Reading...
Play button
Play button
Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
32 Cards in this Set
- Front
- Back
|
Case history:
A 25-year-old Caucasian woman presents with a small papule on her leg Clinical features: Dermatofibroma |
Very common lesions
Usually present on the extremities May be present for years or decades before spontaneously regressing |
|
|
Gross features: Dermatofibroma (DF)
|
Small (3-10 mm), firm, pink to brown (hyperpigmented), dull to shiny lesions with ill-defined borders
Usually solitary and more frequently involve the legs and arms than the trunk |
|
|
Histologic features: Dermatofibroma
|
Characterized by an interlacing fascicles of spindle-shape cells.
The overlying epidermis is often thickened (acanthotic) The bland spindle cells have elongated nuclei and a small rim of blue cytoplasm. |
|
|
What Other Skin Lesions Are in the Differential Diagnosis of DF?
|
Melanoma
Scar Nevus Kaposi sarcoma Metastatic carcinoma |
|
|
What Is the Etiology of DF?
|
Unknown
Possibly a reaction to minor skin injury such as insect bites |
|
|
Case history:
An elderly man presented with an ulcerated papule on the skin of the neck Gross features: Basal Cell Carcinoma |
Pearly papule
May have telangiectasia and ulceration Most arise in the head and neck regions Cross section of white-tan tumor with cystic degeneration and some hemorrhage |
|
|
Histologic features: Basal Cell Carcinoma
|
**Islands and cords** of basaloid cells arising from the basal layer of the epidermis with hyperchromatic nuclei, often accompanied by stromal separation artifact (clefting)
**Palisading** of tumor cells forming the periphery of tumor islands |
|
|
What Are Some Predisposing Factors for Basal Cell Carcinoma?
|
They are seen almost exclusively on hair-bearing skin, especially on the face
They usually occur in persons with light skin Prolonged exposure to sunlight is an important cause, although that alone is not sufficient to produce a BCC |
|
|
Do BCCs Metastasize?
|
As a rule, basal cell carcinomas do not metastasize
However, metastasis to lymph nodes, lungs and bones have been reported in very large and longstanding lesions BCC can also be deeply invasive and can invade bone |
|
|
Case history:
A 67-year-old man presented with a 1-year history of a “sore that would not heal” on his forehead Gross features: Squamous Cell Carcinoma (SCC) |
Most often presents as a nodule with central ulceration and a pink, elevated, indurated border that does not heal spontaneously
|
|
|
Histologic features: SCC
|
Pleomorphism, nuclear hyperchromasia, intercellular bridges, dyskeratosis (abnormal keratinization of individual cells) and atypical mitotic figures
Keratin pearls seen in well-differentiated SCC Areas of “solar keratosis” may often be seen in areas adjacent to the SCC |
|
|
What Is the Metastatic Potential of Cutaneous Squamous Cell Carcinoma?
|
Those arising from sun-damaged skin have a very low propensity for metastasis (0.5%)
Lesions of the lower lip are also induced by sun exposure but they carry a higher incidence of metastasis (16%) Chronic non-healing wounds, burns and stasis ulcers can give rise to squamous cell carcinomas Cutaneous carcinomas arising from these lesions have a higher rate of metastasis, as well as those arising from the oral mucosa, glans penis and vulva |
|
|
What Is the Relationship Between Actinic (Solar) Keratoses and Squamous Cell Carcinomas?
|
Actinic (solar) keratoses are multiple erythematous, scaly lesions on sun-exposed skin (face, scalp, hands) of individuals having fair complexions
They are considered pre-cancerous lesions with scattered atypical keratinocytes within an epidermis overlying solar elastosis Some actinic keratoses evolve into squamous cell carcinoma |
|
|
Case history:
This patient is a 41-year-old man who presented with an 18-month history of a pigmented lesion on his mid-back His wife called this lesion to his attention because of its *enlarging size* and **variation in color** Gross features: Melanoma |
ABCDE criteria
Asymmetry Border Color Diameter greater than 10 mm Elevation or Enlargement of the lesion |
|
|
Histologic features: Melanoma
|
Tumor cells have large, irregular, hyperchromatic nuclei, often with prominent nucleoli
Pagetoid spread of malignant cell into the epidermis is usually seen, as well as individual melanocytes packed together along the dermoepidermal junction |
|
|
Radial Growth and Vertical Growth of Malignant Melanoma
|
Vertical growth phase corresponds to frank deep dermal invasion and is associated with the potential for metastasis.
Radial growth phase refers to an early lesion when atypical melanocytic cells proliferate horizontally in the superficial, papillary dermis Melanoma in radial growth phase has little potential for metastasis The prognosis is excellent if the lesion is completely excised |
|
|
Histologic features: Melanoma
|
Cytoplasm of tumors cells contain variable amounts of dusty melanin pigment
Occasionally no pigment is visible with H&E stains |
|
|
What stain to use if no pigment is visible in H&E stain to look for melanoma?
|
Immunohisto-chemical stains as this one for HMB-45 help identify melanin producing cells when no pigment is visible with H&E stains
|
|
|
Breslow Depth Staging Scheme for Invasive Malignant Melanoma
|
Tumor thickness measured from the top of the granular layer to the deepest extension of the tumor
Has been shown to be the single most important factor in predicting survival for stage I patients (that is, without palpable regional lymph node enlargement) Overall, malignant melanomas less than 0.76 mm thick rarely metastasize (close to 0% risk of mortality) Those between 0.76 to 1.5 mm thick have intermediate risk (23%) Tumors thicker than 1.5 mm have a 37% mortality rate |
|
|
Ocular melanoma
|
Most common malignant neoplasm of the eye
Often see extensive local invasion and late metastases |
|
|
How Does a Compound Nevus Differ From Melanoma?
|
A compound nevus (CN) is a benign tumor characterized by nevus cells at the dermoepidermoid junction and within the dermis
CN’s are usually small pigmented asymptomatic papules or macules Melanoma is a malignant melanocytic tumor |
|
|
Case history:
A HIV+ 18-year-old woman was noted to have multiple small skin-colored dome shaped papules with umbilicated centers in the genital region and lower extremities She also had multiple purple colored patches and nodules, some ulcerated, in the skin of the left lower extremity and on the oral mucosa Gross features: Kaposi sarcoma |
Purple patches, papules, nodules which may ulcerate
|
|
|
Histologic features: Kaposi sarcoma
|
Infiltrative neoplasm composed of spindled endothelial cells forming slit shaped vascular spaces
There is erythrocyte extravasation and hemosiderin deposition within the tumor |
|
|
KS epidemiology
|
In the non-immunocompromised population, Kaposi sarcoma occurs more commonly among elderly Jewish males of European ancestry
In this group of patients, the disease is usually limited to the lower extremities In immunocompromised patients, the lesions not only involve skin but also internal organs |
|
|
What happens if the immune is restored to KS tumor?
|
If normal immune function is restored, the tumors will regress
|
|
|
Gross features: Kaposi sarcoma
|
Lesions may involve not only the skin but may also disseminate and affect any organ in the body (lymph node and small bowel, vetebral body etc)
|
|
|
What virus is associated with KS?
|
Kaposi sarcoma is known to be associated with human herpesvirus type 8 (HHV 8) in both immunocompetent and immunocompromised individuals.
|
|
|
Case history:
A 60-year-old male with history of renal cell carcinoma treated by nephrectomy 20 years ago presents with a solitary vascular appearing lesion on his forehead Metastatic Tumors of the SKIN |
Clinical features:
Three to four percent of malignant tumors may metastasize to the skin Most patients have a history of prior cancer Sometimes, however, the metastases may be the first sign of cancer |
|
|
Gross features: Metastatic Carcinoma
|
Metastases usually present as a solitary firm nodule with a thickened fibrotic appearance
Some tumors, however, present with multiple nodules Their appearance reflects their origin |
|
|
What Extracutaneous Neoplasms Frequently Involve the Skin?
|
Any tumor can present as a skin metastasis.
Common primary solid tumors that spread to the skin are breast, gastric, lung, colon, renal, uterine, prostate and liver cancer. Neuroblastoma in children also may spread to the skin. |
|
|
Gross features: Metastatic Carcinoma
|
Certain areas of the skin are predisposed to metastases localizing near the site of primary cancer.
Abdominal wall metastasis at the umbilicus (Sister Mary Joseph’s nodule), often from adenocarcioma of stomach, kidney, or ovary |
|
|
What Is a Chloroma?
|
Hematologic malignancies, e.g. leukemia may involve the skin.
Chloroma refers to any tumor, usually a myelogenous leukemia, AML, that produces a green-colored tumor. |
