Derm Lecture 2

Front 1

A 40 yo female comes in with this lesion thats been there for a month. its on her neck and she's concerned because she thinks it might be cancer. you tell her it's ________.

Back 1

Seborrheic Keratosis.
Note waxy-looking "stuck on appearance". On section note hyperkeratosis with psuedocysts. This is a lesion of the epidermis.

Front 2

A 65 yo farmer comes in with a crater like lesion on his neck. On histologic section you note a central collection of keratin surrounded by squamous epithelium and no evidence of dermal invasion. This patient has?

Back 2

keratoacanthoma

Front 3

1.What type of skin lesion is caused by HPV?

2. In what age groups are HPV lesions likely to be seen?

3. T/f skin lesions caused by HPV are usually self limited.

Back 3

1. verruca

2. any age group

3. True

Front 4

What is the etiology of the condition in this section?

What pathological findings do you note?

Back 4

1.hyper keratosis
2.papillary epidermal hyperplasia
3. koilocytosis (a halo like cytoplasmic vacuolization)

Front 5

1.Name a premalignant skin lesion found in sunlight exposed areas that's found mostly in adults.

2. What are the three pathological findings of this condition?

Back 5

1. actinic keratosis

2. hyperkeratosis, epidermal cytologic atypia, dermal elastosis

Front 6

1.What type of neoplasm would a farmer who smoked lots of cigarettes be prone to?
2. Does this neoplasm have a high rate of metastasis?

Back 6

1. squamous cell carcinoma
2. no (.5-3%), most are resectable

Front 7

1.What genetic disorder of defective DNA repair results in lots of squamous cell carcinomas in sun exposed areas?

2. How is this disease inherited?

3. What is the DNA repair mechanism that is broken in this condition?

Back 7

1. Xeroderma Pigmentosum

2. Autosomal recessive

3. The nucleotide excision process.

Front 8

What are the pathological findings of squamous cell carcinoma?

Back 8

1. pleomorphic cells
2. individual cell keratinization
3. atypical mitoses
4. KERATIN (horn) pearls

Front 9

1.What distinguishes in-situ squamous cell carcinoma from invasive squamous cell carcinoma?

Back 9

1. in-situ stays in epidermis; invasive invades down into the dermis

Front 10

1.What is the most common skin cancer?
2. Name 5 risk factors
3. T/F metastasis is common for basal cell carcinomas.
4. What is the main danger of basal cell carcinoma, is it local destructiveness or risk of metastasis?

Back 10

1.Basal cell carcinoma

2. age, sun-exposed areas, familial nevoid basal cell carcinoma syndrome, xeroderma pigmentosum
3. False
4. local destructiveness (not risk of metastasis)

Front 11

What are the pathologic findings of basal cell carcinoma?

Back 11

- basaloid cells
-invasive growth in the dermis
- variey of architectural patterns

Front 12

What is the definition of a nevus cell?

Back 12

melanoctye that has lost its dendritic processes

Front 13

1.What is the difference between junctional, compound and intradermal nevi?

2. name two things that distinguish congential nevus from a normal nevus?

3. Which type of nevus cell do the cells of the congenital nevus resemble?

Back 13

1.junctional: cells limited to epidermis, grossly a glat macule,
compound: cells in epi and dermis, "outie"
intradermal: solely in dermis, outie with variable pigment

2. increases risk of melanoma in large variants, growth around adnexa and blood vessels

3. The compound or intradermal nevus

Front 14

Name a nevus that is common in children and may be confused grossly with hemangioma and microscopically with melanoma.

Back 14

The Spindle and Epitheliod Nevus

Front 15

1.What nevus is located deep in the dermis, is made of dendritic and spindle cells and lacks the typical nested pattern of nevi?
2. What causes the color of this type of nevus?

Back 15

1.The Blue nevus
2. It is a result of the depth, not the production of different pigment

Front 16

What causes the histological and gross appearance of this skin neoplasm?

Back 16

The depigmented zone represents lymphopcytic infiltration and attack on nevus cells and normal melanocytes.

Front 17

1.What are the gross characteristics of a dysplastic nevus?

2. What are the histological characteristics of a dysplastic nevus?

Back 17

1. flat->slightly raised, irregular borders, variable pigmentation

2. fusion of the rete (nests join), hyperplasia of epidermis (aka lentiginous hyperplasia), lamellar fibrosis of papillary dermis irregular nuclear contours and hyperchromaisa

Front 18

What is the difference between a freckle, lentigo and a nevus?

Back 18

freckle: normal # of melanocytes, just increased basal pigmentation, pigmented macule
lentigo: pigmented macule with increased melanocytes
nevus: range from macule-> nodule increased # of nevus cells, nests of cells, epidermal and or dermal location.

Front 19

Are lentigos associated with melanocyte proliferation?

Not sure about this one.

Back 19

No. They are associated with increased exposure to the sun and aging.

Front 20

List the types of malignant melanoma from common to uncommon.

Back 20

Superficial spreading(50-75%, Nodular, Lentigo maligna, and acral lentiginous.

Front 21

What are the ABC's of malignant melanoma?

Back 21

A -asymmetry
B- irregular Border
C- Color variable
Diameter > 6mm
Enlargement/ Evolving

Front 22

Name some prominent architectural and cytological features of malignant melanoma.

Back 22

Aysmmetry
Poorcircumscription
variable epidermal nests
Solitary melanocytes with upward spread
Dermal nests of variable size and shape, lack of maturation and variable melanin

Front 23

What are the most common sites for superficial spreading melanoma?

Back 23

Trunk and lower extremities

Front 24

1.Name a type of malignant melanoma with no radial growth phase

2.What is a prominent histological finding with melanoma?

Back 24

Nodular melanoma

2. invasive melanocytic cells that are large and epitheliod

Front 25

1.What type of malignant melanoma is as a result of the confluent growth of single atypical melanocytes along basal layer?

2. When would this type of cancer be expected to invade the dermis and what characteristic would be different about the invasive cells?

Back 25

1.lentigo maligna melanoma

2. 10-50 yrs (it has a long radial growth phase) the invasive cells are usually spindle shaped

Front 26

What melanoma is frequent in palmar, plantar and subungual skin in eastern and dark skinned populations?

Back 26

Acral lentiginous melanoma

Front 27

1. What is the most important prognostic indicator for malignant melanoma?

2.What is the invasion of melanoma into the papillary dermis called?

Back 27

1. the depth of invasion (aka breslow thickness)

2.melanoma with superficial invasion

Front 28

1.What takes a 1-2 mm melanoma from stage 1 to stage 2?

2. What effect does regional lymph node metastasis have on staging and survival?

3. What is the prognosis for Stage 4 melanoma?

Back 28

1. the presence of ulceration

2. Stage III 35-45% survival 5-10 yr

3. 5-10% will survive longer than 10 yrs. (Stage 5 means distant metastasis)

Front 29

1.What is the cause of dermatofibroma?

2. Where is the most common presentation?

Back 29

1.Proliferation of spindle cells in the DERMIS.

2. The lower leg, then arms and trunk

Front 30

Describe the gross and histologic features of hemangioma

Back 30

2mm-2cm, red -blue raised lesion
mature appearing blood vessels of variable caliber. Neoplastic endothelial cells and pericytes can be noted as well. This is considered BENIGN

Front 31

1.What sporadic skin tumor is made of elements of peripheral nerves?
2.What level(s) of the skin does it typically involve?
3. What are the cytological findings?

Back 31

1. Nuerofibroma
2. Dermis +/- cutis
3. Cytologically bland spindle cells with wavy nuclei

Front 32

What syndrome has nuerofibromas and cafe au lait spots and what mutation causes it?

Back 32

Nuerofibromatosis Type I, Autosomal Dominant, mutation of NF1 gene. on 17q11.

Front 33

Aids pt. presents with purple lesions on his trunk. You biopsy a lesion and see this. Your histologic findings of _________support the diagnosis of _______________.

Back 33

Histologic findings are spindle cells and slit like vascular channels that can lead to frank hemmorhage.

Front 34

1.A 65 yo woman comes in with an ill defined red/purple plaque on her scalp. The microscopic appearance is shown. She comes back 2 months later and the plaque has spread and the microscopic appearanec has changed as is shown in the bottom section. You can tell from the findings that this is ______________.

2. You resect the lesion and the patient asks what the prognosis is. You tell her____________.

Back 34

hemangioma

we note small irregular vascular channels -> note they are very numerous in the high grade angiosarcoma.

2. This is an agressive neoplasm, notorious for reoccurence and THIS CAN BE LETHAL. (prognosis is poor.)

Front 35

What is a diagnostic clue to diagnosing an epidermoid cyst?

T/F The lining of an epidermoid cyst has a true granular layer.

Back 35

The punctum, or tiny black dot in the supepidermal mass.

True

Front 36

What distinguishes a Pilar cyst from a epidermoid cyst?

Back 36

Epidermoid cysts have a true granular layer (pilars dont) and epidermoid cysts contain keratin with a basket weave appearance and pilar cysts have a homogenous appearance.

Front 37

What type of cysts are these?

Back 37

The one on the left is an epidermoid cyst. It is lined by a true granular layer and its keratin has a basketweave appearance. The one on the right is a pilar cyst, lacking a granular layer and with homogeneous, plain jane keratin.

Front 38

1. What is the term for epithelium covering a fibrous stalk?

2. Is this malignant?

Back 38

1. acrochordion (aka skin tag)

2. No.