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99 Cards in this Set
- Front
- Back
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what are prickle cells
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the spiny layer, acanthocytes- desmosomes hold this layer of skin together
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whats a langerhan cell
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in the skin- its an APC
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whats a merkel cell
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its a neural cell in the basal layer of epidermis
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what is a...
1. macule 2. patch 3. papule 4. nodule 5. plaque |
1. macule: flat, colored or depigment
2. patch: large macule 3. Papule: elevated 4. nodule: elevated circular 5. plaque: large, flat top elevation |
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whats a...
1. Wheal 2. vesicle 3. bulla 4. pustule 5. crust |
1. wheal: itchy, elevated. blanching erythema due to dermal edema
2. vesicle: fluid filled 3. bullea- large vesicle 4. pustule: pus filled 5. Crust: dried exudate from ruptured vesicle, bulla or pustule |
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what does this describe
Pt has a skin lesion that turns white when pushed, its itchy and there seems to be dermal edema |
wheal
**intercellular edema of epidermis is spongiosis, |
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whats a...
1. Scale 2. lichenification 3. Excoriation 4. onycholysis: |
1. scale: dry "horny" excess keratin. result of imperfect cornificaiton
2. lichenification: thick rough skin, usually caused by repeat rubbing 3. Excoriation: scratch scratch scratch!!! 4. onycholysis: loss of integrity of nail |
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what derm term is being described
cafe au lait mongolian spots erythema hemosiderin |
macule- flat, colored
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what is this...
1. thick stratum corneum 2. when the stratum corneum cells keep their nuclei 3. Epidermal hyperplasia |
1. hyperkeratosis is thick stratum corneum
2. perkeratosis is when cells in the stratum corneum keep their nuclei 3. Acanthosis is epidermal hyperplasia |
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1. what is it called when you loose connection btwn keratinocytes
2. dermal edema 3. epidermal edema 4. what is papillomatosis |
1. acantholyosis
2. dermal edema is seen in a wheel 3. epidermal edema is seen in spongiosis 4. papillomatosis is surface elevation caused by hyperplasia and enlargement of contigous dermal papillae |
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in derm terms what is exocytisis, erosion, ulcer
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exocytosis: when inflamm cells infiltrate the skin
erosion: incomplete loss of epidermis ulcer- complete loss of epidermis, portions of dermis and even subcutaneous tissue |
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what does lentigenous mean
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linear pattern of melanocytes proliforation w/i basal cells of epidermis.
*lentigenous melanocytic hyperplasia can be reactive or neoplastic |
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ok so we know that UV rays from the sun age you and make CA and freckles (fade) and age spots. what some dr things to know
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1. activated immune complexes- SLE
2. blunts the IR |
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Actinic Keratosis
Sq Cell CA Basal Cell CA Malignant Melanoma/Lentigo mailgna |
all are preCA and CA caused by UV radiation
actinic keratosis- UV induced basal cel is most common |
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whats vitiligo
what is it associated with |
1. loose melanocytes. seen in areas of pressure (psoriasis has simliar distribution)
*caused by an immune reaction so often assocated with AI diseases -Graves, Addisions, (thyroid is common) |
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what is the disease that is caused by an immune reaction that leads to a loss of melanocytes
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vitiligo
**pressure distribution as is seen in psoriasis |
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whats oculocutaneous albinism
pathogenesis, manifestatinos, conditions |
*melanocytes are present but they aren't making melanin
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what are the kinds of albinism
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1. ocular- just eyes are affected, no melanin can be made. X recessive
2. oculocutaneous- eyes and skin is affected. predisposed to CA (actinic keratoses, basal cell carsinoma etc). Aurosomal recessive. msot common |
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tell me about oculocutaneous albinism (2 froms)
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its a lack of production of melanin (rather than a lack of melanocytes as is seen in vitiliigo)
1. Tyrosinase positive OCA: more common its a tyrosine transport (P gene) mutation. small amt of pigment accumulation over time. 2. Tyrosine neg OCA: least common, most tested. TOTAL absence of pigment! white hair, red pupil, severe eye problems |
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what ethnic group has a lack of tyrosine transport bc of gene defect?
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navajos- they have a lot of albinism
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what is hyperpigmentation associated with pregnancy? when else is this seen
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melasma
"mask of pregnancy" also seen with OCP |
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whats the ffancy word for freckle
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ephelis
the thing with freckles are they FADE OFF SEASON. its NOT an increase number of melanocytes, its just an increase in melanin production **contrast a freckle (fade, increased melanin) with benign lentigo which wont fade and increased melanocytes |
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compare contrast ephelis and benign lentigo
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ephelis- freckle, it fades off season and is just an increase in melanin production
benign lentigo- increased number of melanocytes. DONT fade |
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your woman comes in 34 weeks preggo and has macules/patches on her face. do you
1. run, its contagious 2. tell her she needs to go to ER bc its DIC 3. tell her sorry about the hyperpigmentation, its called |
melasma
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whats the pathogenesis of nevocellular nevi
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BRAF/NRAS mutations that activate signaling pathway. so it drives proliforation but the brakes are on so limits proliforation
**p16/INK4a arrests the cell cycle as vrajes |
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what is a
1. blue nevus 2. spitz nevus 3. halo nevus |
1. blue- at birth, look blue bc skin is over the dark. important bc it can be confused with melanoma. there are spindle shape cells horizontally orientated in the dermis
2. spitz- red nodule seen in kids, looks like hemangioma or melanoma 3. halo- depigmentation around the nevus, caused by lymphocytic infiltrate (immune response against the melanocytes). can resemble melanoma |
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benign nevocellular nevus
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1. nevocellular nevus- common, benign, increase in melanocytes. uniform pigment, flat, <6mm
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whats a
1 nevus 2. nevocellular/nevomelanocytic nevus |
1. nevus- any congenital skin lesion
2. nevocellular/nevomelanocytic- congenital or acquired neoplasm of melanocytes |
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what is...
junctional nevus copound nevus dermal nevus |
1. junctional- the cells are confined to epidermal dermal jction
2. cmpd nevus- cells at epidermal dermal jction AND in the dermis 3. Dermal nevus: cells clustered in the dermis. matures into neural like cells. can be skin color |
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what is the sombrero nevus
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dysplastic, its a baddie
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what do dysplastic nevi look like, whats the sig
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sombrero, it colored but has a central risen area.
**its melanoma is waiting. treat aggressively. remove if >6mm |
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what are the genes and clinical features of familial dysplastic nevi
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the familial syndrome is a huge increase risk of melanoma, its one of the "non sun" ways to get CA
**if >6mm TAKE IT OFF gene: p16 INK4a AD |
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whats lentigo maligna
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aka hutchinsons freckle, seen on face. its an in situ melanoma- remains in situ for years
**precursor for lentigo maligna melanoma |
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p16 INK4a is associated with what
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familial dysplastic nevus syndrome- its precancerous moles. melanoma-
tx aggressive, >6mm remove |
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hutchinsons freckle
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its lentigo maligna- its in situ CA, that can progress to lentigo maligna melanoma
**on the face |
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risk factors for malignant melanoma
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1 sun exposure- severe sun burns
3. fair skin, albino (decreased melanin production) 4. dysplastic nevus |
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will a dysplastic nevus progress to sq cell CA or malig melanoma
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malignant melanoma
**actinic keratosis progresses to the sq cell |
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is radial or verticle growth more important in malignant melanoma
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verticle, depth of invasion determies liklihood to mets
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ABCDE is used for what, what does it mean
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used for malignant melanoma
Asymetry Borders Color: molted appearance Depth of invasion/diameter Elevation |
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what are the 4 types of malignnat melanoma
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1. Lentigo maligna "Hutchinsons Freckle": starts on face
2. superficial spreading malignant melanoma 3. Nodular melanoma: WORST prognosis, grows vretical 4. acrolentigenous melanoma- acro means hands, toes. can be on plantar sirface |
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tell me about lentigo malignant melanoma
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its a type of malignant melanoma, seen on face and other sun exposed areas
long radial growth phase |
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superficial spreading melanoma
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its a malignant melanoma its the most common form
seen on trunk and extremities Asymmetrical Borders are scalloped Color is molted Diameter is >6 mm Elevation |
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kaposis sarcoma is a form of what kind of skin CA
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malingnat melanome0 its the superficial spreading type
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what malignant melanoma has the worst prognosis
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nodular, it has a verticle growth
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we are great docs and look at our pts feet, what might we find CA wise
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acrolentiginous malignant melanoma of the feet. common in plantar surface
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whats hutchinsons sign
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when its on the face its lentigo meligna
on the nail skin its a subungual malignant melanoma |
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your pt has a black lesion on the bottom of their foot, its a asymmetrical, the borders are scalloped and the color is kinda molted. wahts the deal
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acrolentiginous malignent melanoma
p16INK4a, RAF gene mutations |
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what is the good prognostic factors for malignant melanma
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1. depth <1mm
2. NO ulceration 3. absence of regression (regression in melanoma is a bad thing) 4. favorable in W >M |
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what changes in CA related genes are associated with malignant melanoma
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p16INK4a mutations
bRAFmutations (also seen in benign nevi) |
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how is malignant melanoma treated
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cut it out, BRAF drugs, no chemo or radiaiton
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what are the 6 benign epithelial tumors
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1. seborrheic keratosis: common, seen in ppl over 30, seen in areas of greasy skin- not seen on palms and soles
2. acanthosis nigricans 3. fibroepithelial polyp 4. epithelial cyst 5. keratoacanthoma 6. Adnexal (appendage) tumor |
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whats suborrheic keratoses
what is it called in AA |
its a benign epithelial tumor
*seen in ppl over 30 on greasy skin (NOT palms/soles) AA: Dermatitis Papulosa Nigrans |
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what is acanthosis nigricans
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its a benign epithelial tumors
**seen in the spiny layer, |
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tell me what the gross is of suboherriec keratosis,
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common, >30 yo, face trunk UE,
*sharpe outline, raised, pigmented, "stuck on" "greasy" |
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your pt has a well outlined raised area of hyperpigmentation, its looks stuck on and is NOT seen on palms/soles. what is it. you know its benign
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seborrheic keratosis, must know pic
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what is acanthosis nigricans, whats it associated with
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its a benign epithelial tumor
*hyperkeratosis with pigmentation *gradual development **ASSOCIATIONS obesity DM, IR Visceral adenocarcinomas of stomach/lung |
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so typically your not too worried when you see acanthosis nicricans bc its a benign epithelial lesion. what might make you worry
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well we know its common in obese nad DM, if you are thin and things maybe its an outward sign of a paraneoplastic with stomach or lung adenocarcinoma
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what is a fibro epithelial polyp
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skin tag
common common common preggo DM intestinal polyposis PCOS, IR |
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whats the DR way to say skin tags
WHAT ARE they associated with |
fibroepithelial polyp
*seen in preggo, DM, intestinal polyposis *located in intrageous places (skin folds) |
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whats a wen
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epithelial cyst- "sebaceous cyst"
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whats an epidermal inculision cyst
whats a pilar/tricholemmal cyst |
epidermal inclusion- its a wen "sebaceous cyst" that squirts out white stuff. its squams that fall off and are in the middle of the cyst
pilar/tricholemmal- its a wen of the hair |
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what are the features of skin appendage tumrors
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they are papules and nodules that arise form the appendages (hair follicle, sebaceous gland, apocrine, eecrine etc). benign epithelial
types: cylindroma syringoma- lower eyes, from eccrine glands |
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whats a cylindroma
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benign epitheilal appendage cyst
truban tumor of the scalp |
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whats a turban tunor
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its a cylindroma- a benign epithelial tumor
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whats a syringoma
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benign epithelial tumor of the lower eyelid, its derived from eccrine glands to is considered an appendage tumor
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the benign appendegal tumor that shows up on lower eyelids is what
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syringoma
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whats a tricholemmoma?
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appendage tumor seen in cowdens syndrome, from hair follicle
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eccrine poroma
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its a skin appendage tumor associated iwth the palms and soles of the feet
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whats MSH MLH mutations
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Muir Torre syndrom. its akin appendage tumors associated with internal malignancy
**there are sebaceous adenomas and epitheliomas |
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remember tuberous sclerosis, with the adenomyolipoma? what are the skin manfestations
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AD- variable expressitivity
MR, seizure, brain tubers. SKIN: angiofibroma, ash leaf spots, periungual fibromas, shagreen patches (CT hamartoma) |
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name the disease
MR, AD, ash leaf spots and periungual fibromas |
tuberous sclerosis
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A 42 y/o male was seen for treatment of a
periungual growth. He was otherwise in good health. • Family history revealed a 16 y/o mentally handicapped son with a history of seizures. |
sounds like tuberous sclerosis
its AD with variable expressitivity. dad got skin lesions (angiofibroma, fibroma, ash leaf and the kid got MR) |
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• A 36‐year‐old woman with mild mental
retardation and facial angiofibromas presented for evaluation of recurrent seizures, which she reported having had since childhood. Periungual fibromas were seen in the feet. |
tuberous sclerosis
angiomyolipoma of the kidney |
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whats keratocanthoma
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super fast growing sq neoplasm
**seen in sun exposed areas. its a dome shape nodule with keratin central crater. *central cup of keratin **can regress |
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what is a characteristic of a lesion that has a done shape nodule with central keratin
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its a keratocanthoma- its a super fast growing sq neoplams. seen in sun exposed areas. sometimes regress
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This lesion, which is located at the
outer edge of the vermilion border of the lip, demonstrates a prominent core or plug of keratin |
keratoacanthoma- fast growing sq neoplasm in sin exposed areas
described as having central keratin, ulcer |
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what causes actinic keratosis
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sun exposure in fair ppl
ionizing radiation arsenicals hydrocarbons **risk for sq cell ca can make a cutaneous horn |
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what does actinic keratosis look like
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intraepidermal lesion (precancer) caued by sun exposure, risk for developing sq CA
*8red brown skin colored plaque with sandpaper feel can make a cutaneous horn |
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if you have been in the sun lots so that your natrually light hair gets lighter and you develop a sandpaper feeling papular area that is red brown, skin color etc whats the deal
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actinic keratosis
precursor to sq ce can make a cutaneous horn |
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cutaneous horns come from what
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actinic keratosis- this is caused by sun exposure and can lead to sq CA
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sq cell predisposing factors
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1. UV light
2. teratogens- tar, oil, arsenic 3. tob, betel nut smoking, sun tanning, osteomylitis, immunosuppression, xeroderma pigmentosum, precursors (actinic keratosis or carcinoma in situ) |
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sq cell CA behavior
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locally invasive
mets is rare |
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sq cell, gross and micro
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Gross: ulcerated nodule
Micro: keratin perarls |
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what are some surprising things that predispose to sq CA
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smoke
skin ulcers osteomylitis arsenic immunosuppression betel nut old burn scar |
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what are the precurson lesions to sq CA
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1. actinic keratosis
2. carcinoma in situ (bowens) |
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if a skin Ca has keratin pearls, what might the gross CA look like
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its sq cell carcinoma- it gross will be an ulcerated nodule
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is there a gene associated with sq cell CA
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not a single gene mutation
RAS signal dysfx, p53 |
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whats a benign fibrous histiocytoma?
whats it also called |
tan papules on the legs of women that dimple when squeezed
aka dermatofibroma |
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what is that benign lesion that dimples when you squeeze it
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dermatofibroma, aka benign fibrous histocytoma
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dimple sign
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benign fibrous histocytoma, aka dermatofibroma
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what is the primary malignnat fibrosarcoma of the skin, what does it look like and act like
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dermatofibrosarcoma protuberance
*spindle cell tumor in storiform pattern |
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dermatofibroma
dermatofibrosarcoma |
benign, dimple sign
primary fibrosarcoma of the skin, storiform pattern |
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cutaneous T cell lymphoma
morphology, clinical |
CD4 cells
Clinical: eczema, red papulovesicular crusting, plaques, nodules, mycoses fungiodes, sezary syndrome, pautiriers microabcess |
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your pt has a really bad looking skin lesions that are eczema, red papulovesicular crust, plaques, nodules etc etc. you think he has mycosis fingoides. what cells might be affected
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sounds like cutaneous T cell lymphoma- CD4 T cells
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sezary syndrome is assocaited with what
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Cutaneous T cell lymphoma
*get sezary luztner cells in peripheral blood, erythroderma- red man. **its CD4 T cells affected |
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what is pautriers microabcess
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its CD4 mycoses fungiodes. its with cut T cell lymphoma
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what is the most common type of mastocytoses and what are the clinical features
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utricaria pigmentosum- this is the most common of the wide specturm of disease
**seen in kids, infants, round oval plaques, good prognosis **stroking the skin causes mast cell release |
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what are the sx of systemic mastocytosis
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poor prognosis (contrast with the most common mastocysosis- urticaria pigmentosum)
Ouritis, flushing, rhinorrhea |
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darier sign and dermatographism are seen in what disease. what are they
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seen in the most common type of mastocytosis called Urticaria Pigmentosum
**darier- erythema where lesion is rubbed **dermatographism: where skni is stroked |
