091914 neoplasia Flashcards
seborrheic keratosis
benign
one of most common skin neoplasms
papules and plaques with stuck on, warty appearance
some harbor mutations in FGF receptor 3
seborrheic keratoses occur in whom
middle age/older pts
multiple seborrheic keratoses are associated with?
and what is the term given to it?
internal malignancies (stomach cancer) called the Leser-Trelat sign
verrucous
warty
exophytic
growing outward past the surface epithelium
acanthotic
epithelial hyperplasia
diffuse
hyperkeratosis
thickening of stratum corneum due to keratin
histology of seborrheic keratosis
hyperkeratotic (thickening of stratum corneum), papillomatous, and verrucous epidermis
exophytic
HORN and pseudo horn cysts
variable melanin pigmentation
actinic keratosis
also known as solar or senile keratoses
resulting from chronic sun damage
dysplastic condition
10% of cases do become malignant, some stabilize or regress
in middle aged, elderly
clinical appearance of actinic keratosis
rough, erythematous or yellow/brown, scaly lesions
treatment for seborrheic keratosis
not necessary
but cryotherapy can be performed for symptomatic lesions
treatment for actinic keratoses
surgical destruction (cryotherapy or biopsy) medical therapy
histology of actinic keratoses
cytologic atypia of basal layer of epidermis
corneal layer is thickened with retained nuclei (parakeratosis)
dermis has thickened, blue-gray elastic fibers (blue-know that has been exposed to sun)
squamous cell carcinoma
sun exposed sites
(also other predisposing factors)
SCC in situ is irregular in shape, erythematous, scaly or crusted, plaques.
invasive lesions are nodular, show variable scale, may ulcerate.
5% become invasive
treatment for squamous cell carcinoma
can be completely removed with surgery or sometimes with topical med
histology of squamous cell carcinoma
full thickness dysplasia
lack of polarity of cells
keratoacanthoma
variant of squamous cell carcinoma
often a solitary, pink or flesh colored dome shaped nodule with central keratin plug on sun exposed skin of elderly
tendency to involute spontaneously
tx of keratoacanthoma
mostly surgical
histology of keratoacanthoma
exophytic lesions with invaginating mass of keratinizing, well differentiated squamous epithelium at the sides and bottom of lesion
central kertain filled crater
basal cell carcinoma
most common cutaneous malignant neoplasm
more common in elderly males
PTCH1 mutations in 30% of BCCs
clinical appearance of basal cell carcinoma
papule with pearly translucent edge with visible telangiectasia
tx of basal cell carcinoma
surgery
histology of basal cell carcinoma
several variants
including:
multifocal growths originating from epidermis (superficial type) or
nodular lesions growing downward into dermis (nodular type) of variably basophilic cells with peripheral palisade
melanocytic nevi
melanocytes increase w/ stimulation–acquired nevi
also present at birth-congenital nevi
histology of melanocytic nevi
3 types: junctional, compound, intradermal
melanocytic nevi are initially made of round to oval cells that grow in nests along dermal-epidermal junction (junctional nevi)
eventually, junctional nevi grow into underlying dermis as nests or cords of cells (compound nevi)
in older lesions, the epidermal nests may be entirely lost to leave pure dermal nevi (intradermal nevi)
dysplastic nevus
pts w/ multiple dysplatic nevi have increased risk for melanoma, and dysplatic nevi themselves have some potential for malignant transformation
larger than acquired nevi usually (more than 0.5 cm), irregular in shape, often show uneven color with dark brown centers
dysplastic nevus syndrome
familial or sporadic occurrence of multiple dysplastic nevi
sporadic-usually 2 to 10 develop
familial-usually hundreds develop, lifetime risk of melanoma approaches 100%
histology of dysplastic nevi
junctional or compound, NEVER intradermal
nevus cell nests may be enlarge and abnormally fuse with adjacent nests (bridging)
nevus cells begin replacing normal basal cel layer, producing “lentiginous hyperplasia”
shoulder phenomenon
melanoma
development is multifactorial
risk factors are excessive UV exposure, fair complexion, childhood sunburns, increased number of dysplastic nevi, family history, older age, xeroderma pigmentosum, familial dysplastic nevus syndrome, possibly immunosuppression
radial growth phase-no capacity to metastasize
tx for melanoma
superficial lesions are cured surgically
metastatic-poor prognosis
probability for metastasis is predicted by measuring depth of invasion in millimeters of the vertical growth phase nodule (Breslow thickness)–the most important single prognostic indicator
for invasive melanomas greater than 1 mm in Breslow thickness, sentiel lymph node biopsy is recommended
types of melanoma
lentigo maligna melanoma
superficial spreading melanoma
nodular melanoma
acral lentiginous melanoma
histology of melanoma
melanoma in situ shows asymmetric population of melanocytes within epidermis (single cells and clusters throughout all levels of epidermis). melanoma cells are large with abundant cytoplasm. these atypical melanocytes often show pleomorphic vesicular nuclei with prominent eosinohpilic nucleoli
invasive melanoma (vertical growth phase) shows cells in dermis that grow in poorly formed nests or individual cells as an expansile nodule
mycosis fungoides
T cell lymphoma
most common cutaneous lymphoid malignancy
late adulthood, male predominance
patch, plaque, and nodule phases
patch stage: non specific dermatitis, usually patches on the lower trunk and buttocks. ill-defined patches of varying hue. irregular in size and shape and have random distribution. this stage may go on for many years
plaque stage: well demarcated lesions which are often annular. violaceous and occasionally scaly. may develop de novo or from patches.
tumor stage: usually develops in association with pre-exsiting lesions. red in color. tense, shiny surface. ulceration may occur. usually 1 cm or more.
course of outcome of mycosis fungoides
quite variable
histology of mycosis fungoides
mature CD4 T cells. particular tendency to colonize epidermis.
to a lesser extent in early lesion and more obviously in later stages, the infiltrate has large cells with highly irregular, convoluted nuclei (known as Sezary or mycosis cells)
Pautrier microabscesses
Sezary syndrome
rare variant of cutaneous T cell lymphoma
erythroderma, blood involvement, poor prognosis
