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DM Dermatology
Diagnostic Methods for Dermatology
| Question | Answer |
|---|---|
| Fresh specimen biopsies | drug rashes, vasculitis, viral exanthems |
| Timing is not so critical for more long-standing lesions like | basal cell carcinoma, dysplastic nevi |
| Biopsy site selection | Go for the most characteristic area of the lesion. Go for advancing borders. AVOID: hyperkeratotic (thickly crusted) areas, avoid scarred, excoriated or denuded sample sites. |
| Most common skin cancer | Basal cell carcinoma |
| Types of Biopsy | Shave, punch, excisional biopsy |
| Shave Biopsy is appropriate for many suspicious lesions including | Basal cell carcinoma, squamous cell carcinoma, actinic keratosis, verrucae, molluscum contagiosum, dysplastic nevi |
| A _____ shave is very appropriate to rule out a malignant melanoma | deep. |
| When should you do a punch biopsy? | Do a punch when dermal pathology is suspected or when depth of lesion is needed for staging **MELANOMA. Malignant melanoma, granuloma annulare, erythema nodosum, vasculitis |
| To which layer does a punch biopsy penetrate | Down to subcutaneous fat. Full skin thickness |
| Red, macular, non-blanching lesions | Vasculitis. Punch biopsy b/c it is occurring at a deeper layer. |
| Inky darkly pigmented areas in a melanoma | is considered the worst, biopsy here. |
| Textbook answer for suspicious malignant spot | Excisional biopsy |
| Benign terms | melanocytic, junctional, compound, hyperkeratotic |
| Pathologic terms | atypical, dysplastic, malignant |
| Serology testing may be helpful in confirming the following diagnosis | HSV I, II, Lyme Disease, Automimmune dz (Lupus, Sjorgren's) |
| Indication for Mohs | Surgical treatment for skin cancers of the head and neck, genitals, or for recurrent lesions. Or for young patients (<39) |
| Benefits of Mohs | Benefits include 98% or better cure rate, improved cosmesis due to smaller surgical defect, and patient leaves the office knowing the lesion has been histologically cleared before closure. |
| Jock itch | tinea cruris |
| If you need to tell the difference between erythrasma and tinea cruris | Wood's lamp. Erythrasma turns coral. |
| Tinea Capitus test | History and PE findings are suggestive of severe seborrheic dermatitis vs. tinea capitis,Select a plaque of adherent scale,With pick-ups, pluck 2-3 hairs (with scale) from patient’s scalp,Place in sterile cup and send for culture |
| Diascopy | Useful technique in determining if an erythematous lesion is “blanching” or “non-blanching”. |
| Vesicles are suggestive of ____ etiology | viral. To culture: select a fresh lesion, use a #11 blade and "unroof" the vesicle. Roll swab over lesion to collect fluid and place in viral culture medium (pink and stored in the fridge) |
| Tzanck prep in viral infection shows | multinucleated giant cells |
| Why should you culture a pustule? | b/c MRSA cases are on the rise; do it prior to abx treatment. |
| How to culture a pustule | select a fresh lesion, use #11 blade to gently nick the surface of the pustule, use a bacterial swab to collect contents, send for culture. |
| Consider this when evaluating lesions of a bacterial origin.May be available to you prior to the results of a culture/sensitivity. | Gram Stain. |
| numerous scratch open bumps and burrows located in body's nook and crannies is suggestive of | Scabies |
| Best choice to sample for scabies | linear burrow. Intact papule is acceptable. Look under low power for mites, eggs, feces. |
| How long must a pt be off antihistamines before patch testing? | 2 weeks. must also be off steroids |
| Common patch test offensive agents | Neomycin, black rubber, fragrance, propylene glycol, wool alcohols, etc. |
| Common offensive agent in cosmetics | propylene glycol and fragrance |
| Blanching Erythema | Inflammation |
| Non-blanching erythema | angiomas, purpura, ecchymosis, portwine stain, vasculitis |
Created by:
ltm12