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42 Cards in this Set
- Front
- Back
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Seborrheic Keratosis
(Senile keratosis, verruca senilis) |
-found in middle aged or older
-on trunk, common epidermal tumor -round, brown "pasted on" plaque or papule -granular surface -NO significant risk of malignancy |
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Seborrheic Keratosis
(Senile keratosis, verruca senilis) Histology/Micro |
-consists of exophytic, sharply demarcated lesion composed of sheets of small cells resembling basal cells
-*hyperkeratosis, acanthosis, and small keratin cysts (horn cysts) among epithelial cells |
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Firbroepithelia polyp
(acrochordon, squamous papilloma, skin tag) |
-one of most common cutaneous lesions; neck, face, trunk
-middle aged or older; may be a/w diabetes, intest polysis, and pregos -soft, flesh, pedunculated papule -fibrovascular core covered by hyperplastic epithelium |
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Keratoacanthoma:
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-Rapidly developing neoplasms, clinically and histo resemble SCC
->50 y/o, M>F -tan colored nodules, 1-several cm w/ keratin plug -lesion undergoes involution over a period of 5-7 months-->scar |
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Keratoacanthoma
Micro appearance |
-central keratin filled crater surrounded by proliferating epi cells which may show atypia
-inflammation cells |
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Actinic Keratosis
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-premalignant lesion (may--> SCC)
-sun-exposed areas: face, arms, dorsum of hands -predisposing: radiation, hydrocarbons, arsenic -high % of malig trans, but NOT every pt will develop malignancy |
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Actinic Keratosis
Gross Appearance |
-scaly, red patch, usually less than 1 cm (hyperkeratosis, cutaneous horns)
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Actinic Keratosis
Micro Appearance |
-hyperkeratosis, parakeritosis (abnL nuclei in keratin), acanthosis and cellular atypical lower epidermis
-many mitosises -upper derm shows basophilic degen of collagen and dense lymphocytic infiltration |
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Squamous Cell Carcinoma (SCC)
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-very common, arising in sun-exposed sites
-older people, M>F -carcinoma in situ (remains localized in the squamous epithelium and grows horizontally and flat) -sharply defined, red scaling plaques |
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Basal Cell Carcinoma
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-MOST common malig tumor of skin
-early: pearly papules -Late lesions = ulcerate, borders may be raised and rolled -may invade local bone or sinuses, called rodent ulcers |
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Basal Cell Carcinoma
Micro appearance |
-proliferating basal cells protruding from epidermis or forming large nests extending into dermis
-cells at periphery arranged radially*** |
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Basal Cell Nevus syndrome
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-dominant trait associated w/ numerous basal cell carcinoma in early life and abnormalities of bone, nervous systems, eyes and reproductive system
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Tumors of Dermis:
Benign Fibrous Histiocytoma (Dermatofibroma) |
-extremities, brown nodules
-adults, F>M -well demarcated, nonencapsulated lesion composed of prolif fibroblasts -epidermis may be acanthotic -sclerosing hemangiomas--> numerous BVs and hemosiderin |
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Tumors of Dermis:
Malignant Fibrous Histiocytoma (MFH) |
-MC soft tissue sarcoma in adults
-deep muscle, sometimes dermis -circum, gray-white, unencapsulated -storiform-pleomorphic type (atypical spindle cells in whorls) -very aggressive, 50% metastasize |
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Tumors of Dermis:
Dermatofibrosarcoma Protuberans |
-slow-grow, prtuberant, locally aggressive but rarely metastasize
-indurated plaque w/ multiple, firm, solid nodules on trunk |
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Tumors of Dermis:
Dermatofibrosarcoma Protuberans Micro appearance |
-fibroblasts arranged radially (swirled)
-atypical cells and mitosis present -tumor cells penetrate subQ fat and occasionally penetrate fascia and muscle |
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Tumors of Dermis:
Xanthomas |
-collections of foamy histiocytes w/ rather than true neoplasms
-dermis of histiocytes w/ abundant, vaculated (foamy) cytoplasm containing cholesterol, phosphos, triglycerides -multi-nuc giant cells w/ lipid laden cytoplasms (Touton giant cells) |
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Dermal Vascular Tumors:
Angioma |
-scattered, small cherry-like dots that appear on face and trunk
-middle aged -micro: dilated blood spaces -occur at birth--> disfiguring vascular marks |
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Dermal Vascular Tumors:
Angiosarcoma (hemangiosarcoma) |
-face and scalp of elderly, M>F
-multinodular, red or purple plaques of cystic or spongy consistency -micro: anastomosing vascular channels lined by endothelial cells w/ prominent hyperchromatic nuc |
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Dermal Vascular Tumors:
Kaposi's Sarcoma (KS) |
-vascular proliferative process in skin
-micro appearance similar in all forms, consists of sheets of plump spindle-shaped cells |
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What are the 4 types of KS?
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1. Classic or European - <Jews, 90% M; bluish nodules on LE, bilat
2. African: M>F, lymphadenopathy resembling lymphoma 3. Transplant: pts undergoing immunosuppression 4. AIDS-associated: MC malignant manifestation of AIDS (1/3 of pts) |
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Cutaneous Histiocytosis X
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-disorder characterized by the prolif of Langerhans Cells (contain birbeck granules)
-skin, lymph nodes, BM, viscera -solitary or multiple papules or nodules |
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Mycosis Fungoides
Cutaneous T-Cell Lymphoma |
-MC primary lymphoma of skin
-by neoplastic prolif of mat Th cells -middle aged males, on trunk, extremities, face scalp -non-specific red, scaly eczematous eruption--> fungating nodules w/ LN and viscera |
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Mycosis Fungoides
(Cutaneous T-Cell Lymphoma) Micro appearance |
-infiltration of superficial dermis by atypical mononuclear cells called Sezary Lutzner Cell that show a ceribriform pattern
-Patrieuer microabscess--> invade epidermis as single cells and small clusters that are surrounded by clear spaces |
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Sezary Syndrome
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-presence of malignant T cells in peripheral blood accompanied by diffuse erythema and scaling of entire body surface (exfoliative rash)
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Nevoceullar Nevus
(Pigmented Nevus, Common Mole) |
-any congenital or acquired neoplasm of melanocyte
-all are composed of transformed melanocytes (nevus cells) --> round to oval in shape and contain uniform nuclei w/out prominent nucleoli |
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Classifications of Nevocellular Nevus
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1. Junctional nevus: nests of nevus cells contain melanin pigment along w/ dermoepidermal junction and in the epidermis
2. Compound: derm and epiderm 3. Dermal Nevus |
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What are 5 variants of Nevocellular Nevus?
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1. Common acquired
2. Congenital nevocellular 3. Blue nevus 4. Compound nevus of Spitz 5. Halo Nevus |
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Common acquired nevus
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-small, dark brown, centrally raised, surrounded by flat area that is uniformly pigmented
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Congenital nevocellular nevus
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- may be large and contain hairs
-there is infiltration of lower dermis and subQ fat w/ small clusters of nevus cells a/w neurovascular bundles and skin appendages |
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Blue Nevus
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-deep blue-gray color, small, round or oval, well-circumscribed soft nodule
-MC on face, buttocks, arms -Micro: heavily pigmented, fibroblastic, spindle shaped cells in dermis |
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Compound Nevus of Spitz
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-rapidly growing (so often confused w/ malignant melanoma)
-solitary, tan-colored nodule -kids -Micro: spindle-shaped and plump epitheloid nevus cells that freq show nuclear irregularities |
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Halo Nevus
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-pigmented nevus surrounded by a zone of hypopigmentation, often associated w/ lymph infiltration
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Dyplastic Nevi (BK moles)
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-increased risk of malignant melanoma
-melanin pigment incontinence = phagocytosis of melanin pigment by dermal macros -protection from the sun is very important for dyplastic nevi |
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Malignant Melanoma
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-relatively common, white ppl esp
-most important sign = changes in color in a pigmented lesion -increase in size in 70% of pts -skin, scalp, oral, anorectal mucosal surfaces, nail beds, conjunctivae, orbit |
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Malignant Melanoma
Macro appearance |
-satellite tumors may appear near primary growth
-sometimes spread to LN, liver, lungs or brain -itching, bleeding, ulceration may be present -Surgical excision often curative |
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ABCDE of Dx Malignant Melanoma
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A. Asymmetry
B. Border irreg (edges scalloped) C. Color variation d. Diameter > .6cm E. Elevation |
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Depending on clinical setting and microscopic characteristics, what are the 4 types of malignant melanomas
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1. Lentigo maligna
2. Superficial spreading - MC 3. Nodular - MOST aggressive 4. Acral lentiginous (usually on sole of the feet) |
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What are the 2 statges of malignant melanomas?
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1. Radial or horizontal phase
2. Vertical phase |
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Radial or horizontal growth phase
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-horizontal growth w/in epidermal and superfic derm layers for a long period of time, melanoma cells don't have the capacity to metastasize
-lentigo maligna, superficial, and acral lentiginous: radial growth allows for ID b4 metastasis occurs |
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Vertical growth phase
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-melanoma grows downward into deeper dermal layers AND may metastasize
-nodular malig, rarest melanoma, rapid growth and begins in this phase ***-thickness of tumor in vertical growth phase is MOST important |
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Malignant Melanoma:
3 sites with poor prognosis: BANS |
1. Back of Arm
2. Neck 3. Scalp |
