MSN 620 Final – Skin UPDATED ACTUAL
Exam Questions and CORRECT Answers
What is actinic keratosis? - CORRECT ANSWER - Actinic keratoses (AKs), also referred to
as senile keratoses or solar keratoses, are benign intra-epithelial neoplasms.
Often associated with chronic sun exposure, individuals with AKs may present with irregular,
red, scaly papules or plaques on sun-exposed regions of the body. If left untreated, AKs have the
potential to evolve into invasive squamous cell carcinoma.
What are some risk factors for actinic keratosis? - CORRECT ANSWER - increased age,
males, fair-skinned individuals (Fitzpatrick Skin Phototypes I and II) with red or blonde hair and
blue or light-colored eyes, countries near the equator (such as Australia), immunosuppressed
patients (chemo, AIDs, transplant medications, and leukemia), hx of actinic keratosis and/or skin
malignancy, excessive or chronic skin exposure.
What is the patho of actinic keratosis? - CORRECT ANSWER - Excessive and cumulative
UV radiation exposure from the sun can induce a number of pathologic changes to the epidermal
keratinocyte through the disruption of regulatory pathways involved in cell growth and
differentiation. The resulting inflammation and immunosuppression lead to the intraepidermal
proliferation of dysplastic keratinocytes, which give rise to AKs.
It is limited to the lower third of the epidermis.
What are s/s of actinic keratosis? - CORRECT ANSWER - The presence of any ulceration
and bleeding should be noted. AKs may appear as scaly, erythematous macules, papules,
plaques, or cutaneous horns. Surrounding skin changes may indicate solar damage. AKs often
are better appreciated by their rough texture on palpation as they may demonstrate differing
degrees of hyperkeratosis. Skin lesions are pruritic, painful, and may bleed with minor trauma
such as shaving.
Describe what might be seen on dermoscopy for a patient with actinic keratosis. - CORRECT
ANSWER - On dermoscopy, non-pigmented facial AKs are characterized by a "strawberry
pattern" and include an erythematous vessel pseudo network, prominent follicular openings, and
a surrounding white halo.
,When would you do a punch or shave biopsy for actinic keratosis? - CORRECT ANSWER -
A shave or punch biopsy may be recommended in cases of diagnostic uncertainty, failure to
respond to treatment, or in situations where one wants to determine whether an AK has
progressed to squamous cell carcinoma.
What are the treatment options for actinic keratosis? - CORRECT ANSWER - Lesion-
directed therapies (e.g., cryotherapy, curettage, surgery) target individual AKs, whereas field-
directed therapies (e.g., topical medications, light-based therapies, laser resurfacing) have the
advantage of treating multiple, widespread, and subclinical AKs that may be within a field of
chronic sun damage.
Vitamin B3 dosed at 500 mg twice a day has been shown to reduce the number of AKs after
several months of use.
When is there treatment urgency for actinic keratosis? - CORRECT ANSWER - Urgency is
indicated when lesions are numerous, bleeding, painful, and/or rapidly growing in size.
What are potential adverse effects for all actinic keratosis treatments? How long is the healing
process? - CORRECT ANSWER - pain, inflammation, healing issues, pigment changes, and
scarring. Recurrence and the need for more than one treatment are not uncommon. Healing may
take days to weeks, depending on the location and number of lesions treated. It can turn into
squamous cell carcinoma.
Why might the treatment for actinic keratosis fail? - CORRECT ANSWER - AKs that fail to
respond to aggressive treatment should prompt consideration of treatment noncompliance,
misdiagnosis, and possible malignant transformation to squamous cell carcinoma.
Describe cryotherapy for actinic keratosis. - CORRECT ANSWER - Cryotherapy is a
commonly used lesion-directed treatment modality for AKs. It involves the freezing of skin
lesions through the topical application of liquid nitrogen via spray or cotton tip applicator. With
excellent response rates, it is a viable treatment option for patients with only a few AKs or
isolated lesions. Healing will depend on the duration of liquid nitrogen application and the
number of freeze-thaw cycles.
Describe curettage or shave treatment in AK. - CORRECT ANSWER - Lesion removal with a
curette or blade can be used for hyperkeratotic AKs that may be unresponsive to alternative
, treatments. Curettage or shave allows specimen collection for histopathologic evaluation.
Electrodessication can be added following curettage to assist with hemostasis.
Describe surgery for AK. - CORRECT ANSWER - Surgical excision can be considered when
the diagnosis is unclear or if there is a high suspicion of squamous cell carcinoma. Surgical
excision will yield tissue for histopathologic diagnosis and help guide further treatment.
What are the field directed therapies for AK that treats multiple, widespread AKs? - CORRECT
ANSWER - Dermabrasion, laser, chemical peels, photodynamic therapy, and topical
medications.
Describe dermabrasion in AK. - CORRECT ANSWER - a motorized handheld device with
attached abrasive material is used to remove the superficial skin layers in areas of actinic
damage.
Describe laser therapy in AK - CORRECT ANSWER - Ablative resurfacing lasers (e.g., CO2
and erbium-YAG lasers) can be used to treat AKs by ablating the epidermis and superficial
dermis.
Describe chemical peels in AK. - CORRECT ANSWER - Chemical peels have been used to
treat patients with multiple or widespread facial AKs. A chemical peel involves the topical
application of a caustic agent, such as trichloroacetic acid (TCA), to remove the outer skin layers
to variable depths. The depth of the peel depends on the agent used, its concentration, and the
duration of application. Peels for AKs are approximately 75% effective.
Describe photodynamic therapy for AK. - CORRECT ANSWER - PDT involves the topical
application of a photosensitizer to the treatment area and exposure to a light source of a specified
wavelength, depending on the depth of skin penetration desired. The generation of reactive
oxygen species leads to the destruction of atypical keratinocytes.[3] PDT therapy is an office-
based treatment. Disadvantages of conventional PDT include patient complaints of pain,
extended time spent in the office during treatment sessions as well as frequent office visits for
treatment. These drawbacks have prompted the development of alternative uses of PDT,
including daylight photodynamic therapy, where natural daylight is used to activate the
photosensitizer in place of an artificial light source. Daylight PDT reportedly has a similar lesion
response rate compared to conventional PDT with the advantages of less patient discomfort and
added convenience of treatment outside of the office setting.
Exam Questions and CORRECT Answers
What is actinic keratosis? - CORRECT ANSWER - Actinic keratoses (AKs), also referred to
as senile keratoses or solar keratoses, are benign intra-epithelial neoplasms.
Often associated with chronic sun exposure, individuals with AKs may present with irregular,
red, scaly papules or plaques on sun-exposed regions of the body. If left untreated, AKs have the
potential to evolve into invasive squamous cell carcinoma.
What are some risk factors for actinic keratosis? - CORRECT ANSWER - increased age,
males, fair-skinned individuals (Fitzpatrick Skin Phototypes I and II) with red or blonde hair and
blue or light-colored eyes, countries near the equator (such as Australia), immunosuppressed
patients (chemo, AIDs, transplant medications, and leukemia), hx of actinic keratosis and/or skin
malignancy, excessive or chronic skin exposure.
What is the patho of actinic keratosis? - CORRECT ANSWER - Excessive and cumulative
UV radiation exposure from the sun can induce a number of pathologic changes to the epidermal
keratinocyte through the disruption of regulatory pathways involved in cell growth and
differentiation. The resulting inflammation and immunosuppression lead to the intraepidermal
proliferation of dysplastic keratinocytes, which give rise to AKs.
It is limited to the lower third of the epidermis.
What are s/s of actinic keratosis? - CORRECT ANSWER - The presence of any ulceration
and bleeding should be noted. AKs may appear as scaly, erythematous macules, papules,
plaques, or cutaneous horns. Surrounding skin changes may indicate solar damage. AKs often
are better appreciated by their rough texture on palpation as they may demonstrate differing
degrees of hyperkeratosis. Skin lesions are pruritic, painful, and may bleed with minor trauma
such as shaving.
Describe what might be seen on dermoscopy for a patient with actinic keratosis. - CORRECT
ANSWER - On dermoscopy, non-pigmented facial AKs are characterized by a "strawberry
pattern" and include an erythematous vessel pseudo network, prominent follicular openings, and
a surrounding white halo.
,When would you do a punch or shave biopsy for actinic keratosis? - CORRECT ANSWER -
A shave or punch biopsy may be recommended in cases of diagnostic uncertainty, failure to
respond to treatment, or in situations where one wants to determine whether an AK has
progressed to squamous cell carcinoma.
What are the treatment options for actinic keratosis? - CORRECT ANSWER - Lesion-
directed therapies (e.g., cryotherapy, curettage, surgery) target individual AKs, whereas field-
directed therapies (e.g., topical medications, light-based therapies, laser resurfacing) have the
advantage of treating multiple, widespread, and subclinical AKs that may be within a field of
chronic sun damage.
Vitamin B3 dosed at 500 mg twice a day has been shown to reduce the number of AKs after
several months of use.
When is there treatment urgency for actinic keratosis? - CORRECT ANSWER - Urgency is
indicated when lesions are numerous, bleeding, painful, and/or rapidly growing in size.
What are potential adverse effects for all actinic keratosis treatments? How long is the healing
process? - CORRECT ANSWER - pain, inflammation, healing issues, pigment changes, and
scarring. Recurrence and the need for more than one treatment are not uncommon. Healing may
take days to weeks, depending on the location and number of lesions treated. It can turn into
squamous cell carcinoma.
Why might the treatment for actinic keratosis fail? - CORRECT ANSWER - AKs that fail to
respond to aggressive treatment should prompt consideration of treatment noncompliance,
misdiagnosis, and possible malignant transformation to squamous cell carcinoma.
Describe cryotherapy for actinic keratosis. - CORRECT ANSWER - Cryotherapy is a
commonly used lesion-directed treatment modality for AKs. It involves the freezing of skin
lesions through the topical application of liquid nitrogen via spray or cotton tip applicator. With
excellent response rates, it is a viable treatment option for patients with only a few AKs or
isolated lesions. Healing will depend on the duration of liquid nitrogen application and the
number of freeze-thaw cycles.
Describe curettage or shave treatment in AK. - CORRECT ANSWER - Lesion removal with a
curette or blade can be used for hyperkeratotic AKs that may be unresponsive to alternative
, treatments. Curettage or shave allows specimen collection for histopathologic evaluation.
Electrodessication can be added following curettage to assist with hemostasis.
Describe surgery for AK. - CORRECT ANSWER - Surgical excision can be considered when
the diagnosis is unclear or if there is a high suspicion of squamous cell carcinoma. Surgical
excision will yield tissue for histopathologic diagnosis and help guide further treatment.
What are the field directed therapies for AK that treats multiple, widespread AKs? - CORRECT
ANSWER - Dermabrasion, laser, chemical peels, photodynamic therapy, and topical
medications.
Describe dermabrasion in AK. - CORRECT ANSWER - a motorized handheld device with
attached abrasive material is used to remove the superficial skin layers in areas of actinic
damage.
Describe laser therapy in AK - CORRECT ANSWER - Ablative resurfacing lasers (e.g., CO2
and erbium-YAG lasers) can be used to treat AKs by ablating the epidermis and superficial
dermis.
Describe chemical peels in AK. - CORRECT ANSWER - Chemical peels have been used to
treat patients with multiple or widespread facial AKs. A chemical peel involves the topical
application of a caustic agent, such as trichloroacetic acid (TCA), to remove the outer skin layers
to variable depths. The depth of the peel depends on the agent used, its concentration, and the
duration of application. Peels for AKs are approximately 75% effective.
Describe photodynamic therapy for AK. - CORRECT ANSWER - PDT involves the topical
application of a photosensitizer to the treatment area and exposure to a light source of a specified
wavelength, depending on the depth of skin penetration desired. The generation of reactive
oxygen species leads to the destruction of atypical keratinocytes.[3] PDT therapy is an office-
based treatment. Disadvantages of conventional PDT include patient complaints of pain,
extended time spent in the office during treatment sessions as well as frequent office visits for
treatment. These drawbacks have prompted the development of alternative uses of PDT,
including daylight photodynamic therapy, where natural daylight is used to activate the
photosensitizer in place of an artificial light source. Daylight PDT reportedly has a similar lesion
response rate compared to conventional PDT with the advantages of less patient discomfort and
added convenience of treatment outside of the office setting.
