Pathology - S2B4 - Skin 3

Front 1

Melanocytic nevi that is superficial & is in the Epidermis only

Back 1

Lentigo nevi

Front 2

Melanocytic nevi that occur at the junction of the epidermis & dermis

Back 2

Junctional nevus

Front 3

Nevi in which cells are present in both the epidermis & dermis

Back 3

Compound nevi

Front 4

Nevi in which benign melanocytes are only within the dermis

Back 4

Dermal nevus

Front 5

T or F: most melanocytic nevi mature over time

Back 5

True

Front 6

List the stages in which Melanocytic nevi mature

Back 6

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

Front 7

What kind of neoplasm are Melanocytic Nevi?

Back 7

Benign tumor of neural crest derived Nevus cells

Front 8

Melanomas may appear de novo, but they may also occur via this way

Back 8

In benign melanocytic nevi which acquire a malignant phenotype = Atypical Nevus with aberrant differentiation

Front 9

Congenital Melanocytic Nevus
-usually present at birth
-usually large

Back 9

What is seen here?

Front 10

Intradermal Nevus
-on the right

Back 10

What is seen here?

Front 11

Compound nevus
-within Epidermis & Dermis
-a couple of nests of cells at the base of the epidermis

Back 11

What is seen here?

Front 12

What are the clinical signs of Malignant Melanoma?

Back 12

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

Front 13

Malignant Melanoma

Back 13

What are these pictures showing?

Front 14

What are the 4 classifications of Malignant Melanoma?

Back 14

1. Superficial spreading melanoma
2. Nodular melanoma
3. Acral Lentiginous Melanoma
4. Lentigo Maligna Melanoma

Front 15

This is the most common for of Malignant Melanoma

Back 15

Superficial Spreading Melanoma = radial phase predominates with no invasion of dermis
-70% of cases

Front 16

Malignant melanoma form in which the vertical growth phase predominates

Back 16

Nodular Melanoma

Front 17

Acral Lentiginous Melanoma

Back 17

Malignant Melanoma form in which it is normally seen on the palms, soles, & sub-ungual regions

More common in dark-skinned individuals

Front 18

Lentigo Maligna Melanoma

Back 18

Large superficial spreading malignant melanoma occuring in the elderly (radial growth phase)

Front 19

List the characteristics of Vertical Growth of Melanomas

Back 19

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

Front 20

List the prognostic features in Malignant Melanoma

Back 20

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

Front 21

List the definitions of the 5 Clark's levels

Back 21

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

Front 22

-

Back 22

-

Front 23

Malignant Melanoma

Back 23

What is this showing?

Front 24

Malignant Melanoma in the vertical growth phase = Nodular

Back 24

What is this showing?

Front 25

Malignant Melanoma with Lymphocytic reaction

Back 25

What is this showing?

Front 26

Malignant Melanoma
-anaplastic tumor cells with no evidence of pigmentation

Back 26

What is this?

Front 27

Fine Needle Aspiration of Lymph Node from Metastatic Melanoma

Back 27

What is this?

Front 28

What correlates an increased risk of metastasis of Melanoma?

Back 28

Depth of tumor

Front 29

Malignant Melanoma

Back 29

This is a positive S-100 immunostain. What neoplasm?

Front 30

Malignant Melanoma
-radial growth phase
-edge of lesion, with nests of melanoma cells at the dermal-epidermal jxn

Back 30

What is this showing?

Front 31

Superficial Spreading Melanoma = radial phase predominates
-most common form of melanoma

Back 31

What is seen here?

Front 32

Malignant Melanoma in the Vertical Growth Phase (Nodular)
-poorer prognosis
-melanoma cells are now beginning to move down into the dermis

Back 32

What is seen here?

Front 33

Acral Lentiginous Melanoma
-common in dark-skinned people
-affects palms, soles, subungual area

Back 33

What is seen here?

Front 34

_________ refers to any growth composed of a benign, localized proliferation of keratinocytes

Back 34

Keratosis

Front 35

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

Back 35

Seborrheic Keratosis

Front 36

What parts of the body do Seborrheic Keratosis not occur?

Back 36

Palms & Soles
-pretty much every where else though

Front 37

Seborrheic Keratosis = benign squamoproliferative neoplasm
-tan to brown coin-shaped plaques with a granular surface
-"stuck on" appearance

Back 37

What are these lesions called?

Front 38

Seborrheic Keratoses

Back 38

Horn Cysts...Dx???

Front 39

Seborrheic Keratoses

Back 39

Horn Cysts...Dx???

Front 40

Seborrheic Keratosis
-"horn cysts"

Back 40

Dx???

Front 41

Circumscribe plaque or patch, commonly in sun-exposed areas

may evolve into Squamous Cell Carcinoma

Back 41

Actinic Keratosis

Front 42

What are the most common sites for Actinic Keratosis?

Back 42

Face, neck, back of hands

Front 43

Actinic Keratosis

Squamous Cell Carcinoma

Back 43

What are these lesions?

What do they have a chance of progressing to?

Front 44

Actinic Keratosis
-premalignant lesion

Back 44

What are these?

Front 45

Actinic Keratosis

Back 45

Dx?

Front 46

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

Back 46

What is this?

Front 47

Actinic Keratosis

Back 47

Dx?

Front 48

What may certain subtypes of HPV evole into?

Back 48

Squamous Cell Carcinoma

Front 49

Verruca Vulgaris = HPV type I

Back 49

What is seen here?

Front 50

Verruca Vulgaris = HPV type I

Back 50

What is this?

Front 51

Verruca Vulgaris = HPV type I

Back 51

Dx?

Front 52

Condyloma Accuminatum = Koilocytosis

Back 52

What is this biopsy from?

Front 53

What are the classifications of Basal Cell Carcinoma?

Back 53

1. Pearly papule
2. Rodent Ulcer
3. Superficial BCC
4. Morphea-like BCC
5. Pigmented BCC (may resemble melanoma)

Front 54

What are the most common sites of Basal Cell Carcinoma?

Back 54

Sun-exposed areas of the body

Front 55

MC malignant skin tumor

Back 55

Basal Cell Carcinoma

Front 56

Basal Cell Carcinoma - Pearl type

MC sites are:
1. Inner Canthus of Eye
2. Upper Lip

Back 56

Dx?

Front 57

Locally aggressive, infiltrating skin cancer that DOES NOT METASTASIZE

Back 57

Basal Cell Carcinoma

Front 58

Basal Cell Carcinoma
-invasive nests of basoloid cells with palisading growth pattern

Back 58

Dx?

Front 59

Dx?

Back 59

Basal Cell Carcinoma
-tumor clumps surrounded by cells at the periphery with palisading arrangement of nuclei

Front 60

Skin Carcinoma that may evolve from Actinic Keratosis or from sun exposure

Back 60

Squamous Cell Carcinoma

Front 61

Skin carcinoma that has the potential to metastasize

Back 61

Squamous Cell Carcinoma

Front 62

What are the most common sites of Squamous Cell Carcinoma?

Back 62

Face, neck, back of hands
*BRS = tends to involve Lower part of face = lower lip & down + ears + dorsum of hand

Front 63

Squamous Cell Carcinoma
-small, ulcerating nodule

Back 63

Dx?

Front 64

Squamous Cell CA arising in Actinically damaged skin

Back 64

What is your Dx?

Front 65

Squamous Cell Carcinoma
-keratin pearls

Back 65

Dx?

Front 66

Squamous Cell Carcinoma
-infiltrating with Keratin Pearls

Back 66

Dx?

Front 67

Squamous Cell Carcinoma
-dyskeratosis = premature keratinization in cells that are not in the keratinizing surface layer of the skin
-Intercellular bridges

Back 67

Dx?

Front 68

Rapidly growing, benign crateriform tumor with a central keratin plug
-sun-exposed skin
-spontaneous regression
-variant of Squamous Cell CA

Back 68

Keratoacanthoma

Front 69

Keratoacanthoma
-rapidly growing skin epidermal tumor that mimics Squamous Cell Carcinoma
-crateriform tumor with central keratin plug

Back 69

What are seen here?

Front 70

Keratoacanthoma
-central, keratin filled crater surrounded by proliferating epidermal cells similar to those seen in squamous cell CA

Back 70

What is this?

Front 71

Tumor of the Dermis that is a dome-shaped, firm, rubbery nodule 3-5 mm in diameter

Back 71

Dermatofibroma

Front 72

Where do most Dermatofibromas occur?

Back 72

Arms & legs

Front 73

Dermatofibroma = Benign Fibrous Histiocytoma

Back 73

What are these benign tumors of the dermis?

Front 74

Where does HIV-related Kaposi's Sarcoma usually occur?

Back 74

Head & neck

Front 75

Where does the classic form of Kaposi's Sarcoma usually occur?

Back 75

Lower leg & Feet

Front 76

Kaposi's sarcoma = flat, pink lesion

Back 76

What is this?

Front 77

Kaposi's Sarcoma

Back 77

What are these showing?

Front 78

Kaposi's Sarcoma

Back 78

What is this?

Front 79

Where do most Cutaneous T-cell Lymphoma's occur?

Back 79

-

Front 80

Cutaneous T-cell Lymphoma

Back 80

Dx?

Front 81

Cutaneous T-cell Lymphoma

Back 81

Dx?