Benign and Malignant Skin Conditions Flashcards
Other names of Epidermal cyst
Epidermal inclusion cyst, infundibular cyst
Origin of Epidermal cyst
Infundibulum of hair follicle (nonacral skin)
Implantation of epidermis into dermis thru trauma
Clinical Features of Epidermalcyst
Solitary or multiple 1-5cm cyst
Slowly growing, round, firm, movable
(+) surface punctum
Often found in face, neck torso; Occasionally palms and soles
When you squeeze Epidermal cyst
foul smelling cheesy, whitish material coming out
Histopathology of epidermal cyst
Cyst wall is made up of stratified squamous epithelium with several layers including a GRANULAR CELLULAR LAYER.
Cavity contains laminated, horny, or keratinous material
Any cavity lined by epithelium
Cyst
Miniature epithelial cysts, small versions of epidermoid cysts
Milium
Origin of Milium
Infundibulum of hair follicle (Primary milium)
Epithelial structures e.g eccrine ducts (secondary milium)
Clinical features of Milium
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
Histopathology of Milium
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
Other names of Pilar cyst
Trichilemmal cyst, isthmus-catagen cyst
Origin of Pilar cyst
Isthmus of anagen hairs or sac surrounding catagen and telogen hairs
Clinical Features of Pilar cyst
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)
Histopathology of Pilar cyst
Content is homogenous, compact. eosinophilc keratin
No granular cell layer
Keratinocytes abrupty keratinize
Origin of Steatocystoma
Sebaceous duct (only true sebaceous cyst)
Clinical Features of Steatocystoma
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
histopathology of steatocystoma
Convouted cystic structure
Cyst wall = stratified squamous epithelium without an intervening granular cell layer
Cavity may contain hair, sebum, keratin
Diagnostic for steatocystoma
presence of an sebaceous lobule that is found adjacent to or within the cyst wall.
Other name for Seborrheic keratosis
Senile warts
Clinical features of Seborrheic keratosis
Mostly multiple
flesh-colored, gray brown to black papules with stuck on appearance
Older patients
5 histologic types of Seborrheic keratosis
Hyperkeratotic type Acanthotic type Reticulated type Clonal type Irritated type
Hyperkeratotic SK
Increased thickening of stratum corneum
Papillomatosis (Upward projection of dermal papillae)
Acanthosis (Thickened spinous cell layer)
Acanthotic type SK
Thickening of the spinous cell layer
interwoven tracts of epithelial cells surrounding islands of dermal stroma
Presence of Pseudohorn cysts
Reticulated type SK
lace like or net like pattern (thin, interlacing strands of basaloid cells)
Clonal type SK
Hyperkeratsis, papillomatosis, acanthosis
Nests or clones of basaloid cells
Irritated type SK
Hyperkeratosis, papillomatosis, acanthosis
numerous squamous eddies (Flattened squamous cells in an onion peel-like fashion)
Numerous small, well-circumscribed whorls of flattened eosinophilic squamous cells that gradually keratinize towards the center
Squamous Eddies
Three common features of seborrheic keratosis
Hyperkeratosis
Papillomatosis
Acanthosis
Clinical features of Epidermal Nevus
Younger age group
mostly single
Brown > grey, black, flesh colore warty, papule plaque
2 forms of Epidermal Nevus
Localized (nevus verrucosus) - plaque or linear
Systematized
Systematized EN with long linear usually unilateral lesions on extremities
Nevus unius lateris
Systematized EN with bilateral and more extensive distribution on trunk
Ichthyosis hystrix
Histopathology of Epidermal nevus
Hyperkeratosis, papillomatosis, and acanthosis
Other names for Bowen’s Disease
SCC in situ
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)
two variants of SCC
Glabrous skin (naturally hairless) Anogenital areas (eythroplasia of Queyrat - glans penis, inner prepuce)
2nd most common skin malignancy
SCC
-more frequent in males
Risk Factors for SCC
Increased age Light skin pigmentation Genetic disorders (xeroderma pigmentoum, albinism) Immunosuppresion Smoking and tobacco chewing
Etiology of SCC
Cummulative UVR exposure (UVB >UVA) Oncogenic HPV (16, 18, 31)
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
Histopathology of SCC
atypical keratinocytes, proliferating downwards, discontinued and detached from overlying epidermis
Keratin pearls or horn pearls which look like squamous eddies
Basal Cell Carcinoma
rarely metastasize
Most common skin malignancy
Basal cell carcinoma
More fequent in males
Age of onset:>40
Etiology of BCC
cummulative UV exposure (UVB>UVA)
PTCH gene mutation
Nodo-ulcerative type of BCC
ToL : Papule ,nodule
Color: Pearly, tranlucent
Smooth surface, telangiectasia, ulcer with pearly rolled border
Pigmented type of BCC
ToL: Papule, nodule
Color: Brown, blue, black
Smooth glistening surface, hard, firm, may be indistinguishable from nodular melanoma or SSM
Superficial type of BCC
ToL: Patch, plaque
Color: Pink, red
Scaling, telangiectasia, fine threadlike border
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
Fibroepithelioma type of BCC
ToL: Nodule
Color: Pink to flesh colored
Soft resembling fibroma or papilloma
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
CF of Common Acquired Melanocytic Nevi
Benign Tumors -> moles
White people have more moles
Darker people -> palms, soles, and nailbeds
Junctional nevus
Nests of nevus cells on the epidermis
Dermal (Intradermal) nevus
nests of nevus cells in the dermis
Compound nevus
nests of nevus cells in the epidermis and dermis
Evolution of Nevus
Junctional -> compound -> dermal
Histology of Common acquired Melanocytic Nevi
Only note where nests is
CF of malignant Melanoma
Generally after puberty
Most frequent: 30-70
Most common sites: Lower extremities and trunk of women, trunk(back) of men
Fitzpatrick (MMRISK)
Moles (atypical or dysplastic >5) Moles (numerous, >50, size >5 mm) Red hair or freckling Inability to tan SUnburn indred
Six signs of Malignant Melanoma (ABCDEE)
Asymmetry Border Color Diameter (>6mm) Elevation Enlargement
4 major types of Malignant Melanoma
Superficial Spreading Melanoma (SSM) - Most common
Nodular Melanoma (NM)
Lentigo Malignant Melanoma (LMM)
Acral lentiginous Melanoma (ALM)
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
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
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
Hyperpigmentation around the nail plate
HUTCHINSON’s SIGN (peri-ungual pigmentation)
May look like a stain, enlarging
Hyperplastic epidermis
Acral Lentiginous Melanoma
Most important prognostic factor for localized melanomas
Tumor thickness
Tumor infiltrating lymphocytes
Better with TIL (immune system wards off tumor)
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
Most common benign proliferative abnormality of the sebaceous glands in older individuals
Sebaceous Tumors
Yellowish to tan papules, umbilicated 2-3 cm, with side telangiectasia
Sebaceous Tumors
Histopathology of Sebaceous glands
Markedly enlarged sebaceous gands
Numerous lobules grouped around a central dilated sebaceous duct
Poorly differentiated hartoma of hair germs
Trichoepithelioma
More common in nasolabial folds versus nose, forehead, upper lip
Pilar tumor
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)
Adenomas of the intraepidermal Eccrine ducts
Syringoma (Eccrine Tumors)
M>F
Usually multiple
Small, whitish, or yellowish soft papules in the lower eyelids, upper chin, genitalia or thighs
Eccrine Tumor
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
Tends to flatten, regress with time. It doesn’t extend beyond site of injury
Hypertrophic Scar
Extends beyond site of injury and grows progressively with claw-like extensions
KELOID
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
Histopathology of Keloids
Presence of markedly thickened hypereosinophilic bands of thickened collagen
Zebra pattern
also known as Vascular tumor
Juvenile capillary hemangioma/strawbery nevus
Most common vascular tumor in infancy
More common in females
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
Hemorrhage from entrapment of platelets in hemangioma, causing coagulopathy
Kasabach-Meritt phenomenon
Histopathology of vascular tumors
Proliferation of capillaries in lobular configuration
Exopytic, dome-shaped
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
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
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
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
Manfests atypical basaloid cells that grow in thin lacy strands radiating down from points of continuity with the overlying epidermis
Fribroepithelioma of Pinkus
