Benign and Malignant Skin Conditions

Question 1

Solitary or multiple 
occur in middle age, female 
predilection (scalp 90%) 
dome-shaped, 0.5-5 cm nodules 
no surface punctum but easy to excise

Answer 1

Pilar cyst

Question 2

1-2 mm papules, found on face, occurs at any age, secondary to trauma and sunburn
like the epidermoid cyst w/ granular cell layer

Answer 2

Milium

Question 3

Histopathology 
homogenous, compact, eosinophilic keratin 
stratified squamous epithelium 
no granular cell layer
lining similar to epidermal cyst

Answer 3

Pilar cyst

Question 4

origin is sebaceous duct
steatocystoma simplex ( solitary, noniherited)
steatostoma multiples ( multiple)
yellowish to skin color
papules or cyst ( < 3 mm to 3 cm)
common in chest, axilla and groin, trunk, extremities

Answer 4

Steatocystoma

Question 5

Histopathology
convoluted, cystic structure in the dermis
stratified squamous epithelium
(-) granular cell layer
(+) sebaceous lobule adjacent or within the wall

Answer 5

Steatocytoma

Question 6

common in older individuals (> 30 yrs old) 
, senile warts 
multiple, stuck on appearance 
sharply demarcated, centimeter or less 
found in head, neck or trunk

Answer 6

Seborrheic keratosis

Question 7

papillomatosis and acanthosis

with marked thickened stratum corneum

Answer 7

Hyperkeratotic type Seborrheic Keratosis

Question 8

thickening of spinous cell layer

Answer 8

acanthotic type seborrheic keratosis

Question 9

thickening of spinous cell layer with pseudohorn cysts

Answer 9

acanthotic type seborrheic keratosis

Question 10

Lace-like or net like pattern

Answer 10

reticulated type seborrheic keratosis

Question 11

Hyperkeratosis, papillomatosis acanthosis with nets or clones of basaloid cells

Answer 11

clonal type seborrheic keratosis

Question 12

Hyperkeratosis, papillomatosis acanthosis with squamous eddies ( squamous cells in onion like fashion)

Answer 12

Irritated type seborrheic keratosis

Question 13

differential for seborrheic keratosis 
occur in younger population (< 30 yrs old) 
single 
brown 
found in neck, trunk and extremities

Answer 13

Epidermal nevus

Question 14

Localized nevus

Answer 14

nevus verrucosus

Question 15

systematized nevus

unilateral

Answer 15

Nevus unius lateris

Question 16

systematized nevus

Bilateral

Answer 16

Ichthyosis hystrix

Question 17

Hyperkeratosis, papillomatosis, acanthosis but occurs in younger population, single , brown can be localized or systemic

Answer 17

Epidermal nevus

Question 18

Other name: Squamous cell carcinoma in situ

Answer 18

Bowen’s disease

Question 19

Slotary, slowly enlarging, well defined, erythematous scaly patch or plaque
few mm to cm
sun exposed skin
squamous cell carcinoma in situ

Answer 19

Bowen’s disease

Question 20

2nd most common skin malignancy
frequent in males
older (> 55)
white skin (Pht type I & II)

Answer 20

Invasive SCC

Question 21

Risk factors of SCC

Answer 21

age 
light skin pigmentation 
genetic ( xeroderma pigmentosum) 
immunosuppression 
Smoking and tobacco chewing

Question 22

most important etiology of Invasive SCC

Answer 22

UVB exposure

Question 23

other sources of SCC

Answer 23

UVB
oncogenic HPV exposure ( type 16, 18, 31)
arsenic ingestion
coal tar and various hydrocarbon exposure
immunosuppression
dermatoses

Question 24

lesion single rather than multiple, common in males, found in exposed areas, old age
scalp, ears, vermillion part of the upper lips, shallow ulcer with crust and raised indurated border

Answer 24

Invasive SCC

Question 25

atypical, irregular keratinocytes, proliferating downwards, presence of keratin pearls or horn pearls which look like squamous eddies

Answer 25

Invasive SCC

Question 26

``` most common skin malignancy males > 40 yrs old white skin pht type 1 & 2 UVR exposure arsenic ingestion immunosuppresion pre-existing inflammatory/degenerative process ( e.g. ulcers,sinuses) genodermatoses ( xerodermal pigmentosum, albinism) ```

Answer 26

Basal cell carcinoma

Question 27

isolated single or mutiple lesions (85%) head and neck exposed areas slow growing, relatively on aggressive tumors

Answer 27

Basal cell carcinoma

Question 28

Histopathology | presence of junctional nevi present with nests at tips of rete ridges

Answer 28

Basal cell carcinoma

Question 29

Common called as moles

Answer 29

Common acquired melanocytic nevi

Question 30

Nevus in the epidermis, flat and more pigmented than other types

Answer 30

Junctional nevus

Question 31

Nevus in the dermis

Answer 31

Dermal ( intradermal nevus)

Question 32

Nevus in the epidermis or dermis

Answer 32

Compound nevus

Question 33

MMRISK

Answer 33

``` Moles ( > 5 atypical mole) Moles ( numerous, > 50, size > 5 mm) Red hair Inability to tan sunburn Kin ```

Question 34

Six signs of Malignant Melanoma (ABCDEE)

Answer 34

``` Asymmetric in shape Border is irregular Color not uniform Diameter is usually large Elevation Enlargement ```

Question 35

Most common type of melanoma involving sun-exposed skin epitheloid or spindle pagetoid spread s100 positive

Answer 35

Superficial spreading melanoma

Question 36

indolent lesion in the face of older men; may remain in the radial growth phase for several decades plump spindle cells along basal layer, thin and atrophic dermatitis solar elastosis ( disturbance in dermal connective tissue; sign of sun damaged skin)

Answer 36

Lentigo Maligna Melanoma

Question 37

Melanoma unrelated to sun exposure hyperpigmentation around the nail plate plaque-like dark lesion; usually seen in OPD patients Hutchinson's sign ( periungual pigmentation) hyperplastic epidermis

Answer 37

Acral lentiginous melanoma

Question 38

Exophytic, dome shaped cells invading the dermis, uniform, blackish; looks like pigmented BCC no radial or horizontal growth; only vertical

Answer 38

Nodular melanoma

Question 39

Clark's Anatomic Level of Invasion

Answer 39

Level 1: in situ melanoma Level 2: melanoma within the epidermis and a few in within papillary dermis Level 3: tumor cells Level 4: melanoma in reticular dermis Level 5: melanoma cells had gone down to subcutaneous fat

Question 40

yellowish to tan papules, umbilicated 2-3 mm with side telangiectasia ( rule out BCC) markedly enlarged sebaceous glands numerous lobules grouped around a central dilated sebaceous duct

Answer 40

Sebaceous tumor

Question 41

``` poorly differentiated hamartoma of hair germs common in children and adults solitary > multiple autosomal dominant common in nasolabial folds ```

Answer 41

Pilar tumor

Question 42

Histopathology

Answer 42

Tumor lobules/islands of basaloid cells several horn cysts embedded in upper dermis (fibrous stroma)

Question 43

adenomas of the intreepidermal eccrine duct

Answer 43

syringoma

Question 44

small, whitish or yellowish soft papules in the lower eyelids, upperchin, genitalia or thighs

Answer 44

eccrine tumors

Question 45

Histopathology Ductal structures lined by 2 layers of cuboidal cells, with comma-like tails, tail like structures that look like tadpoles

Answer 45

Syringoma

Question 46

Histopathology Fibroblastic proliferation and increased collagen oriented parallel to the skin surface vascularization oriented perpendicular to the skin surface

Answer 46

Hypertrophic scar

Question 47

Presence of markedly thicked hypereosinophilic bands of thickened collagen zebra pattern

Answer 47

Keloid

Question 48

Most common vascular tumor in infancy more common in females (3:1) solitary or multiple more common in head and neck (50%) than trunk (25%)

Answer 48

vascular tumor

Question 49

Histopathology Vascular proliferation of capillaries in lobular configuration exopytic, dome-shaped

Answer 49

vascular tumor