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68 Cards in this Set
- Front
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Freckles (Ephelis) |
Pigmented lesions of skin. Mutated clone of melanocytes which overproduces melanin. (this is enhanced in red heads) Small 1 to several mm in diameter tan-red or light brown macules in sun exposed areas. Each freckle is form a genetic hit |
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Incisional biopsy vis excisional biopsy |
Incisional is done to remove the neoplasm as well as make a diagnosis.
Excisional is done to make a diagnosis, include normal skin if possible. |
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Nevus |
aka mole Mutated clone of melaoncytes which have lost their way.
Normal melanocytes are repopulated from schwann cells.
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Melasma |
Areas of dark skin which are exposed to sun
Extra pigment production |
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Lentigo |
Extra pigment and someone elongated rete pegs.
Stable moles. |
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Nevi genetics |
acquired mutations of NRAS or BRAF down stream of RAS.
Activated BRAF and RAS allows for melanocyte proliferation. p16/INK4a and CDK4 , CDK6 holds cells in check (they are lost in melanoma) |
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What limits the potential of nevi to become malignant? |
Oncogene-induced senescence |
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Junctional nevi what do they look like |
small flat lesions. Symmetric and uniform.
Round nest of nevomelanocytes at junction or tips of rete ridges. |
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Compound nevi what do they look like |
Symmetrical architecture well circumscribed. regular arrangement of nests which are at dermal and rete ridges which it involves. (Junctional and intraepidermal components) mature cells seen in cytology. |
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Intradermal nevi what does it look like |
Nevus cells are primarily within the dermis and DO NOT involve the dermal epidermal junction. The cells do not reach the junction. Architecture is symmetrical and lots of mature collagen. Nested pattern without dermal activity. innocent features in cytology. |
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Congenital nevi -when does it occur -what are the sizes -what does it look like |
Present at birth but may not make melanin right away.
Can be small, medium, or giant
Nevus cells deep in dermis can be clustered below hair. |
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Mongolian Spot |
Blueish, purple natural tattoo usually over butt or sacral area.
Don't call it child abuse |
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Blue Nevi -what do they look like |
black-blue nodule can be confused with melanoma
Non-nested dermal infiltration often with fibrosis. Melanocytes look like dendritic cells and are heavily pigmented. Spindle-shaped melanocytes deep in dermis |
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Spindle and Epithelioid nevi What is the most common form how big its it what color is it who typically gets it |
Most common form is spitz nevus Usually under 6mm Reddish to pink in color or brown red common in children on face. Usually lacks hair and grows rapidly. |
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Spindle and Epithelioid nevi under the microscope |
Symmetrical with hyperplastic epidermis compound with nest of spindle shaped cells which rain down Melanocytes can also be in epithelioid Kamino bodies at dermoepidermal junction Desmoplastic varieties can be seen. |
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Halo nevi |
Small red to brown papule surrounded by a depigmented area.
A typical nevus with tons of inflammatory lymphocytic infiltrate. because the immune system is distorting near by melanocytes. |
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Ota's nevus -what do they look like -where are they found -who normally gets them |
Oculo-dermal-melanocytosis large and light colored blue-brown macules in skin which is innervated by 2nd and 3rd trigeminal nerves. Asians get them on forehead, temple, cheeks and nose. |
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Becker's nevus -what is it -who gets it more often |
pigmented hairy epidermal nevus more common In males (androgen sensitive) overgrowth of epidermis, melanocytes and hair follicles. (hairy) |
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Becker's nevus under the microscope |
Hyperpigmentation, increased melanin increased hair follicles and vascular channels Increased smooth muscle forming a hamartoma type lesion with small bundles which are irregularly dispersed within the dermis. |
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Dysplastic nevi |
precursors to malignant melanoma loss of function in CDKN2A gene Notch 1 positive (most dysplastic nevi do not progress to melanoma and not all melanomas arise from dysplastic nevi) usually larger than normal nevi (>5mm) |
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Dysplastic nevi under the microscope |
can occur on both sun exposed and non-sun exposed parts. Architectural and cytologic atypia is key Nest fusion, enlarged nests, both in the epidermis and dermis. Single cells may be seen. Melanin incontinence, fibrosis along rete ridges in linear fashion. (fused rete ridges) |
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Lentigo Maligna |
Melanoma in situ on sum damaged skin No invasive features (slow grower) bump formation on skin surface
looks like a freckle or lentigo but has ugly cells |
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Lentigo maligna under the microscope |
Sun damaged skin (solar elastosis) epidermal atrophy, bizarre melanocytes often with fine dusty pigment. |
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Melanoma -how does it happen - what mutations occur |
From sun exposure or can be sporadic from AD inherited defect. UV damage induces DNA damage Mutation in CDKN2A, P15/INK4b, P16/INK4a, and P14/ARF. Increase RAS P13K/AKT The mutations lead to increased melanocytic proliferation. |
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Which genes are affected by melanoma |
BRAF, RAS, NRAS, KIT, NF1 and PTEN |
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Teleomere preservation and melanoma -what happens -what gene is responsible |
preservation of telomeres can result in uncontrolled growth
TERT gene is responsible |
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what does melanoma look like |
irregular borders, asymmetric often notched variation in color from black to red to blue to brown. Spreads within dermis and epidermis quickly Gets larger quickly. |
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Breslow depth of melanoma |
the deeper the melanoma spreads the less likely survival. |
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Melanoma under the microscope |
Atypia can vary Mitotic figures, pagetoid spread, single cells in the epidermis, solar elastosis pigmentation, fine dusty pigment lymphocytic response, fibrosis and regression |
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acral lentiginous melanoma |
lentiginous covered with small spots
on non hair bearing surfaces, the palms, soles, under the nails and in oral mucosa.
more common in dark skinned people |
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acral lentiginous melanoma |
Longitudinal tan brown or black streaks on a finger or toe nail, nail fold, or palms of hands or soles of feet.
atypical melanocytes singly at the junction, associated with desmoplasia and dermal invasion. |
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Amelanotic Melanoma |
malignant cells do not make melanin
skin may be pink, purple, red, of normal color, asymmetrical in shape, irregular shaped faintly pigmented border.
poor prognosis |
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Nevus Sebaceus -what do they look like -when do they present -what disease are they associated with -histology |
on face or scalp often present at birth slightly raised hairless palque at puberty lesion can become nodular and verrucous associated with neurocutaneous syndrome Histology epidermal hyperplasia with increased sebaceous glands and hair follicals. |
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Seborrheic keratoses |
benign basal-type cells horn cysts (benign pearls) wart-like dark growths on skin
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The sign of laser- trelat |
sudden eruption of seborrheic keratoses warns of internal malignancy |
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Dermatosis papulosa nigra |
looks similar to seborrheic keratosis on black people morgan freeman |
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Acanthosis nigricans |
warns of internal adenocarcinoma and/or syndrome insulin resistance |
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Fibroepithelial polyps what are they |
skin tags or acrochordons |
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Angiokeratomas |
little red spots If they are all over think fabrys |
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Multiple epidermoid inclusion cysts |
think gardner's syndrome
Send for colonoscopy |
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Epidermoid inclusion cyst |
lining looks like epidermis and it keeps in the nastiness |
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Milia |
white bumps or small cysts on skin |
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Keratoacanthoma |
seen on sun damaged skin. Rapid growth, umbilicated lesion Crateriform lesion (filled with keratin) DO NOT SHAVE likely to vanish |
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keratoacanthoma under the microscope |
epidermis extends to lip of lesion and looks similar to SCC. Well differentiated glassy cells with prominent nucleoli. |
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Eccrine (dermal) cylindroma |
benign adnexal tumor which grows on the scalp or forehead. Multiple tumors can form a turban. |
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Eccrine (dermal) Cylindroma under the microscope |
nests of cells surrounded by collagen like eosinophilic material, hyperchromatic nuclei that may palisade. Other cells which stain light have ovoid nuclei in the center. Key feature: Decreased lymphocytes |
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Syringoma |
benign sweat duct tumor. Typically clustered on eye lids, vulva, armpits. tan colored firm round bumps 1-3mm in diameter which can be confused with xanthelasma. |
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syringoma under the microscope |
tadpole morphology to the cells embedded in a fibrous stroma with numbers small ducts with two rows of cells ducts may have amorphous material in them |
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Trichoepithelioma -what does it look like -where are they found |
Round, firm skin colored nodules (2-8mm)in nasal labial folds, upper lip, nose, and forehead.
Horn cuts which can have keratin center and are surrounded by basophilic cells.
The basophilic cells form islands in stroma. |
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Pilomatrixoma -what is it? -where are they found? |
Calcifying epithelium of Malherbe Usually solitary on face and upper extremities. firm deep nodule, can be superficial. Blue-red in color
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Pilomatrixoma -what does it look like under the microscope |
stroma has multinucleate giant cells basaloid cells surrounding shadow cells
(shadow cells = cytoplasmic ghost without nuclei) |
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Actinic keratosis -what does it look like |
multiple lesions on sun damaged skin. Smaller than 1cm in size erythematous, covered in scales may or may not have pigment Squamous cell in situ (premalignant) can occasional turn into real squamous CA |
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Actinic keratosis under the microscope |
Bands of parakeratosis and orthokeratosis. Mild to moderate atypia of cells. lymphocytic infiltrate in dermis |
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Bowen's disease |
Neoplastic skin disease which is intraepidermal. (squamous carcinoma in situ) erythematous plaque with irregular border and surface crusting.
from solar damage, arsenic, immunosuppression, HPV, chronic skin injury |
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Paget's disease |
there is mammary and extramammary. extramammary is rare and slow growing noninvasive intraepithelial adenocarcinoma.
Seen on vulva or penis |
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Squamous cell carcinoma |
Keratinizing and non-keratinizing variety. Sun damaged skin Asymptomatic ulcer or red plaque which may bleed. |
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Basal cell carcinoma -what does it look like |
superficial well demarcated edges. Pink to red rolled borders Nodular, pigmented ulcerated center |
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Basal cell carcinoma under the microscope |
peripheral palisading basaloid cells in buds and irregular shaps collagen like stroma scattered lymphocytes |
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Gorlin syndrome |
AD unusual facial appearances and predisposition for basal cell carcinoma.
mutation of PTCH gene on Chr 9q
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findings of gorlin syndrome |
multiple basal cell carcinomas of skin Odontogenic keratocyst (mandible and young) Rib and vertebrae anomalies intracranial calcification skeletal abnormalities early calcification of flax cerebri distinct faces |
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Atypical fibroxanthoma -what do you get it from -what does it look like -histo |
sun damaged skin, head and neck, radiation, younger patients. solitary or multiple tumors red juicy lesion which is ulcerated or crusted.
spindly reactive appearing stroma with frequent mitotic figures, hypercellular. |
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Juvenile xanthrogranuloma what does it look like? histo? |
firm slightly raised papulonodule dense dermal infiltrate of lymphocytes, histocytes and touton type giant cells, eosinophils, neturophils. Mitiotic figures may be seen. |
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What does juvenile xanthrogranuloma stain with |
Vimentin CD68, HAM56, Factor 13a, NKI-C3/ CD63 (60%), lysozyme, alpha 1 antichymotrypsin |
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When do cherry hemangiomas start popping up |
around 20 |
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Pyogenic granuloma |
Form of lobular capillary hemangioma (doesnt form pus) usually lobulated or smooth. Can be red-pink or purple
Chunk of granulation tissue that never heals itself |
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Cutaneous lymphoma |
Mostly T-Cell origin Biopsy to confirm T-cells with convoluted nucleus |
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Pautrier microabscess |
Rash with dermatographism mycosis cells located within the epidermis in T-cell lymphomaand mycosis fungoides.
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Mastocytosis |
Urticaria pigmentosum They are all mast cells DO NOT rub the spot on baby's head |
