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Benign

Not related to sun exposure (can be anywhere)

Proliferation (hyperplasia) of small stratum basale cells that have melanin inside (epidermis)

Hyperkeratosis on top of lesions

Small keratin-filled cysts (horn cysts) on top of lesions (superficial)

Downgrowth of keratin into the main tumor mass (pseudo-horn cysts) (in dermis)

**Melasma, hyperpigmented patches on face

**sometimes shows up during pregnancy

**can occur when women are on oral contracepttives (tanning beds + OCPs women get this a lot)

**Typical: pink to flesh colored hyperkeratotic papule or plaque on sun exposed areas. 70% on face or neck.

**Bowen's: SSC in situ (confined to epidermis). Marjolin ulcer, Chronically inflamed skin

**Intraoral SCC: Appearance of white plaque inside mouth: leukoplakia.

**Keratotic invasive SCC: INVASIVE thru epidermis and dermis. Ulcerated, painful.

**Warts that are contagious. Auto-inoculation possible

**60 types of papilloma virus

**Incubation 1-6 months

**More common in children (puberty)

**Flesh colored papules --> grey/brown hyperkeratotic --> autoinoculation

Etiology: poxvirus

Transmission by skin contact, autoinocculation

Incubation 2 weeks to 2 months

Flesh-colored, yellow waxy papules with central umbilification

Can be itchy

Small 2-6 mm, usually 1 - 20 papules

Trunk in children. Genitalia in adults

Hereditary Spherocytosis - Autosomal Dominant

First test should be PBS- reveals spherical blood cells  Second test should be osmotic fragility which will be positive

*jaundice

*splenomegaly

*CBC: anemia with spherocytosis, reticulocytosis

++Reactivation of dormant varicella virus (located in DRG)

**Pain is the first symptom of any lesion

**Wherever the dermatome is "my seatbelt hurts"

**Pain for 2-3 days before lesions show up

**Lesions last for 3-5 days

*NOT ITCHY, but painful

**Less than 4% patients have recurrence

**50% chance of transmission during vaginal childbirth

**60-80% of mothers who deliver have no evidence of outbreak (internal sores not visible)

**C-section common preventative measure

**SEM present 10-12 days of age: skin eye and mucous membranes only

**grouped vesicles usually in eye

**Transmission via direct contact with saliva, genital secretions, open sores

**HSV-1 can lead to herpetic encephalitis

**HSV-2 can lead to genital herpes

**Initial outbreaks: first outbreak is the worse (fever, malaise, regional LAO) Causes grouped vesicles on an erythematous base (patch)

**Subsequent outbreaks: prodromal sensation (tingling) prior to an outbreak

**Superficial cutaneous infection

**Common in infants

**worse in children with atopic dermatitis

**Caused by bacteria: staph or strep

**Commonly found on the nose, face, legs, arms

**Non-bullous: pustules and vesicles break open and leave honey colored crusts

**Bullous: rupturing leave denuded (bright red, peeled back) patches)

**Sarcoptes scabei

**Itching worse at night (females burrow and lay eggs --- > linear raised areas around fingers, waistline)

**72 hours for eggs to hatch

**These lice can jump

**One of most common/ contagious STI

**Fomite transmission (objects: hats, combs)

**Common in elementary school children

**Not related to cleanliness

**Nits are eggs cemented to the hair shaft

**Autoimmune disease caused by destruction of melanocytes

**Hypo-pigmented patches (initially on hands and face, starts out as macules and becomes patches)

**Common around mouth and dorsum of hand

**Wood's lamp positive

**Negative KOH prep

++Dysplastic Nevi (BK mole): non-sun exposed area. Relatively large. Flat macules or slightly raised papules with darker center. Irregular borders.

++Usually compound (superficial dermis aka papillary layer)

++Lentiginous hyperplasia: proliferation of atypical melanocytes

++Cytotypical atypia

***Increased number of melanocytes (MOLE)***Benign

++Congenital, often has hair in the center, grows with aging.

++Acquired: associated with sun exposure and genetic predisposition. Morphology depends on site of lesion.

++Junctional nevus, develops at junction between dermis and epidermis. Flat, nonpalpable, macular

++Compound nevus: extends into dermis. Papular. Increased risk for melanoma if >50 moles.

++Atypical nevi: risk for malignant melanoma. Large, indistinct border. Fried egg appearance.