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81 Cards in this Set

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Melanocytic nevi that is superficial & is in the Epidermis only
Lentigo nevi
Melanocytic nevi that occur at the junction of the epidermis & dermis
Junctional nevus
Nevi in which cells are present in both the epidermis & dermis
Compound nevi
Nevi in which benign melanocytes are only within the dermis
Dermal nevus
T or F: most melanocytic nevi mature over time
True
List the stages in which Melanocytic nevi mature
1. Lentigo = superficial, epidermis only
2. Junctional = jxn of epidermis & dermis
3. Compound = nevus cell present in both epidermis & dermis
4. Dermal = dermis only
5. Skin tag = Achrocordon
What kind of neoplasm are Melanocytic Nevi?
Benign tumor of neural crest derived Nevus cells
Melanomas may appear de novo, but they may also occur via this way
In benign melanocytic nevi which acquire a malignant phenotype = Atypical Nevus with aberrant differentiation
Congenital Melanocytic Nevus
-usually present at birth
-usually large
What is seen here?
Intradermal Nevus
-on the right
What is seen here?
Compound nevus
-within Epidermis & Dermis
-a couple of nests of cells at the base of the epidermis
What is seen here?
What are the clinical signs of Malignant Melanoma?
1. Asymmetry = shape of one half does not match the other
2. Border = edges are often ragged, notched, blurred, or irregular in outline; pigment may spread into surrounding skin
3. Color = uneven; shades of black, brown, & tan may be present; areas of white, grey, red, pink, or blue
4. Diameter = melanomas are usually larger than the eraser of a pencin (5 m or 1/4 inch)
5. Elevation = usually present but not always
Malignant Melanoma
What are these pictures showing?
What are the 4 classifications of Malignant Melanoma?
1. Superficial spreading melanoma
2. Nodular melanoma
3. Acral Lentiginous Melanoma
4. Lentigo Maligna Melanoma
This is the most common for of Malignant Melanoma
Superficial Spreading Melanoma = radial phase predominates with no invasion of dermis
-70% of cases
Malignant melanoma form in which the vertical growth phase predominates
Nodular Melanoma
Acral Lentiginous Melanoma
Malignant Melanoma form in which it is normally seen on the palms, soles, & sub-ungual regions

More common in dark-skinned individuals
Lentigo Maligna Melanoma
Large superficial spreading malignant melanoma occuring in the elderly (radial growth phase)
List the characteristics of Vertical Growth of Melanomas
1. cells tend to differ in appearance from those of the radial growth phase (e.g. no pigmentation)
2. the dominant site of tumor growth shifts from the epidermis to the dermis
3. tumors that extend into the lower half of the reticular dermis are, by definition, in the vertical growth phase
4. Cellular immune response may be absent
List the prognostic features in Malignant Melanoma
1. Mitotic rate
2. Lymphocytic response
3. Tumor thickness (Breslow level
4. Location = extremeties have best prognosis
5. Sex = females have better prognosis
6. Regression = bad
7. Clark's level
List the definitions of the 5 Clark's levels
1. tumor cells are above the basement membrane
2. invasive cells are present only in the papillary dermis (radial growth phase)
3. tumor impinges on the reticular dermis, forming nodules that widen the papillary dermis
4. Tumor cells clearly invade the reticular dermis
5. tumor extends into the subcutaneous fat
-
-
Malignant Melanoma
What is this showing?
Malignant Melanoma in the vertical growth phase = Nodular
What is this showing?
Malignant Melanoma with Lymphocytic reaction
What is this showing?
Malignant Melanoma
-anaplastic tumor cells with no evidence of pigmentation
What is this?
Fine Needle Aspiration of Lymph Node from Metastatic Melanoma
What is this?
What correlates an increased risk of metastasis of Melanoma?
Depth of tumor
Malignant Melanoma
This is a positive S-100 immunostain. What neoplasm?
Malignant Melanoma
-radial growth phase
-edge of lesion, with nests of melanoma cells at the dermal-epidermal jxn
What is this showing?
Superficial Spreading Melanoma = radial phase predominates
-most common form of melanoma
What is seen here?
Malignant Melanoma in the Vertical Growth Phase (Nodular)
-poorer prognosis
-melanoma cells are now beginning to move down into the dermis
What is seen here?
Acral Lentiginous Melanoma
-common in dark-skinned people
-affects palms, soles, subungual area
What is seen here?
_________ refers to any growth composed of a benign, localized proliferation of keratinocytes
Keratosis
Scaly, pigmented, elevated lesion or plaque in which the scales are easily rubbed off

Benign lesion

Occurs most commonly in elderly

Look like brown bubble gum that has been thrown at the skin & stuck there
Seborrheic Keratosis
What parts of the body do Seborrheic Keratosis not occur?
Palms & Soles
-pretty much every where else though
Seborrheic Keratosis = benign squamoproliferative neoplasm
-tan to brown coin-shaped plaques with a granular surface
-"stuck on" appearance
What are these lesions called?
Seborrheic Keratoses
Horn Cysts...Dx???
Seborrheic Keratoses
Horn Cysts...Dx???
Seborrheic Keratosis
-"horn cysts"
Dx???
Circumscribe plaque or patch, commonly in sun-exposed areas

may evolve into Squamous Cell Carcinoma
Actinic Keratosis
What are the most common sites for Actinic Keratosis?
Face, neck, back of hands
Actinic Keratosis

Squamous Cell Carcinoma
What are these lesions?

What do they have a chance of progressing to?
Actinic Keratosis
-premalignant lesion
What are these?
Actinic Keratosis
Dx?
Actinic Keratosis
-Hyperkeratosis = Hypertrophy of the cornea or the horny layer of the skin
-Parakeratosis = Retention of nuclei in the cells of the stratum corneum of the epidermis
What is this?
Actinic Keratosis
Dx?
What may certain subtypes of HPV evole into?
Squamous Cell Carcinoma
Verruca Vulgaris = HPV type I
What is seen here?
Verruca Vulgaris = HPV type I
What is this?
Verruca Vulgaris = HPV type I
Dx?
Condyloma Accuminatum = Koilocytosis
What is this biopsy from?
What are the classifications of Basal Cell Carcinoma?
1. Pearly papule
2. Rodent Ulcer
3. Superficial BCC
4. Morphea-like BCC
5. Pigmented BCC (may resemble melanoma)
What are the most common sites of Basal Cell Carcinoma?
Sun-exposed areas of the body
MC malignant skin tumor
Basal Cell Carcinoma
Basal Cell Carcinoma - Pearl type

MC sites are:
1. Inner Canthus of Eye
2. Upper Lip
Dx?
Locally aggressive, infiltrating skin cancer that DOES NOT METASTASIZE
Basal Cell Carcinoma
Basal Cell Carcinoma
-invasive nests of basoloid cells with palisading growth pattern
Dx?
Dx?
Basal Cell Carcinoma
-tumor clumps surrounded by cells at the periphery with palisading arrangement of nuclei
Skin Carcinoma that may evolve from Actinic Keratosis or from sun exposure
Squamous Cell Carcinoma
Skin carcinoma that has the potential to metastasize
Squamous Cell Carcinoma
What are the most common sites of Squamous Cell Carcinoma?
Face, neck, back of hands
*BRS = tends to involve Lower part of face = lower lip & down + ears + dorsum of hand
Squamous Cell Carcinoma
-small, ulcerating nodule
Dx?
Squamous Cell CA arising in Actinically damaged skin
What is your Dx?
Squamous Cell Carcinoma
-keratin pearls
Dx?
Squamous Cell Carcinoma
-infiltrating with Keratin Pearls
Dx?
Squamous Cell Carcinoma
-dyskeratosis = premature keratinization in cells that are not in the keratinizing surface layer of the skin
-Intercellular bridges
Dx?
Rapidly growing, benign crateriform tumor with a central keratin plug
-sun-exposed skin
-spontaneous regression
-variant of Squamous Cell CA
Keratoacanthoma
Keratoacanthoma
-rapidly growing skin epidermal tumor that mimics Squamous Cell Carcinoma
-crateriform tumor with central keratin plug
What are seen here?
Keratoacanthoma
-central, keratin filled crater surrounded by proliferating epidermal cells similar to those seen in squamous cell CA
What is this?
Tumor of the Dermis that is a dome-shaped, firm, rubbery nodule 3-5 mm in diameter
Dermatofibroma
Where do most Dermatofibromas occur?
Arms & legs
Dermatofibroma = Benign Fibrous Histiocytoma
What are these benign tumors of the dermis?
Where does HIV-related Kaposi's Sarcoma usually occur?
Head & neck
Where does the classic form of Kaposi's Sarcoma usually occur?
Lower leg & Feet
Kaposi's sarcoma = flat, pink lesion
What is this?
Kaposi's Sarcoma
What are these showing?
Kaposi's Sarcoma
What is this?
Where do most Cutaneous T-cell Lymphoma's occur?
-
Cutaneous T-cell Lymphoma
Dx?
Cutaneous T-cell Lymphoma
Dx?