Path Derm 1 Ex 2

Front 1

Skin Tumors can derive from

Back 1

Epidermal components
Dermal components
Hypodermal components
“Immigrant cells” (i.e.lymphocytes,
histiocytes, metastases, etc,)

Front 2

Epidermis 2 major cell types

Back 2

Keratinocytes
Melanocytes

Front 3

Seborrheic Keratosis

Back 3

Hyperkeratotic pigmented papules and plaques
( especially on face and trunk)
Occurs in middle aged/elderly
Stuck on appearance

Front 4

Papules similar to seborrheic keratosis in african americans known as

Back 4

Dermatosis Papulosa Nigra

Front 5

Sign of “Lesser Tralet

Back 5

is a sudden onset of numerous seborrheic keratosis due to a paraneoplastic syndrome

Front 6

Histology of Seborrheic Keratosis

Back 6

Sharply demarcated, exophytic, hyperplastic epithelium with pigmented basal cells

Keratin Horn Cyst formation and hyperkeratosis

Front 7

Acanthosis Nigricans

Back 7

Thickened, hyperpigmented velvety zones in flexural areas (axilla, groin, anogenital)

Usually arises in childhood (autosomal dominant)
Associated with obesity and endocrine disorders (i.e. diabetes)

Front 8

Sudden onset of Acanthosis Nigricans may be associated with

Back 8

occult malignancy (i.e. adenocarcinoma releasing growth factors)

Front 9

Fibroepithelial Polyp(a.k.a. Skin tag, Acrochordon, Squamous papilloma)

Back 9

Commonly found on neck, trunk, face or intertriginous (skin folds)
Soft flesh colored polyps

Front 10

Keratoacanthoma

Back 10

A self limited spontaneously healing, rapidly growing lesion in sun exposed Caucasians (usually > 50 y/o)
Flesh colored dome-like nodule with a central keratin filled crater often on hand or hand

Front 11

Epithelial Inclusion Cyst

Back 11

Common, well circumscribed, firm dermal or subcutaneous nodules formed by downgrowth and cystic expansion of:

Epidermis (i.e. epidermal inclusion cyst)
Clinicians sometimes refer to these as “sebaceous cyst”

Front 12

A small Epithelial Inclusion Cyst known as

Back 12

milium

Front 13

Xanthelasma

Back 13

Not a tumor but a lipid deposition (i.e.xanthoma) that typically occurs around the eye
Appears as soft yellow plaques on eyelids (“chicken fat”)
May or may not be associated with lipid abnormalities
A patient with xanthoma(s) should have a lipid profile work up

Front 14

Most common form of cancer in United States

Back 14

Almost 50% of people living to the age of 65 will have skin cancer at least once in their lifetime

Front 15

Epidermal transformation into skin cancer

Back 15

KeratinocytesNonmelanoma
Melanocytes Melanoma

Front 16

3 Major types of skin cancer

Back 16

Squamous Cell Carcinoma (SCC)
Basal Cell Carcinoma (BCC)

3. Melanoma

Front 17

The vast majority of skin cancers are of non

Back 17

melanoma type usually begin as Actinic Keratosis

Front 18

Actinic (Solar) Keratosis (premalignant) can develop into

Back 18

Squamous cell carcinoma (SCC)
Basal cell carcinoma (BCC)

Front 19

Dysplastic nevus (premalignant)
can develop into

Back 19

Melanoma (can also occur de novo)

Front 20

Actinic Keratosis(Solar Elastosis)

Back 20

, dysplastic lesion associated with sun exposure, especially in light skinned individuals
Ionizing radiation, hydrocarbon, arsenicals may induce similar lesion

Front 21

In actinic Keratosis, hyperkeratosis increases leading to

Back 21

Cutaneous Horn

Front 22

Actinic (Solar) Keratosis Histology

Back 22

Cytologic atypia in the lower epidermis frequently with
basal cell hyperplasia and dyskeratosis; usually have damaged collagen
in the dermis (elastosis) demonstrated by blue-gray elastic fibers.

Front 23

Squamous Cell Carcinoma (SCC) predisposing factors

Back 23

Sunlight (UV) irradiation include:
Other predisposing factors include:
Industrial carcinogens
Old burn scars
Tobacco
Immunosuppression
Human Papilloma Virus (i.e. HPV36,18,16)
Xeroderma pigmentosum (inherited defect in DNA repair)

Front 24

Squamous Cell Carcinoma In Situ SCC ( Bowen’s Disease)
Appears as

Back 24

well demarcated red scaling plaques

Front 25

Squamous Cell Carcinoma In Situ SCC ( Bowen’s Disease) Histology shows

Back 25

full thickness epidermal atypia”
- lack of epidermal maturation
- intact basement membrane at epidermal-dermal junction

Front 26

Squamous Cell Carcinoma (SCC) Invasive SCC

Back 26

nodular, variably hyperkeratotic
Prone to ulceration -> “nonhealing ulcer”

Front 27

Squamous Cell Carcinoma (SCC) Invasive SCC Histology shows

Back 27

atypical squamous cells breaking through D-E junction (basement membrane) into underlying dermis

Front 28

Mucosal involvement by SCC looks like

Back 28

white thickened plaques (i.e. leukoplakia)

can be seen in:
Lips, oral cavity
Esophagus
Ano-genital area

Front 29

Most common malignant skin tumor

Back 29

Basal Cell Carcinoma slow growing tumor, typically in
sun-exposed skin
Appear as “pearly papules” or plaques that
may ulcerate ->nonhealing ulcer
May extensively invade local tissue
(i.e. rodent ulcer)

Front 30

Basal Cell Carcinoma Histology:

Back 30

Atypical basal cell proliferation with peripheral pallisading, multifocal (skip lesions), budding, superficial growths or nodular extensions from the basal cell layer of epidermis into dermis

Front 31

A nonhealing ulcer needs to be biopsied!

Back 31

MUST RULE OUT MALIGNANCY!

Front 32

benign Melanocytic Neoplasms can be

Back 32

a. Lentigo (simplex

b. Melanocytic Nevus (Mole):

Front 33

. Lentigo (simplex)

Back 33

It is an increase in number of single basal melanocytes

Common, benign hyperpigmented macules (5-10mm on skin and mucous membrane that appear in infancy and childhood)
In contrast to freckles, these do not darken due to sun exposure

Front 34

Melanocytic Nevus (Mole):

Back 34

can be acquired or congenital - common variants:
i. Junctional nevus
ii. Compound nevus
iii. Intradermal nevus

Front 35

Lentigo Simplex histology

Back 35

Linear basal pigmentation due to# melanocytes along basal cell layer with elongation of epidermal rete ridges (lentiginous growth)

Front 36

Melanocytic Nevus may appear as

Back 36

flat, papular or pedunculated black or brown pigmented lesions

Front 37

Junctional Nevus clinical manifestations

Back 37

flat, smooth bordered, uniformly pigmented (brown to black) pigmented lesions

Front 38

Junctional Nevus Histology

Back 38

well defined, symmetrical nests of melanocytes along the dermal-epidermal (DE) junction

Front 39

Blue Nevus Clinical manifestation

Back 39

common, well-circumscribed, small, bluish-black nodules

Front 40

Blue Nevus Histology

Back 40

common blue nevus has heavily pigmented dendritic melanocytes

Front 41

Dysplastic Nevus may occur as

Back 41

isolated sporadic lesions
- may be associated with an autosomal dominant inheritance (on chromosome 1)  pt has hundreds
of lesions (Dysplastic Nevus Syndrome)

Front 42

Dysplastic Nevus Can occur on both

Back 42

sunexposed and nonexposed areas

Front 43

Dysplastic Nevus increases the risk for

Back 43

melanoma transformation (Heritable Melanoma Syndrome)

Front 44

Dysplastic Nevus Clinical

Back 44

Gross appearance warrants biopsy to rule out melanoma

Front 45

Dysplastic Nevus Histology

Back 45

Cytologic and architectural atypia
 shows features of “pre-melanoma”

Front 46

Malignant melanoma causes more than

Back 46

75% of all deaths from skin cancer

Front 47

Malignant melanoma Metastatic sites include:

Back 47

Local and regional sites in skin and lymph nodes
lung, liver, bone and intestines

Tumor spreads both through
blood and lymphatics

Front 48

Risk of Malignant Melanoma

Back 48

Family history
Presence of red or blonde hair
Presence of marked freckling
History of >3 blistering sunburns
before 20 y/o
History of >3 outdoor jobs as a teenager
Presence of actinic keratosis
Dysplastic nevus syndrome
UVA light therapy, tanning salons
Increased socioeconomic status

Front 49

Risk of Malignant Melanoma

Back 49

3.5x  risk if you have 1 or 2 risk factors
20 x increase risk if you have 3 or more risk factors

Front 50

Main risk factor Skin Cancer Risk

Back 50

UV (light exposure) Main risk factor

Front 51

Major types of Melanoma

Back 51

Superficial spreading melanoma
Nodular melanoma
Lentigo maligna melanoma
Acral lentiginous melanoma:
Unclassified type

Front 52

Acral lentiginous melanoma

Back 52

Pigmented lesions on soles, palms,subungual areas
Usually occurs in nonwhite individuals

Front 53

Melanoma most commonly invovles skin, but can involve

Back 53

mucosa, conjunctiva, orbit, nailbeds, esophagus and leptomeninges

Front 54

5 Signs of Malignant Melanoma(the A,B,C,D,E’s)

Back 54

Asymmetry in shape
Border is irregular, fuzzy or scalloped
Color is mottled, variegated
Diameter is >5mm (greater than an eraser tip)
Elevation (almost always present, except for acral sites)

Front 55

The most important clinical sign of melanoma is

Back 55

change in color in a pigmented lesion

Front 56

Histology Of Melanoma

Back 56

Atypical melanocytes with:

Nuclear enlargement, hyperchromasia and nucleoli
Cell necrosis
Mitosis
Lack of maturation
Immunpositivity for S-100, HMB45 and MART (melanoma related antigen)

Front 57

Melanoma Prognosis is mainly dependent upon:

Back 57

. Depth of invasion:
Breslow depth
Clark’s level

2. Clinical stage:
Nodal involvement
Distant metastasis

Front 58

Breslow Depth

Back 58

Measurement of vertical tumor depth
below the stratum granulosum
Superficially invasive (<1.0mm) have better prognosis than deeper invading tumors

Front 59

Clark’s Leveland Prognosis of 5 year survival
class 1-5

Back 59

1)In Situ =100% survival
2) Superficial dermal invasion-->90% survival
3)Tumor filling papillary dermis->70% "
4) Reticular dermis involvement-> 40% "
5) Tumor extension into fat->25%

Front 60

Malignant Melanoma Metastatic sites include

Back 60

Local and regional sites in skin and lymph nodes
Lung, liver,bone and intestines

Tumor spreads both through blood and lymphatics