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38 Cards in this Set
- Front
- Back
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1) The most common sites for a cutaneous metastasis is the ________ and/or ___________ |
1) scalp and/or the chest or abdominal wall
2) lungs, breast, kidney and gastrointestinal tract. (LGB_K) |
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EPITHELIAL NEOPLASMS
BENIGN (examples) |
Seborrheic keratosis,
Clear cell acanthoma Large cell acanthoma Each shows classic acanthosis (thickening) of the epidermis. The etiology / pathogenesis of these lesions in unknown. |
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EPITHELIAL NEOPLASMS
BENIGN Seborrheic Keratosis |
- have a “stuck-on”, pastry dough-like quality and are frequently skin colored or light grey.
- can be heavily, unevenly pigmented, raising concern for melanoma. - occur on any hair-bearing skin (i.e. NOT on the palms/soles). - lesions of middle-aged to older adults. |
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EPITHELIAL NEOPLASMS |
Leser-Trelat
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EPITHELIAL NEOPLASMS
BENIGN Seborrheic Keratosis Clinical features: Histologic features: |
Clinical features:
- Single or multiple, papules or plaques - Hairbearing skin of middle-aged to elderly - “Stuck-on” appearance, pastry dough-like - Pigment varies from tan to brown to black Histologic features: - Acanthosis - Bland, basaloid keratinocytes - Horn (or pseudohorn) cysts - Variable melanin pigment |
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PRE-MALIGNANT/DYSPLASTIC
Actinic Keratosis |
- scaly, often erythematous lesions on sun-damaged skin; particularly of the head and neck and upper extremities.
- do NOT occur on sun-protected skin - are the result of ultraviolet radiation damage to the nuclei of the basal keratinocytes. - they are considered to be precursor lesions to squamous cell carcinoma. |
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PRE-MALIGNANT/DYSPLASTIC
Actinic Keratosis associated with enormous excess of keratin in a structure called a __________ |
“cutaneous horn”.
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PRE-MALIGNANT/DYSPLASTIC |
Clinical features:
- Scaly, erythematous papules or plaques - Arise on skin with other signs of sun/solar damage - Most common in middle-aged to elderly Histologic features: - Parakeratosis (retained nuclei in the most superficial keratinocytes) - Hypo-/agranulosis (absence of the granular cell layer) - Cytologically atypical basal keratinocytes - Short, blunt and crowded rete - Alternating pattern of normal and abnormal; the adnexal epithelium is normal |
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MALIGNANT skin lesions
Name 3 |
Squamous Cell carcinoma In Situ
Squamous Cell Carcinoma Basal Cell Carcinoma |
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T/F |
True
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MALIGNANT |
also known as Bowen’s disease.
It can be linked to solar/ultraviolet radiation, ingested arsenic (well water) and human papilloma virus 16 & 18. As originally described, it was due to coal tars trapped against the skin by clothing. |
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MALIGNANT
Squamous Cell carcinoma In Situ Clinical features: Histologic features: |
Clinical features:
- Scaly, erythematous plaque - Any skin or mucosal epithelium - Most commonly seen on sun-damaged skin Histologic features: - Acanthosis - Replacement of the spinous and granular layer by basaloid (immature) keratinocytes - High nuclear to cytoplasmic ratio gives a basophilic (blue) appearance to the epidermis - Atypical keratinocytes also replace the adnexal epithelium - Often has a relatively normal basal keratinocyte layer |
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Compare Actinic keratosis and SCCIS:
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AK: Parakeratosis, always
SCCIS: Parakeratosis, usually AK: Atypical basal keratinocytes SCCIS: Relatively normal basal keratinocytes AK: Short, blunt rete SCCIS: Acanthosis AK: Eosinophilic cytoplasm (pink) SCCIS: Minimal cytoplasm, mostly nucleus (blue) AK: Skips across follicles/ducts SCCIS: Spreads to involve follicles/ducts AK:UV-related, always SCCIS: UV, viral, topical carcinogen-related |
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MALIGNANT
Squamous Cell Carcinoma |
- denotes an invasive malignancy
- can be caused by UVB radiation, radiation therapy (historically used to treat acne), coal tar, human papilloma virus and ingested arsenic from well water - common in immunosuppressed individuals, particularly those who are medically immunosuppressed because of organ transplantation - increased in patients with chronic ulcers/sinus tracts, burn or vaccination scars, decreased protection from melanin – such as vitiligo or albinism, and disorders with impaired DNA repair such as xeroderma pigmentosa |
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MALIGNANT
Squamous Cell Carcinoma Clinical features: Histologic features: |
Clinical features:
- Firm nodules or ulcers - Skin-colored to erythematous - Most common on sun-exposed/sun-damaged skin - Immunosuppressed persons and elderly most affected Histologic features: - Keratinocytes with eosinophilic cytoplasm at all levels of the epidermis - Nuclear pleomorphism - Dyskeratotic keratinocytes - Invasion into the dermis - Swirls of parakeratotic keratin (keratin pearls) |
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Findings that suggest squamous cell carcinoma is more malignant (inc. metastassi):
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prominent acantholysis,
poorly-differentiated, deeply invasive or perineural invasion |
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T/F
Immunosuppressed patients tend to have more aggressive SCCs |
True
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Aggressive SCC behavior appears to be multifactorial at the molecular level and includes: |
- loss of SKALP (skin-derived antileukoproteinase – an inhibitor of elastase and proteinase 3),
- reduced expression of vinculin (an adherens junction protein) and - increased expression of matrix metalloproteinases (which degrade extracellular matrix) |
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Basal Cell Carcinoma
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- most common malignant neoplasm in humans
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Cutaneous squamous cell carcinoma is more common than basal cell carcinoma
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False
BCCs account for approximately 70% of malignancy in the skin and are approximately 5 times more common than cutaneous squamous cell carcinoma. |
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Basal Cell Carcinoma
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- They occur preodominantly on sundamaged skin of middle-aged to elderly people and 80% occur on the head and neck.
- also occur in children/teens in the setting of the nevoid basal cell carcionoma syndrome; they are more common in people who are immunosuppressed. |
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Basal Cell Carcinoma |
Clinical features:
- Vary from pearly papule/nodule, ulcer with a rolled-border, scaly erythematous patch - Most common on sundamaged skin of the head and neck -May present at any age and in any location Histologic features: - Nests/islands/aggregates of cells with minimal cytoplasm (basaloid) - Islands of basaloid cells have a peripheral “palisade” - Basaloid cells attach to a relatively normal epidermis - Stroma/dermis surrounding the nests is mucinous and desmoplastic - Tumor islands/nests separate from surrounding stroma (clefting) - Apoptotic cells are numerous |
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T/F |
True
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The clinically aggressive BCCs can be classified histologically as:
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- micronodular
- metatypical - basosquamous - infiltrative - morpheaform (sclerosing, desmoplastic) |
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BCCs
For most clinical subypes, a ________ is appropriate to document the diagnosis If on clinical grounds you suspect a morpheaform BCC, a _______ biopsy is required |
simple shave biopsy
punch A morpheaform BCC, which appears scar-like on clinical examination, also appears scar-like on histology. There may be little connection to the epidermis (thus a punch is required) |
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Pathogenesis of BCC, like other forms of skin cancer, is directly related to __________.
Mutations in __________ both in the setting of the nevoid basal cell carcinoma syndrome and in sporadic cases have been noted |
ultraviolet (UVB) radiation
PATCHED gene |
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VIRAL INFECTIONS
Examples of viruses without specific histologic features include: |
rubella,
roseola, and Epstein-Barr virus. |
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VIRAL INFECTIONS
Examples of viruses WITH specific histologic features include: |
- human papilloma virus
- molluscum contagiosum, - cytomegalovirus - three herpes viruses – herpes simplex I, herpes simplex II and varicella. |
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Human papilloma virus (HPV) |
- these DNA viruses infect the nucleus and affect the morphology of the nucleus and the cytoplasm of individual keratinocytes and the epidermal profile
1) plantar warts/deep palmoplantar warts/myrmecia which are most common on acral skin (palms/soles) 2) common wart or verruca vulgaris 3) flat warts or verruca plana |
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T/F
The morphology in an individual HPV-associated lesion is nearly always predictive of the route of exposure or the specific HPV-type. |
False
The morphology in an individual HPV-associated lesion is NOT always predictive of the route of exposure or the specific HPV-type. |
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HPV Infections |
- Normal skin can harbor HPV
- Immunosuppressed persons are at increased risk - Some HPV types are associated with malignancy - The morphology of the lesion does not always predict the HPV type. |
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Verruca Vulgaris
Clinical features: Histologic features: |
Clinical features:
- May be single or multiple - Occur predominantly in children; but affect all ages - Are most common on fingers/hands, but can affect any cutaneous site - Occur with increased frequency in immunosuppressed persons Histologic features include: - Papillomatosis - Parakeratosis at the “peaks” of the epidermis - Hypergranulosis, increased and “clumped” keratohyaline granules - Koilocytosis - Elongated rete that point toward the center of the lesion (like a “V”) |
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FOLLICULITIS
Clinical features: Histologic features: |
- Acute (neutrophils) inflammation in and around the hair follicle
- Any portion of the follicle can be affected (infundibulum, isthmus, deep segment) - If severe, the follicle can rupture into the surrounding dermis resulting in an intense granulomatous response - Bacteria can sometimes be demonstrated with a tissue gram stain - Fungi are generally readily visible on H&E, but can be highlighted with a GMS or PAS stain - Herpes viral cytopathic effect or molluscum bodies may be seen - Demodex mites are commonly seen in follicles from the face |
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FOLLICULITIS
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- Acute inflammation of the hair follicle
- may be bacterial, fungal, or simply occlusion of the follicle with keratin and sebaceous secretions that are retained and that distort the follicle - can also be due toherpes virus, and Treponema pallidum in secondary syphilis |
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Folliculitis, as seen in acne, is the result of:
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- bacteria(Propionibacterium acnes),
- excess sebum/sebaceous secretions under the control of androgenic hormones and keratin plugs. |
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T/F
All types of folliculitis share the clinical feature of erythema that centers on the hair follicle |
True
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INFESTATIONS |
Clinical features:
- Variable - intensely pruritic papules, vesicles, nodules, dandruff-like (really bad). - Papular form common on the hands/in the web spaces - May see a linear “burrow”; mite at the advancing edge - Children, elderly, immunosuppressed, institutionalized Histologic features: - Subcorneal burrow - specific - Mites - specific - Excreta – specific - Dermis (sometimes) has the appearance of a “bug bite”, including perivascular inflammation with eosinophils; these findings are NOT specific to scabies |
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INFESTATIONS
Arthropod-induced diseases |
Mosquito bites, chigger bites and tick bites are yearly, seasonal events that usually do not require medical intervention
- most common arthropod-induced pathology we see in routine practice is Demodex folliculitis |
