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128 Cards in this Set
- Front
- Back
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Which layer of skin?
Seborrheic keratosis |
Epidermis: immature keratinocytes
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Which layer of skin?
Acanthosis nigricans |
Epidermis: hills and valleys of keratinocytes with dermal cores.
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Which layer of skin?
Fibroepithelial polyp |
Epidermis: variable acanthosis
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Which layer of skin?
Epithelial inclusion cyst |
Epidermis:
- squamous epithelial lining - laminated keratin content |
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Which layer of skin?
Keratoacanthoma |
Epidermis:
- big keratinocytes, atyical nuclei, glassy cytoplasm - fast growth |
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How to differentiate seborrheic keratosis from melanoma?
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Biopsy:
- seborrheic keratosis: immature basaloid keratinocytes, acanthosis, hyperkeratosis, keratin pseudocyst. - melanoma: dysplastic melanocytes either confined to epidermis (in-situ) or invade the dermis (malignant) Minor differences grossly: - seborrheic keratosis: granular surface, look "stuck on", round, well demarcared. - melanoma: irregular border, variation in color, asymmetric. |
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What is this disease?
Micro: - immature basaloid keratinocytes - acanthosis - hyperkeratosis - keratin pseudocyst |
Seborrheic keratosis
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What is disease?
External feature: - round, tan-brown plaques - granular surface - look "stuck on", well demarcated |
Seborrheic keratosis
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What is this disease?
- explosive development of multiple round tan plaques with granular sufarce and well damarcated. - high serum TGF-alpha |
Paraneoplastic syndrome: seborrheic keratosis with internal malignant neoplasm.
This is called the Leser-Trelat sign. |
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What does Leser-Trelat sign tell you?
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Paraneoplastic syndrome: underlying internal malignancy.
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Name three skin tumor we learned so far that can be associated with internal malignancy.
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- seborrheic keratosis
- acanthosis nigricans - adnexial tumor: cowden syndrome (breast cancer+trichilommas), sebaceus adenoma. |
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What is this disease?
External feature: - thickened dark skin - usually on axilla, neck groin. - gradual development in childhood/puberty. - associated with obesity/endocrine disorders |
acanthosis nigricans
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What is this disease?
Micro: - hills and valleys of keratinocytes with dermal cores - hyperkeratosis - acanthosis - pigmented basal keratinocytes |
acanthosis nigricans
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When an obeise kid presents with thickened dark skin in the axilla, what is the disease and what should you also test him for?
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benign acanthosis nigricans
should also test doe endocrine disorders. |
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When an adult presents with thickened dark skin in the axilla, what is the disease and what should you also test him for?
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malignant acanthosis nigricans
should also test growth hormones, may be related to internal malignancy. |
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What is the name(s) for this skin presentation?
- soft, flesh-colored, bag-like polyp |
fibroepithelial polyp
acrochordon skin stag |
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What do fibroepithelial polyps look like under microscope?
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core of loose fibrovascular tissue covered by normal epithelium with variable acanthosis.
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What might be a cause of skin tags (acrochordon / fibroepithelial polup)
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hormone receptor problem since they are more like to be found in pregnant women.
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What skin lesions are pregnant women at risk for?
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- fibroepithelial polyp
- melasma/chloasma (latinos and asians) |
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What is this disease?
External features: - firm, malleable nodule, well demarcated. - semi-solid, gray-white greasy material |
Epithelial inclusion cyst
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How are epithelial inclusion cysts different from lipoma externally?
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epithelial inclusion cysts: firm
Lipoma: soft |
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What is this disease?
Cyst biopsy: - squamous epithelium with granular layer - laminated keratin content |
epithelial inclusion cyst
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What happens when an epithelial cyst ruptures?
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- painful: foreign body reation in dermis
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Does draining the epithelial inclusion cyst curative?
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No! Has to excise the entire cyst wall to prevent recurrence. Otherwise the cyst wall lining cells will make keratins and cysts will reappear.
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How are epithelial inclusion cysts different from pilar cysts (epithelial adnexial cysts) microscopically?
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epithelual inclusion cysts: has granular layer in the cyst wall.
Pilar cysts: no granular layer (like in hair follicles), may see calicifications in the content. |
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How do epithelial inclusion cysts occur?
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plugged follicle -> ectasia of hair follicle infundibulum
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How are epithelial inclusion cysts different from pilar cysts (epithelial adnexial cysts) externally?
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They look very similar, only difference is location.
- epithelial inclusion cysts: skin. - pilar cysts: mostly on scalp. |
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What is this disease?
External feature: - dome-shaped nodule with central keratin plug - developed in weeks - on sun exposed skin |
keratoacanthoma
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What is this disease?
Micro: - cup shaped: central crater of keratin, downward pushing rounded border - big keratinocytes, mild atypical nuclei, glassy cytoplasm |
keratoacanthoma
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How to differentiate keratoacanthoma from SCC?
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keratoacanthoma develops in weeks.
SCC develops in yrs. |
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What is this disease?
- multiple dome-shaped papules and nodules on forehead. - breast cancer |
Cowden syndrome: breast carcinoma + multiple trichilomas
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What is the name(s) of this skin lesion?
cyst biopsy: - hair follicle epithelium (no granular layer) - keratin content, may see calcifications |
Pilar cyst
epithelial adnexal cyst trichilemmal cyst |
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What is this disease?
- tumor of sebaceus gland - internal malignancy |
sebaceus adenoma
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What is this disease?
Micro: - jigjaw like islands of basaloid cells with small ductal lumina. |
Cylindroma (apocrine)
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What age group is more likely to get tuban tumor?
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Turban tumor (cylindroma):
- age 20s (they got AD inherited) |
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What is this disease?
External feature: - dome-shaped papules and nodules on forehead |
cylindroma
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What is this disease?
External feature: - cluster of small flesh-colored papules - around eyes, axilla, low abdomen, genitals |
syringomas (eccrine)
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What is this disease?
Micro: - tadpole-shaped nests of epithelial cells - pink central lumen |
syringoma (eccrine)
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You see these more in women, begin at puberty, progressively increase in numbers in adults.
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Syringomas (eccrine)
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What skin tumor(s) could this cause?
- cumulative sun exposure - fair skin, inability to tan |
actinic keratosis
SCC |
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What skin tumor(s) could this cause?
- prolonged intermittent sun exposure and overexposure - light color skin |
Basal cell carcinoma
Melanoma |
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What is the most common skin cancer and what is the second most common?
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most common: basal cell carcipma
2nd most common: squamous cell carcinoma |
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What are some risk factors for actinic keratosis, squamous cell carcinoma, and basal cell carcinoma besides sun exposure?
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- arsenic
- hydrocarbons - thermal - ionizing radiation - HPV - smoke - XP - chronic non-healing wound (long term inflammation) - immunosuppression (AIDs) |
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Pathogenesis of AK and SCC.
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UV light -> single transformed keratinocyte lineage(P53 alteration) and damage to langerhan cells.
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What is this disease?
External features: - skin-colored, red-brown macules or papules - rough sandpaper texture, scaly - not well demarcated, not uniform color - no ulceration |
acintic keratosis
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What is this disease?
Exernal features: - sharply demarcated pink-red papule Micro: - enlarged keratinocytes with hyperchromatic nuclei - extends to entire epidermis - intact basal layer |
SCC in-situ (Bowmen's disease)
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What is this disease?
Micro: - nuclear dysplasia in basal keratinocytes |
acintic keratosis
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How to differentiate AK from seborrheic keratosis externally?
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AK
- rough sandpaper texture, scaly - not well demarcated - color not uniform seborrheic keratosis - round, well demarcated - grannular surface - color more uniform |
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What is this disease?
External feature: - firm, skin colored or red nodules, elevated. - irregular edges, variable crusting - often central ulcer |
invasive SCC
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What is this disease?
Micro: - irregular toungue of dysplastic squamous epithelium invading dermis |
invasive SCC
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What is the risk of metastasize if SCC appears in lip or mucosal surface?
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very high
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How are SCC graded?
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degree of cytoplasmic keratinization and nuclear pleomorphism.
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Where do invasive SCC metastasize to?
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Lymph node (local)
hematogenous spread (distant) |
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What are some treatments for actinic keratosis?
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- freeze
- 5-fluorouracil (also brings out hidden AKs) |
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What is this disease?
External feature: - excessive mound of hyperkeratosis on top of a skin lesion. |
cutaneous horn.
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What should you do when you see a cutaneous horn?
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Biopsy to differentiate it from other tumors such as AK, Bowmens, SCC.
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What are some genetic risk factors for BCC?
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- albinism
- XP - NBCCS (Nevoid basal cell syndrome): AD germiline mutation in PTCH gene on ch9q22, 2nd hit inactivation. |
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What abnormalities would you see in patients with NBCCS?
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- in eye, bone, reproductive organs.
- BCC appear early in life (20s). |
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What is the risk of metastases in BCC patients?
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Low. <0.5%
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What gene is located on ch9q22?
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tumor suppressor PTCH gene (NBCCS)
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What is this disease?
External features: - shiny raised ray-pink nodule - some with telangiectasias - many ulcerate centrally |
BCC
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What is this disease?
Micro: - solid, cystic islands of basaloid keratinocytes invading dermis - clear margin |
BCC
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Name a neuroendocrine neoplasm of the epidermis.
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Merkel cell carcinoma.
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What is this disease?
Micro: - nests of blue cells, minimal cytoplasm. EM: - membrane bound dense core neurosecretory grannules. - stacks of perinuclear cytokeratin filaments |
Merkel cell carcinoma
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What is the prognosis of BCC?
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curable by complete excision
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What is this disease?
External features: - firm, pink-tan nodules, painless - dimple inward on lateral compression - on extremities |
Dermatofibroma (benign fibrous histiocytoma) in dermis.
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What is this disease?
Micro: - hyperplasia of fibrocytes with spindle shaped nuclei - histiocytes and reactive acanthosis. |
benign fibrous histiocytoma (dermatofibroma)
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What is this disease?
External feature: - firm, solid red-tan nodules - bigger and firmer than dermatofibroma - on trunks |
Dermatofibrosarcoma: locally invasive, malignant.
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What is this disease?
Micro: - proliferation of spindle cells, arranged in fasicles - invade to subcutis and muscle fibers |
Dermatofibrosarcoma: locally invasive, malignant.
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What is this disease?
Tumor like collections of foamy histiocytes in the dermis. |
xanthoma
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What is this disease?
External features: - crops of small, yellow papules with red halo - on buttocks, thigh, knee, elbows |
eruptive xanthoma: wax and wane depending on level of chylomicrons
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What is this disease?
External features: - small to large yellow nodules - on elbow, knees, buttocks |
tuberous xanthoma:
- familial hypercholesterolemia - dysbetalipoproteinemia |
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What is the underlying cause of tuberous xanthoma?
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- familial hypercholesterolemia
- dysbetalipoproteinemia |
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What is the underlying cause of tendinous xanthoma?
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heterozygous familial hypercholesterolemia: see hard, flesh colored nodules on tendons.
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What is the underlying cause of planar xanthoma?
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homozygous familial hypercholesterolemia: see soft yellow macules on skin folds
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What is this disease?
External features: - hard flesh colored nodules - on tendons |
tendonous xanthoma
- heterozygous familial hypercholesterolemia - slow growing |
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What is this disease?
External features: - soft yellow macules - on skin folds (eye lids, palmar crease) |
plannar xanthoma
- homozygous familial hypercholesterolemia |
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What is this disease?
External features: - solitary, flat macules - in oral cavity - normal lipid metabolism |
verruciform xanthoma
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What is this disease?
External features - worm like hypertrophic nerve trunks in the dermis - lisch nodules - cafe au-lait spots - gliomas of optic nerve |
Neurofibroma I: Ch17q11
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What is this disease?
External features - CNS neoplasms - cafe au-lait spots |
Neurofibroma II: Ch22q12
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What is this disease?
Micro: - haphazard bundles of collagen - spindle shaped wavy nuclei |
Neurofibroma I: Ch17q11
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What is this disease?
External features: - well demarcated macular zones of pigment loss. |
vitiligo
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What is this disease?
Micro: - partial or complete loss of melanocytes in basal layer of epidermis |
vitiligo
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What causes the loss of melanocytes in vitilligo?
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- autoimmune (favored hypothesis): cell mediated cytotoxicity of NK cells against melanocytes, enhanced by antibodies.
- neural: neurochmical mediator released at nerve endings destroy melanocytes - self-destructive: inability to protect melanocytes from known toxicity of melanin precursors. |
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What is this disease?
External features: - tan-red macular in fair skins - increase in number after sun exposure |
freckles (ephelis)
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What is this disease?
Micro: - increase in melanin in basal keratinocytes - no hyperplasia of melanocytes |
freckles (ephelis)
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What is this disease?
Micro: - melanin deposition in basal keratinocytes - pigments can be reduced by hydroquinone |
epidermal type melasma/chloasma
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What is this disease?
Micro: - macrophages in superficial dermis with phagocytosed melanin - pigments can not be reduced by hydroquinone |
dermal type melasma/chloasma
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What is this disease?
External features: - symmetric macular zone of hyperpigmentation - forehead, temples, cheeks in pregnant women |
melasma/chloasma
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What is this disease?
External features: - oval tan-brown macules - evenly distributed pigments - well demarcated - do not darken with sun exposure |
lentigo
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What is this disease?
Micro: - elongation and thinning of rete ridges (non-neoplastic hyperplasia of melanocytes) |
lentigo
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Which life stage of nevi should you worry about seeing in elderly?
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jucntional nevi.
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Name the life stages of nevi.
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1) mild melanocytic hyperplasia
2) junctional nevi 3) compound nevi 4) intradermal nevi |
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Which lifestage of nevi are these?
External feature - small, flat, symmetric, uniform Micro - nests of ovoid melanocytes in basal layer only |
junctional nevi
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Which lifestage of nevi are these?
External feature - dome shaped papule, sharp edge, uniform Micro - junctional and intrademal nests of melanocytes |
compound nevi
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Which lifestage of nevi are these?
External feature - macular-papule, sharp edge, uniform Micro - nests and cords of melanocytes confined to dermis - cell size decrease with depth |
intradermal nevi
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What genes are involved in the familial form of dysplastic nevus?
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AD (1p36, del 9p21): will see hundreds of nevi, many >5mm
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How is the diagnosis of dysplastic nevus made?
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long term surveilence
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Name the precursor of melanoma.
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dysplastic nevus
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What are the risk factors for melanoma?
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- genetic 9p21 (CDNK2, p16INK4A, p14ARF)
- light skin, blonde hair, blue eyes - prominent freckling, large congenital nevi - carcinogens - chronic intermittent sun exposure - immune suppression - defective DNA repair (XP) |
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What are some genetic risks for melanoma?
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defective cyclin dependent kinase inhibitors (CDNK2, p16INK4A, p14ARF) -> continued phosphrylation of RB -> E2F transcription factor -> uncontrolled cell growth
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What are some warning signs of moles?
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- change in color
- enlargement - itching, pain, ulceration, bleeding |
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What is this disease?
External features: - asymmtric - irregular boder - variation in color - diammeter >6mm |
melanoma
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What is this disease?
Micro: - dysplastic melanocytes confined to epidermis |
melanoma in situ
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What is this disease?
Micro: - dysplastic melanocytes confined to epidermis and invade dermis |
malignant melanoma
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Name the four types of melanoma?
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1) superficial spreading
2) nodular 3) lentigo 4) acral lentiginous |
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Where do you usually see superficial spreading type of melanoma?
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trunk in male
legs in women |
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What type of melanoma do you usually see on the cheeks of elderly?
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lenticular
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Where do you usually see acral lentiginous type of melanoma?
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palms and soles of dark skined people
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What are the five stages of melanoma?
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I: melanoma in-situ
II: invasion to papillary dermis III: invasion to papillary-reticular dermis IV: invasion to reticular dermis V: invasion of subcutaneous fat |
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What is a marker of the progressive melanoma?
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LDH
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Prognosis of melanoma is better predicted with ___.
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Breslow's depth:
<0.76mm: >95% survival in 5 yrs. <1.5mm: 77% >1.5: 63% |
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How to treat stage I/II melanoma?
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- surgical excision with 1-3mm margins
- consider sentinel lymph node biopsy |
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How to treat stage III melanoma?
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- surgical excision with 1-3mm margins
- sentinel lymph node biopsy - adjuvent alpha IFN therapy |
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How to treat stage IV melanoma?
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- palliative
- chemo if patient choose to |
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What are some preventions for melanoma?
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- avoid UV exposure 10am-4pm, especially in infants and children
- protective clothing, wide brimmed hat - sunscreen >SPF30, reappply every 2-3 hrs |
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What are some good ingredients to have in a sun screen?
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- titanium dioxide
- zinc oxide - avobenone - mexoryl |
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What is this disease?
Micro: - Birbeck granules (tennis racket looking) |
Histiocytosis X
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What is this disease?
External features - disseminated red scaly papules - fever, lymphdenopathy,hepatosplenomegaly - age onset: 2 |
Letterer-Siwe disease (lethal): histiocytosis X
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What is this disease?
External fearures - onset age: older children - bone defect in calvarium - diabetes mellitus - exophthalmos |
Hand-Schuller-Christian disease: histiocytosis X
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What is this disease?
External fearures - onset: children, adults - focal disease in single bone or internal organ - indolent, cured by excision and radiotherapy |
eosinophillic granuloma (histiocytosis X)
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What is this called?
langerhan cell histiocytosis |
histiocytosis X: CD1a phenotype
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What is this disease?
- CD4 neoplastic cells in peripheral blood] - erythroderma: diffuse erythematous scaling of skin |
Sezary syndrome
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What is this disease?
Micro: Pautrier's microabscess |
mycosis fungoides: cutaneous CD4 T cell lymphoma
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What are the stages in mycosis fungoides?
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1) patch: scaly red-brown
2) plaque: raised scales, look like psoriasis 3) nodule: multiple red-brown |
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What is this disease?
Micro - uniform cells with ovoid nuclei filling dermis, purple cytoplasmic granules |
mastocytosis
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Pathogenesis of mastocytosis?
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mast cells infiltrate skin and other organ
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Name three mastocytosis.
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1. urticaria pigmentosa: multiple red-brown papules/plaques in children
2. solitary mastocytomas: rare 3. systemic mastocytomas: multiorgan infiltrate, poor prognosis. |
