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OS 212 DERMATOLOGY > Benign and Malignant Skin Conditions > Flashcards

Benign and Malignant Skin Conditions Flashcards

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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
Q

Clonal type SK

A

Hyperkeratsis, papillomatosis, acanthosis

Nests or clones of basaloid cells

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26
Q

Irritated type SK

A

Hyperkeratosis, papillomatosis, acanthosis

numerous squamous eddies (Flattened squamous cells in an onion peel-like fashion)

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27
Q

Numerous small, well-circumscribed whorls of flattened eosinophilic squamous cells that gradually keratinize towards the center

A

Squamous Eddies

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28
Q

Three common features of seborrheic keratosis

A

Hyperkeratosis
Papillomatosis
Acanthosis

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29
Q

Clinical features of Epidermal Nevus

A

Younger age group
mostly single
Brown > grey, black, flesh colore warty, papule plaque

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30
Q

2 forms of Epidermal Nevus

A

Localized (nevus verrucosus) - plaque or linear

Systematized

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31
Q

Systematized EN with long linear usually unilateral lesions on extremities

A

Nevus unius lateris

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32
Q

Systematized EN with bilateral and more extensive distribution on trunk

A

Ichthyosis hystrix

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33
Q

Histopathology of Epidermal nevus

A

Hyperkeratosis, papillomatosis, and acanthosis

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34
Q

Other names for Bowen’s Disease

A

SCC in situ

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35
Q

Clinical Features of Bowen’s Disease

A

Solitary, slow growing, well-defined, erythematous, scaly patch or plaque

Occurs in sun-exposed skin

Also in unexposed (arsenic)

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36
Q

two variants of SCC

A 
Glabrous skin (naturally hairless)
Anogenital areas (eythroplasia of Queyrat - glans penis, inner prepuce)
37
Q

2nd most common skin malignancy

A

SCC

-more frequent in males

38
Q

Risk Factors for SCC

A 
Increased age
Light skin pigmentation
Genetic disorders (xeroderma pigmentoum, albinism)
Immunosuppresion
Smoking and tobacco chewing
39
Q

Etiology of SCC

A 
Cummulative UVR exposure (UVB >UVA)
Oncogenic HPV (16, 18, 31)
40
Q

Clinical Features of SCC

A

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
Q

Histopathology of SCC

A

atypical keratinocytes, proliferating downwards, discontinued and detached from overlying epidermis

Keratin pearls or horn pearls which look like squamous eddies

42
Q

Basal Cell Carcinoma

A

rarely metastasize

43
Q

Most common skin malignancy

A

Basal cell carcinoma

More fequent in males
Age of onset:>40

44
Q

Etiology of BCC

A

cummulative UV exposure (UVB>UVA)

PTCH gene mutation

45
Q

Nodo-ulcerative type of BCC

A

ToL : Papule ,nodule

Color: Pearly, tranlucent

Smooth surface, telangiectasia, ulcer with pearly rolled border

46
Q

Pigmented type of BCC

A

ToL: Papule, nodule

Color: Brown, blue, black

Smooth glistening surface, hard, firm, may be indistinguishable from nodular melanoma or SSM

47
Q

Superficial type of BCC

A

ToL: Patch, plaque

Color: Pink, red

Scaling, telangiectasia, fine threadlike border

48
Q

Morpheaform/fibrosing/sclerosing type of BCC

A

ToL: Macule, Patch, plaque

Color: Whitish, yellowish, skin colored

Smooth shiny surface, indurated, superficial scar. INVERTED FORM OF INVASION

49
Q

Fibroepithelioma type of BCC

A

ToL: Nodule

Color: Pink to flesh colored

Soft resembling fibroma or papilloma

50
Q

Histopathology of BCC

A

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
Q

CF of Common Acquired Melanocytic Nevi

A

Benign Tumors -> moles
White people have more moles
Darker people -> palms, soles, and nailbeds

52
Q

Junctional nevus

A

Nests of nevus cells on the epidermis

53
Q

Dermal (Intradermal) nevus

A

nests of nevus cells in the dermis

54
Q

Compound nevus

A

nests of nevus cells in the epidermis and dermis

55
Q

Evolution of Nevus

A

Junctional -> compound -> dermal

56
Q

Histology of Common acquired Melanocytic Nevi

A

Only note where nests is

57
Q

CF of malignant Melanoma

A

Generally after puberty
Most frequent: 30-70
Most common sites: Lower extremities and trunk of women, trunk(back) of men

58
Q

Fitzpatrick (MMRISK)

A 
Moles (atypical or dysplastic >5)
Moles (numerous, >50, size >5 mm)
Red hair or freckling
Inability to tan
SUnburn
indred
59
Q

Six signs of Malignant Melanoma (ABCDEE)

A 
Asymmetry
Border
Color
Diameter (>6mm)
Elevation
Enlargement
60
Q

4 major types of Malignant Melanoma

A

Superficial Spreading Melanoma (SSM) - Most common
Nodular Melanoma (NM)
Lentigo Malignant Melanoma (LMM)
Acral lentiginous Melanoma (ALM)

61
Q

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

A

Superficial Spreading Melanoma

62
Q

Exophytic, uniform, blackish; looks like pigmented BCC

Dome-shaped, cells from epidermis have invaded the dermis

No radial or horizonal growth phase: only vertical

A

Nodular melanoma

63
Q

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)

A

Lentigo Maligna Melanoma

64
Q

Hyperpigmentation around the nail plate

HUTCHINSON’s SIGN (peri-ungual pigmentation)

May look like a stain, enlarging

Hyperplastic epidermis

A

Acral Lentiginous Melanoma

65
Q

Most important prognostic factor for localized melanomas

A

Tumor thickness

66
Q

Tumor infiltrating lymphocytes

A

Better with TIL (immune system wards off tumor)

67
Q

Clark’s anatomic Level of Invasion

A

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
Q

Most common benign proliferative abnormality of the sebaceous glands in older individuals

A

Sebaceous Tumors

69
Q

Yellowish to tan papules, umbilicated 2-3 cm, with side telangiectasia

A

Sebaceous Tumors

70
Q

Histopathology of Sebaceous glands

A

Markedly enlarged sebaceous gands

Numerous lobules grouped around a central dilated sebaceous duct

71
Q

Poorly differentiated hartoma of hair germs

A

Trichoepithelioma

72
Q

More common in nasolabial folds versus nose, forehead, upper lip

A

Pilar tumor

73
Q

Histopathology of Pilar Tumor

A

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
Q

Adenomas of the intraepidermal Eccrine ducts

A

Syringoma (Eccrine Tumors)

M>F

Usually multiple

75
Q

Small, whitish, or yellowish soft papules in the lower eyelids, upper chin, genitalia or thighs

A

Eccrine Tumor

76
Q

Histopathology of Eccrine Tumor

A

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
Q

Tends to flatten, regress with time. It doesn’t extend beyond site of injury

A

Hypertrophic Scar

78
Q

Extends beyond site of injury and grows progressively with claw-like extensions

A

KELOID

79
Q

Histopathology of hypertrophic Scar

A

Fibrobastic proliferation of increased collagen oriented PARALLEL to the skin surface

Vascularization with blood bessels oriented PERPENDICULAR to the skin surface

80
Q

Histopathology of Keloids

A

Presence of markedly thickened hypereosinophilic bands of thickened collagen

Zebra pattern

81
Q

also known as Vascular tumor

A

Juvenile capillary hemangioma/strawbery nevus

Most common vascular tumor in infancy

More common in females

82
Q

Natural History of Vascular tumors

A

Proliferating stage (8-12 months)

Involuting stage (1-5 years)

> 50% regress after 5 years
70-90% usually regress by age 7

83
Q

Hemorrhage from entrapment of platelets in hemangioma, causing coagulopathy

A

Kasabach-Meritt phenomenon

84
Q

Histopathology of vascular tumors

A

Proliferation of capillaries in lobular configuration

Exopytic, dome-shaped

85
Q

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

A

NODULAR BCC

86
Q

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

A

Pigmented BCC

87
Q

A proliferation of basaloid cells parallel to the long axis of the epidermis. Slit like stromal retraction with mucin deposition in the papillary dermis

A

Superficial BCC

88
Q

densely proplastic and heavily collagenized stroma, small, irregular tongues of neoplastic basaloid cells, often 1-4 cells thick, are embedded in the collagen table

A

Morpheaform BCC

89
Q

Manfests atypical basaloid cells that grow in thin lacy strands radiating down from points of continuity with the overlying epidermis

A

Fribroepithelioma of Pinkus

OS 212 DERMATOLOGY (9 decks)

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