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99 Cards in this Set

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what are prickle cells
the spiny layer, acanthocytes- desmosomes hold this layer of skin together
whats a langerhan cell
in the skin- its an APC
whats a merkel cell
its a neural cell in the basal layer of epidermis
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
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
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,
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
what derm term is being described

cafe au lait
mongolian spots
erythema
hemosiderin
macule- flat, colored
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
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
in derm terms what is exocytisis, erosion, ulcer
exocytosis: when inflamm cells infiltrate the skin

erosion: incomplete loss of epidermis

ulcer- complete loss of epidermis, portions of dermis and even subcutaneous tissue
what does lentigenous mean
linear pattern of melanocytes proliforation w/i basal cells of epidermis.

*lentigenous melanocytic hyperplasia can be reactive or neoplastic
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
1. activated immune complexes- SLE
2. blunts the IR
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
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)
what is the disease that is caused by an immune reaction that leads to a loss of melanocytes
vitiligo

**pressure distribution as is seen in psoriasis
whats oculocutaneous albinism

pathogenesis, manifestatinos, conditions
*melanocytes are present but they aren't making melanin
what are the kinds of albinism
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
tell me about oculocutaneous albinism (2 froms)
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
what ethnic group has a lack of tyrosine transport bc of gene defect?
navajos- they have a lot of albinism
what is hyperpigmentation associated with pregnancy? when else is this seen
melasma

"mask of pregnancy" also seen with OCP
whats the ffancy word for freckle
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
compare contrast ephelis and benign lentigo
ephelis- freckle, it fades off season and is just an increase in melanin production

benign lentigo- increased number of melanocytes. DONT fade
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
whats the pathogenesis of nevocellular nevi
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
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
benign nevocellular nevus
1. nevocellular nevus- common, benign, increase in melanocytes. uniform pigment, flat, <6mm
whats a

1 nevus
2. nevocellular/nevomelanocytic nevus
1. nevus- any congenital skin lesion

2. nevocellular/nevomelanocytic- congenital or acquired neoplasm of melanocytes
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
what is the sombrero nevus
dysplastic, its a baddie
what do dysplastic nevi look like, whats the sig
sombrero, it colored but has a central risen area.

**its melanoma is waiting. treat aggressively. remove if >6mm
what are the genes and clinical features of familial dysplastic nevi
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
whats lentigo maligna
aka hutchinsons freckle, seen on face. its an in situ melanoma- remains in situ for years

**precursor for lentigo maligna melanoma
p16 INK4a is associated with what
familial dysplastic nevus syndrome- its precancerous moles. melanoma-

tx aggressive, >6mm remove
hutchinsons freckle
its lentigo maligna- its in situ CA, that can progress to lentigo maligna melanoma

**on the face
risk factors for malignant melanoma
1 sun exposure- severe sun burns
3. fair skin, albino (decreased melanin production)
4. dysplastic nevus
will a dysplastic nevus progress to sq cell CA or malig melanoma
malignant melanoma

**actinic keratosis progresses to the sq cell
is radial or verticle growth more important in malignant melanoma
verticle, depth of invasion determies liklihood to mets
ABCDE is used for what, what does it mean
used for malignant melanoma

Asymetry
Borders
Color: molted appearance
Depth of invasion/diameter
Elevation
what are the 4 types of malignnat melanoma
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
tell me about lentigo malignant melanoma
its a type of malignant melanoma, seen on face and other sun exposed areas

long radial growth phase
superficial spreading melanoma
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
kaposis sarcoma is a form of what kind of skin CA
malingnat melanome0 its the superficial spreading type
what malignant melanoma has the worst prognosis
nodular, it has a verticle growth
we are great docs and look at our pts feet, what might we find CA wise
acrolentiginous malignant melanoma of the feet. common in plantar surface
whats hutchinsons sign
when its on the face its lentigo meligna

on the nail skin its a subungual malignant melanoma
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
acrolentiginous malignent melanoma

p16INK4a, RAF gene mutations
what is the good prognostic factors for malignant melanma
1. depth <1mm
2. NO ulceration
3. absence of regression (regression in melanoma is a bad thing)
4. favorable in W >M
what changes in CA related genes are associated with malignant melanoma
p16INK4a mutations

bRAFmutations (also seen in benign nevi)
how is malignant melanoma treated
cut it out, BRAF drugs, no chemo or radiaiton
what are the 6 benign epithelial tumors
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
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
what is acanthosis nigricans
its a benign epithelial tumors

**seen in the spiny layer,
tell me what the gross is of suboherriec keratosis,
common, >30 yo, face trunk UE,

*sharpe outline, raised, pigmented, "stuck on" "greasy"
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
seborrheic keratosis, must know pic
what is acanthosis nigricans, whats it associated with
its a benign epithelial tumor
*hyperkeratosis with pigmentation
*gradual development

**ASSOCIATIONS
obesity
DM, IR
Visceral adenocarcinomas of stomach/lung
so typically your not too worried when you see acanthosis nicricans bc its a benign epithelial lesion. what might make you worry
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
what is a fibro epithelial polyp
skin tag

common common common
preggo
DM
intestinal polyposis
PCOS, IR
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)
whats a wen
epithelial cyst- "sebaceous cyst"
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
what are the features of skin appendage tumrors
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
whats a cylindroma
benign epitheilal appendage cyst

truban tumor of the scalp
whats a turban tunor
its a cylindroma- a benign epithelial tumor
whats a syringoma
benign epithelial tumor of the lower eyelid, its derived from eccrine glands to is considered an appendage tumor
the benign appendegal tumor that shows up on lower eyelids is what
syringoma
whats a tricholemmoma?
appendage tumor seen in cowdens syndrome, from hair follicle
eccrine poroma
its a skin appendage tumor associated iwth the palms and soles of the feet
whats MSH MLH mutations
Muir Torre syndrom. its akin appendage tumors associated with internal malignancy

**there are sebaceous adenomas and epitheliomas
remember tuberous sclerosis, with the adenomyolipoma? what are the skin manfestations
AD- variable expressitivity

MR, seizure, brain tubers.

SKIN: angiofibroma, ash leaf spots, periungual fibromas, shagreen patches (CT hamartoma)
name the disease

MR, AD, ash leaf spots and periungual fibromas
tuberous sclerosis
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)
• 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
whats keratocanthoma
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
what is a characteristic of a lesion that has a done shape nodule with central keratin
its a keratocanthoma- its a super fast growing sq neoplams. seen in sun exposed areas. sometimes regress
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
what causes actinic keratosis
sun exposure in fair ppl
ionizing radiation
arsenicals
hydrocarbons

**risk for sq cell ca

can make a cutaneous horn
what does actinic keratosis look like
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
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
actinic keratosis

precursor to sq ce

can make a cutaneous horn
cutaneous horns come from what
actinic keratosis- this is caused by sun exposure and can lead to sq CA
sq cell predisposing factors
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)
sq cell CA behavior
locally invasive

mets is rare
sq cell, gross and micro
Gross: ulcerated nodule

Micro: keratin perarls
what are some surprising things that predispose to sq CA
smoke
skin ulcers
osteomylitis
arsenic
immunosuppression
betel nut
old burn scar
what are the precurson lesions to sq CA
1. actinic keratosis
2. carcinoma in situ (bowens)
if a skin Ca has keratin pearls, what might the gross CA look like
its sq cell carcinoma- it gross will be an ulcerated nodule
is there a gene associated with sq cell CA
not a single gene mutation

RAS signal dysfx, p53
whats a benign fibrous histiocytoma?

whats it also called
tan papules on the legs of women that dimple when squeezed

aka dermatofibroma
what is that benign lesion that dimples when you squeeze it
dermatofibroma, aka benign fibrous histocytoma
dimple sign
benign fibrous histocytoma, aka dermatofibroma
what is the primary malignnat fibrosarcoma of the skin, what does it look like and act like
dermatofibrosarcoma protuberance

*spindle cell tumor in storiform pattern
dermatofibroma
dermatofibrosarcoma
benign, dimple sign
primary fibrosarcoma of the skin, storiform pattern
cutaneous T cell lymphoma
morphology, clinical
CD4 cells

Clinical:
eczema, red papulovesicular crusting, plaques, nodules, mycoses fungiodes, sezary syndrome, pautiriers microabcess
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
sounds like cutaneous T cell lymphoma- CD4 T cells
sezary syndrome is assocaited with what
Cutaneous T cell lymphoma

*get sezary luztner cells in peripheral blood, erythroderma- red man.

**its CD4 T cells affected
what is pautriers microabcess
its CD4 mycoses fungiodes. its with cut T cell lymphoma
what is the most common type of mastocytoses and what are the clinical features
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
what are the sx of systemic mastocytosis
poor prognosis (contrast with the most common mastocysosis- urticaria pigmentosum)

Ouritis, flushing, rhinorrhea
darier sign and dermatographism are seen in what disease. what are they
seen in the most common type of mastocytosis called Urticaria Pigmentosum

**darier- erythema where lesion is rubbed
**dermatographism: where skni is stroked