, pre-malignant lesions Epidemiology common in fair-skinned individuals common in elderly patients results from significant lifetime sun exposure keratinocyte damage May lead to squamous cell carcinoma Presentation Symptoms typically asymptomatic Physical exam thin, adherent scale that is transparent or yellow rough, “sand-paper” texture may see some telangiectasias frequently on sun-exposed areas face, head, neck, dorsal hands, ears Evaluation Skin biopsy dysplastic epidermis with keratinocyte atypia no invasion into dermis Differential Squamous cell carcinoma Actinic cheilitis Lentigo maligna Photoaging presents as rough texture, abundant wrinkles, and diffuse mottled pigmentation seen on histology as flattening of dermal papillae with basophilic depositions. Treatment Lifestyle modification avoid sun exposure use sunscreen Surgical liquid nitrogen (cryotherapy) = most common treatment Pharmacological topical 5-fluorouracil Prognosis, Prevention, and Complications Prognosis typically slow-growing and persistent if untreated Prevention avoid sun exposure use sunscreen Complications risk of progression to squamous cell carcinoma
QUESTIONS 1 of 3 1 2 3 Previous Next Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK (M1.MK.15.75) A 57-year-old male with a history of obesity, diabetes, and asthma presents to his primary care physician because he is concerned about recent changes to his skin. He says that he has noticed the skin around his neck and armpits appears to be darker as shown in Figure F. He is very concerned and asks the physician if these new changes could progress to skin cancer. The physician reassures the patient that they will not, but does state that other skin findings carry the risk of progressing to invasive squamous cell carcinoma. Which of the following images depict such a finding? QID: 106752 FIGURES: A B C D E F Type & Select Correct Answer 1 Figure A 13% (33/248) 2 Figure B 3% (8/248) 3 Figure C 2% (6/248) 4 Figure D 4% (11/248) 5 Figure E 75% (187/248) M 4 Question Complexity D Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 5 Review Tested Concept Review Full Topic Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK
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