Path I: Skin Lecture Iii

Front 1

dermatofibroma aka:

Back 1

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

Front 2

presentation of dermatofibroma

Back 2

tan brown papules (red when young with incr blood supply)
small
tender
raised
often appears after trauma

Front 3

benign fibrous histiocytoma (dermatofibroma) how does lesion present histologically?

Back 3

local proliferation of fibroblasts in dermis surrounding collagen bundles
centrally, epidermal basal cells proliferate over benign fibrous tissue

Front 4

what 2 variants do we not want to confuse with dermatofibromas? (why?)

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1. dermatofibrosarcoma Protuberans- malignant superficial variant (aggressive locally, rarely metastasizes)
2. malignant fibrous histiocytoma-large, very malignant

Front 5

seborrheic keratosis: population

Back 5

very common
middle aged to old

Front 6

describe presentation seborrheic keratosis

Back 6

round, flat but elevated above skin
"coin-like," stuck on
various size
trunk, prox extremities, face, neck (low sun exposure)

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morphology seborrheic keratosis

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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

Front 8

adnexal neoplasms: benign or malignant?

Back 8

99% benign: symmetrical, small, superficial, vertical (grow along original plane of appendages)
malignant: asymmetrical, large, deep and wide

Front 9

types of malignant adnexal tumors; which is most common?

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sebaceous carcinoma (most common)
eccrine carcinoma
apocrine carcinoma (rare)

Front 10

charac of adnexal neoplasms

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tend to run in families
often in hair bearing areas

Front 11

cylindroma

Back 11

islands of proliferating basaloid cells surrounding hair shaft
"jigsaw puzzle"

Front 12

where does multiple trichoepitheliomas arise from?

Back 12

epithelium of hair shaft

Front 13

why is chondroid syringoma called mixed tumor?

Back 13

has dilated sweatgland-like ducts (epithelium) with components of cartilage (stroma)

Front 14

defn actinic keratosis

Back 14

precancerous skin condition
sun exposed areas (other skin damage)
generates keratin (white, flaky crust)

Front 15

what cond put ppl at risk for actinic keratosis? (5)

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fair skin
old scars
transplantation (immunosuppressed)
albinism
genetic syndromes (XP)

Front 16

actinic keratosis clinical presentation

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erythematous
red brown macules, minimally elevated papules
overlying scales (keratin)
size varies- can form cutaneous horn
asx or tender

Front 17

who presents with actinic keratosis and where?

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middle aged to elderly
sun exposed areas (forehead, neck, back hands and arms

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why is actinic keratosis dangerous?

Back 18

considered nascent squamous cell carcinoma

Front 19

morphology of actinic keratosis

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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)

Front 20

what happens in the dermis in actinic keratosis?

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minimal papillary dermis
solar elastosis- sun damaged fibroblasts->degeneration of collagen in reticular dermis
irreversible and cummulative

Front 21

squamous cell carcinoma: defn

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malignant prolif of epidermal keratinocytes
potential for metastasis (local and distant)
usually doesn't metastasize but is locally aggressive

Front 22

SCC: etiology

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long term sun exposure (UVB 280-340)
HPV
arsenics
xs xrays
genetic syndromes (XP)
immunosuppression (transplant)

Front 23

SCC epidemiology

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incidence increases with age
male predominance
second most common malignancy of skin

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clinical charc :SCC

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early: small, firm, skin colored or erythematous
nodule
indistinct margins
surface: smooth, verrucous, or papillomatous; may bleed easily
older: larger, invasive, ulcerated center

Front 25

when does SCC in situ -> invasive?

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when breaks through BM to enter dermis

Front 26

mortality in SCC

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mortality quite low

Front 27

keratoacanthoma: charac

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RAPIDLY GROWING (days to weeks)
histologically a SCC (SCC, keratoacanthoma type)
rarely metastasize

Front 28

who gets keratoacanthoma and where?

Back 28

older adults (men more than women) on sun exposed areas (face, hands)

Front 29

morphogenesis keratoacanthoma

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central crater of keratin
proliferating epithelial edges also extend down into dermis
squamous cells are large, glassy; eosinophilic keratin islands

Front 30

keratoacanthoma presentation

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flesh colored
domeshaped nodule
central keratin plug (crater)

Front 31

basal cell carcinoma: defn

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malignant skin neoplasm
seldom metastasizes
have potential for local invasion

Front 32

etiology and epidemiology of BCC

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incr sun exposure
genetic syndromes
most common skin neoplasm
98% dev after 40 yo
males =females

Front 33

presentation BCC (where?)

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85% head and neck; rest trunk and limbs
hair-bearing skin on sun exposed areas
different type det appearance

Front 34

histological types of BCC (4)

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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

Front 35

morphology of BCC

Back 35

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

Front 36

what is the favored location of BCC

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lower eyelid (medial canthus)

Front 37

clinical course of BCC types

Back 37

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