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OS 212 DERMATOLOGY > Benign and Malignant Skin Conditions > Flashcards

Benign and Malignant Skin Conditions Flashcards

1
Q

Other names of Epidermal cyst

A

Epidermal inclusion cyst, infundibular cyst

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2
Q

Origin of Epidermal cyst

A

Infundibulum of hair follicle (nonacral skin)

Implantation of epidermis into dermis thru trauma

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3
Q

Clinical Features of Epidermalcyst

A

Solitary or multiple 1-5cm cyst
Slowly growing, round, firm, movable
(+) surface punctum
Often found in face, neck torso; Occasionally palms and soles

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4
Q

When you squeeze Epidermal cyst

A

foul smelling cheesy, whitish material coming out

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5
Q

Histopathology of epidermal cyst

A

Cyst wall is made up of stratified squamous epithelium with several layers including a GRANULAR CELLULAR LAYER.

Cavity contains laminated, horny, or keratinous material

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6
Q

Any cavity lined by epithelium

A

Cyst

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7
Q

Miniature epithelial cysts, small versions of epidermoid cysts

A

Milium

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8
Q

Origin of Milium

A

Infundibulum of hair follicle (Primary milium)

Epithelial structures e.g eccrine ducts (secondary milium)

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9
Q

Clinical features of Milium

A

Small, multiple, white, globoid, firm 1 to 2 mm papules
Found in face; eyelids, cheeks and forehead
Occurs at any age
Can be secondary to trauma, sunburn

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10
Q

Histopathology of Milium

A

Lining is composed of normal epidermis just like epidermoid cyst including a GRANULAR CELL LAYER

Cavity conntains laminated, horny, or keratinous material

Cysts are small and located way up, close to the epidermis unlike epidermoid cysts

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11
Q

Other names of Pilar cyst

A

Trichilemmal cyst, isthmus-catagen cyst

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12
Q

Origin of Pilar cyst

A

Isthmus of anagen hairs or sac surrounding catagen and telogen hairs

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13
Q

Clinical Features of Pilar cyst

A

Solitary or multiple
Middle age, female
Predilection for scalp
Smooth, firm, dome-shaped 0.5-5 cm nodules/tumor
No surface punctum, easily nucleated (easy to excise)

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14
Q

Histopathology of Pilar cyst

A

Content is homogenous, compact. eosinophilc keratin
No granular cell layer
Keratinocytes abrupty keratinize

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15
Q

Origin of Steatocystoma

A

Sebaceous duct (only true sebaceous cyst)

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16
Q

Clinical Features of Steatocystoma

A

Simplex (solitary, noninherited)
Multiplex (Multiple, autosomal)
Yellowish to skin colored, papules or cysts < 3mm to 3cm
Predilection for chest but also axillae, groin, trunk, extemities

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17
Q

histopathology of steatocystoma

A

Convouted cystic structure
Cyst wall = stratified squamous epithelium without an intervening granular cell layer

Cavity may contain hair, sebum, keratin

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18
Q

Diagnostic for steatocystoma

A

presence of an sebaceous lobule that is found adjacent to or within the cyst wall.

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19
Q

Other name for Seborrheic keratosis

A

Senile warts

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20
Q

Clinical features of Seborrheic keratosis

A

Mostly multiple
flesh-colored, gray brown to black papules with stuck on appearance

Older patients

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21
Q

5 histologic types of Seborrheic keratosis

A 
Hyperkeratotic type
Acanthotic type
Reticulated type
Clonal type
Irritated type
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22
Q

Hyperkeratotic SK

A

Increased thickening of stratum corneum
Papillomatosis (Upward projection of dermal papillae)
Acanthosis (Thickened spinous cell layer)

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23
Q

Acanthotic type SK

A

Thickening of the spinous cell layer
interwoven tracts of epithelial cells surrounding islands of dermal stroma
Presence of Pseudohorn cysts

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24
Q

Reticulated type SK

A

lace like or net like pattern (thin, interlacing strands of basaloid cells)

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25
Clonal type SK
Hyperkeratsis, papillomatosis, acanthosis | Nests or clones of basaloid cells
26
Irritated type SK
Hyperkeratosis, papillomatosis, acanthosis | numerous squamous eddies (Flattened squamous cells in an onion peel-like fashion)
27
Numerous small, well-circumscribed whorls of flattened eosinophilic squamous cells that gradually keratinize towards the center
Squamous Eddies
28
Three common features of seborrheic keratosis
Hyperkeratosis Papillomatosis Acanthosis
29
Clinical features of Epidermal Nevus
Younger age group mostly single Brown > grey, black, flesh colore warty, papule plaque
30
2 forms of Epidermal Nevus
Localized (nevus verrucosus) - plaque or linear | Systematized
31
Systematized EN with long linear usually unilateral lesions on extremities
Nevus unius lateris
32
Systematized EN with bilateral and more extensive distribution on trunk
Ichthyosis hystrix
33
Histopathology of Epidermal nevus
Hyperkeratosis, papillomatosis, and acanthosis
34
Other names for Bowen's Disease
SCC in situ
35
Clinical Features of Bowen's Disease
Solitary, slow growing, well-defined, erythematous, scaly patch or plaque Occurs in sun-exposed skin Also in unexposed (arsenic)
36
two variants of SCC
``` Glabrous skin (naturally hairless) Anogenital areas (eythroplasia of Queyrat - glans penis, inner prepuce) ```
37
2nd most common skin malignancy
SCC -more frequent in males
38
Risk Factors for SCC
``` Increased age Light skin pigmentation Genetic disorders (xeroderma pigmentoum, albinism) Immunosuppresion Smoking and tobacco chewing ```
39
Etiology of SCC
``` Cummulative UVR exposure (UVB >UVA) Oncogenic HPV (16, 18, 31) ```
40
Clinical Features of SCC
Mostly isolated and single Head, neck, dorsum of hands Scalp, ears, vermillion part of lower lip Shallow ulcer with crust and raised indurated border Highly differentiated: Firm, hard (keratinization) Pootly Differentiated: Fleshy/granulomatous, soft, asymptomatic unless with perineural invasion
41
Histopathology of SCC
atypical keratinocytes, proliferating downwards, discontinued and detached from overlying epidermis Keratin pearls or horn pearls which look like squamous eddies
42
Basal Cell Carcinoma
rarely metastasize
43
Most common skin malignancy
Basal cell carcinoma More fequent in males Age of onset:>40
44
Etiology of BCC
cummulative UV exposure (UVB>UVA) | PTCH gene mutation
45
Nodo-ulcerative type of BCC
ToL : Papule ,nodule Color: Pearly, tranlucent Smooth surface, telangiectasia, ulcer with pearly rolled border
46
Pigmented type of BCC
ToL: Papule, nodule Color: Brown, blue, black Smooth glistening surface, hard, firm, may be indistinguishable from nodular melanoma or SSM
47
Superficial type of BCC
ToL: Patch, plaque Color: Pink, red Scaling, telangiectasia, fine threadlike border
48
Morpheaform/fibrosing/sclerosing type of BCC
ToL: Macule, Patch, plaque Color: Whitish, yellowish, skin colored Smooth shiny surface, indurated, superficial scar. INVERTED FORM OF INVASION
49
Fibroepithelioma type of BCC
ToL: Nodule Color: Pink to flesh colored Soft resembling fibroma or papilloma
50
Histopathology of BCC
note where the nests are on junctional nevi present with nests at tips of rete ridges Compound nevi: some nexts in epidermis and dermis Dermal nevi: nests in the dermis and none in the epidermis
51
CF of Common Acquired Melanocytic Nevi
Benign Tumors -> moles White people have more moles Darker people -> palms, soles, and nailbeds
52
Junctional nevus
Nests of nevus cells on the epidermis
53
Dermal (Intradermal) nevus
nests of nevus cells in the dermis
54
Compound nevus
nests of nevus cells in the epidermis and dermis
55
Evolution of Nevus
Junctional -> compound -> dermal
56
Histology of Common acquired Melanocytic Nevi
Only note where nests is
57
CF of malignant Melanoma
Generally after puberty Most frequent: 30-70 Most common sites: Lower extremities and trunk of women, trunk(back) of men
58
Fitzpatrick (MMRISK)
``` Moles (atypical or dysplastic >5) Moles (numerous, >50, size >5 mm) Red hair or freckling Inability to tan SUnburn indred ```
59
Six signs of Malignant Melanoma (ABCDEE)
``` Asymmetry Border Color Diameter (>6mm) Elevation Enlargement ```
60
4 major types of Malignant Melanoma
Superficial Spreading Melanoma (SSM) - Most common Nodular Melanoma (NM) Lentigo Malignant Melanoma (LMM) Acral lentiginous Melanoma (ALM)
61
Cells of melanoma are either epitheloid or spindle large, round cells, single or in clusters seeding the dermis from the epidermis PAGETOID spread - Invasion of all levels of epidermis as single or group of cells upwards Positive for S100
Superficial Spreading Melanoma
62
Exophytic, uniform, blackish; looks like pigmented BCC Dome-shaped, cells from epidermis have invaded the dermis No radial or horizonal growth phase: only vertical
Nodular melanoma
63
Atrophic epidermis, proliferation along basal layers of hair structures and ducts (Eccrine) Infiltrates hair follicle and downward invasion May present as patch or nodule Proliferation of plump spindle cells along basal layer, thin and atrophic epidermis Solar elastosis (disturbance in dermal connective tissue)
Lentigo Maligna Melanoma
64
Hyperpigmentation around the nail plate HUTCHINSON's SIGN (peri-ungual pigmentation) May look like a stain, enlarging Hyperplastic epidermis
Acral Lentiginous Melanoma
65
Most important prognostic factor for localized melanomas
Tumor thickness
66
Tumor infiltrating lymphocytes
Better with TIL (immune system wards off tumor)
67
Clark's anatomic Level of Invasion
Level 1 - in situ melanoma level 2 - melanoma within the epidermis and a few within the papillary dermis Level 3- Tumor cells that has invaded the papilalry dermisl propensity for vertical growth phase for metastasis Level 4; Melanoma in the reticular dermis Level 5: melanoma cells had gone down to SQ fat
68
Most common benign proliferative abnormality of the sebaceous glands in older individuals
Sebaceous Tumors
69
Yellowish to tan papules, umbilicated 2-3 cm, with side telangiectasia
Sebaceous Tumors
70
Histopathology of Sebaceous glands
Markedly enlarged sebaceous gands Numerous lobules grouped around a central dilated sebaceous duct
71
Poorly differentiated hartoma of hair germs
Trichoepithelioma
72
More common in nasolabial folds versus nose, forehead, upper lip
Pilar tumor
73
Histopathology of Pilar Tumor
Tumor lobules/islands of basaloid cells either be solid or lace-like/net-like (reticulated) Several horn cysts (Attempts to form hair shaft) Embedded in upper dermis (fibrous stroma)
74
Adenomas of the intraepidermal Eccrine ducts
Syringoma (Eccrine Tumors) M>F Usually multiple
75
Small, whitish, or yellowish soft papules in the lower eyelids, upper chin, genitalia or thighs
Eccrine Tumor
76
Histopathology of Eccrine Tumor
Presence of ductal structures lined by 2 layers of cuboidal cells, with COMMA like tails, tail-like structures that look like a tadpole -Dx factor Small nests, strands of epithelial cells
77
Tends to flatten, regress with time. It doesn't extend beyond site of injury
Hypertrophic Scar
78
Extends beyond site of injury and grows progressively with claw-like extensions
KELOID
79
Histopathology of hypertrophic Scar
Fibrobastic proliferation of increased collagen oriented PARALLEL to the skin surface Vascularization with blood bessels oriented PERPENDICULAR to the skin surface
80
Histopathology of Keloids
Presence of markedly thickened hypereosinophilic bands of thickened collagen Zebra pattern
81
also known as Vascular tumor
Juvenile capillary hemangioma/strawbery nevus Most common vascular tumor in infancy More common in females
82
Natural History of Vascular tumors
Proliferating stage (8-12 months) Involuting stage (1-5 years) >50% regress after 5 years 70-90% usually regress by age 7
83
Hemorrhage from entrapment of platelets in hemangioma, causing coagulopathy
Kasabach-Meritt phenomenon
84
Histopathology of vascular tumors
Proliferation of capillaries in lobular configuration Exopytic, dome-shaped
85
Manifests multiple variably sized and rounded nodules with a pushing contour in apposition to a stroma that shows no significat fibroplasias. The nodule of tumor show a peripheral palisade of basaloid cells and, at their interface with the stoma, slit-like retraction. With Eosinophilic condensation of basement membrane aterial adherent to the cytoplasms of the palisading basaloid cells
NODULAR BCC
86
Histologic feature similar to those of nodular BCC but with the addition of melanin. The melanocytes are interspersed between tumor cells and contain numerous melanin granules in their cytoplasm and dendrites
Pigmented BCC
87
A proliferation of basaloid cells parallel to the long axis of the epidermis. Slit like stromal retraction with mucin deposition in the papillary dermis
Superficial BCC
88
densely proplastic and heavily collagenized stroma, small, irregular tongues of neoplastic basaloid cells, often 1-4 cells thick, are embedded in the collagen table
Morpheaform BCC
89
Manfests atypical basaloid cells that grow in thin lacy strands radiating down from points of continuity with the overlying epidermis
Fribroepithelioma of Pinkus

OS 212 DERMATOLOGY (9 decks)

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