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37 Cards in this Set

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dermatofibroma aka:
benign fibrous histiocytoma: family of related benign dermal neoplasms of fibroblasts and histiocytes (may not be true neoplasm; more like exaggerated fibroblastic resp to trauma)
adults (young-mid aged women)
legs
presentation of dermatofibroma
tan brown papules (red when young with incr blood supply)
small
tender
raised
often appears after trauma
benign fibrous histiocytoma (dermatofibroma) how does lesion present histologically?
local proliferation of fibroblasts in dermis surrounding collagen bundles
centrally, epidermal basal cells proliferate over benign fibrous tissue
what 2 variants do we not want to confuse with dermatofibromas? (why?)
1. dermatofibrosarcoma Protuberans- malignant superficial variant (aggressive locally, rarely metastasizes)
2. malignant fibrous histiocytoma-large, very malignant
seborrheic keratosis: population
very common
middle aged to old
describe presentation seborrheic keratosis
round, flat but elevated above skin
"coin-like," stuck on
various size
trunk, prox extremities, face, neck (low sun exposure)
morphology seborrheic keratosis
benign prolif of keratinocytes at surface; grows out because less resistance
sheets of small cells that look like basal cells
horn cysts, invagination cysts- both full of keratin
adnexal neoplasms: benign or malignant?
99% benign: symmetrical, small, superficial, vertical (grow along original plane of appendages)
malignant: asymmetrical, large, deep and wide
types of malignant adnexal tumors; which is most common?
sebaceous carcinoma (most common)
eccrine carcinoma
apocrine carcinoma (rare)
charac of adnexal neoplasms
tend to run in families
often in hair bearing areas
cylindroma
islands of proliferating basaloid cells surrounding hair shaft
"jigsaw puzzle"
where does multiple trichoepitheliomas arise from?
epithelium of hair shaft
why is chondroid syringoma called mixed tumor?
has dilated sweatgland-like ducts (epithelium) with components of cartilage (stroma)
defn actinic keratosis
precancerous skin condition
sun exposed areas (other skin damage)
generates keratin (white, flaky crust)
what cond put ppl at risk for actinic keratosis? (5)
fair skin
old scars
transplantation (immunosuppressed)
albinism
genetic syndromes (XP)
actinic keratosis clinical presentation
erythematous
red brown macules, minimally elevated papules
overlying scales (keratin)
size varies- can form cutaneous horn
asx or tender
who presents with actinic keratosis and where?
middle aged to elderly
sun exposed areas (forehead, neck, back hands and arms
why is actinic keratosis dangerous?
considered nascent squamous cell carcinoma
morphology of actinic keratosis
loss of keratin "basket weave"; more condensed b/c of proliferation
densely packed blue cells at surface(immature keratinocytes; eventually mature enough to prod keratin and flatten but nuclei still present in stratum corneum- parakeratosis)
what happens in the dermis in actinic keratosis?
minimal papillary dermis
solar elastosis- sun damaged fibroblasts->degeneration of collagen in reticular dermis
irreversible and cummulative
squamous cell carcinoma: defn
malignant prolif of epidermal keratinocytes
potential for metastasis (local and distant)
usually doesn't metastasize but is locally aggressive
SCC: etiology
long term sun exposure (UVB 280-340)
HPV
arsenics
xs xrays
genetic syndromes (XP)
immunosuppression (transplant)
SCC epidemiology
incidence increases with age
male predominance
second most common malignancy of skin
clinical charc :SCC
early: small, firm, skin colored or erythematous
nodule
indistinct margins
surface: smooth, verrucous, or papillomatous; may bleed easily
older: larger, invasive, ulcerated center
when does SCC in situ -> invasive?
when breaks through BM to enter dermis
mortality in SCC
mortality quite low
keratoacanthoma: charac
RAPIDLY GROWING (days to weeks)
histologically a SCC (SCC, keratoacanthoma type)
rarely metastasize
who gets keratoacanthoma and where?
older adults (men more than women) on sun exposed areas (face, hands)
morphogenesis keratoacanthoma
central crater of keratin
proliferating epithelial edges also extend down into dermis
squamous cells are large, glassy; eosinophilic keratin islands
keratoacanthoma presentation
flesh colored
domeshaped nodule
central keratin plug (crater)
basal cell carcinoma: defn
malignant skin neoplasm
seldom metastasizes
have potential for local invasion
etiology and epidemiology of BCC
incr sun exposure
genetic syndromes
most common skin neoplasm
98% dev after 40 yo
males =females
presentation BCC (where?)
85% head and neck; rest trunk and limbs
hair-bearing skin on sun exposed areas
different type det appearance
histological types of BCC (4)
nodular- dome shaped papule; telangiectasias; crusted
sclerosing/morpheaform- yellow/pearl-white;indurated plaque; poor margins
pigmented: dark, irregular pigmentation; confused with malignant melanoma
superficial: NON-sunexposed areas (prox limbs, trunk);erythematous, scaly plaque; elevated edges
morphology of BCC
artifactual cleft b/w nests of basaloid cells in dermis and surrounding stroma
proliferation into dermis; may push out epidermis but not as raised as SCC
not ulcerated
what is the favored location of BCC
lower eyelid (medial canthus)
clinical course of BCC types
nodular and pigmented: if large may disfigure; very rarely metastasize
sclerosing: hard to remove (infiltrating fingers, pucker);recurrent; disfiguring; Mohs surgery
superficial:no deep infiltration or metastasis