Ch 20 Skin Tumors

Question 1

Benign Epidermal Tumors

Answer 1

Wart, Cutaneous Horn, Epidermal Nevus, Melanoxytic Nevus, SK, Achrocordon, Epidermal/Pilar Cyst, Milia, CDNH

Question 2

Benign Dermal Tumors

Answer 2

Lipoma, Hemangioma, PG, Glomus Tumor, DF, Neuroma, Neurofibroma, Keloid, Lymphocytoma Cutis, Mastocytosis

Question 3

Malignant Epidermal

Answer 3

MM, SCC, BCC, Pagets

Question 4

Malignant Dermal

Answer 4

DFP, Kaposi Sarcoma, Lymphoma, Mets

Question 5

ENGLAND (Painful umors)

Answer 5

Eccrine spiradenoma, Neuroma, Glomus, Leiomyoma, Angioma, Neuroma, DF

Question 6

Melanocytic Nevi

Answer 6

Congential are larger and darker with hair, contain a possibblity of malignant transformation
-Most childhood nevi start as junctional then turn into compound and finally into dermal

Question 7

Spitz Nevus

Answer 7

• Often redder, grows rapidly and then stops or involutes

- Histology will show spindle shaped malignant appearing melanocytes in the epidermis with edema

Question 8

Atypical Nevi Mutation

Answer 8

CDNK2A, P16

Question 9

BCC

Answer 9

• Most commonly in hedgehog pathway
• Gorlin syndrom
• Generally nodular, can be superficial, cicatricial, pigemnted
• Mohs for large lesions (1cm) cicatricial, or on sensitive areas

Question 10

SCC

Answer 10

Most commonly P53 mutations, Ferguson-Smith is congenital

• Palpate local nodes , mohs for high risk
• Bowens is SCCIS

Question 11

KA

Answer 11

• Can’t tell difference unless get whole slide histologically
• often on face and often involute

Question 12

Malignant Melanoma Genetics and Risk Factors

Answer 12

CDKN2A (P16), CDK4 also phenotype and sun exposure

Question 13

Clinical Features

Answer 13

Begin with superficial spreading or radial growth phase before nodular invasive phase

Question 14

Types

Answer 14

• Lentigo maligna: Melanocyte proliferation confined to the epidermis, may track down hair follicles
• Lentigo Maligna Melanoma: Breaks into the dermis
• Superficial Spreading: Most common, has a long radial growth phase
• Acral: Palms and soles
• Nodular: Skips the radial growth phase and goes straight to invasive
• Amelanotic: Diagnostic quandry

Question 15

Staging

Answer 15

I- Depth less than .75
Ib-.75-1.5
IIA-1.5-4
IIB/III-Nodal Mets
IV-Widely metastatic

Question 16

Clark Level

Answer 16

Epidermis is I
Papillary dermis is 2
Reticular Dermis is 3
Deep dermis is 4
Sub Q is 5

Question 17

Breslow Depth

Answer 17

Measured from granular layer to depth of tumor

Question 18

Dx

Answer 18

Excisional biopsy is required to get full appearance of tumor

Question 19

Tx

Answer 19

Margins must be clear 1cm for each mm of invasion up to 3cm. 2mm=2cm etc.

• Chemo can be darbazine
• Most common met location is the lung

Question 20

Pagets

Answer 20

Adenoma that invades into the epidermis

Question 21

Benign Dermal Malformations, don’t resolve

Answer 21

-Salmon Patch (Exception)
-Capillary (PWS)
-AV
Klippel Trelawny - hypertrophy
-Parkes Weber - PWS with no neurologic

Question 22

Hemangiomas involute

Answer 22

(Strawberry)
Superficial, Deep and mixed
-May require treatment if interferes with eye or other
-Steroids or others may be used

Question 23

Signs of poor prognosis in Melanoma

Answer 23

• Depth
• Age greater than 50
• Males worse than females
• Ulceration is poor prognosis

Question 24

Pyogenic Granuloma

Answer 24

-Acquired vascular malformatoin often follows trauma

Question 25

Lymphocytoma Cutis

Answer 25

B cell proliferation in the dermis leads to violet/purple nodule, benign

Question 26

Mastocytosis

Answer 26

• Rubbing or toughing will lead to urticaria/welt
• Comon in childern and spontaneously resolve
• Can measure tryptase in adult form

Question 27

Kaposi Sarcoma

Answer 27

• HHV8 induced vascular tumor
• In mediteranians
• Or immunosupressed

Question 28

CTCL

Answer 28

• CD30+ T helper cells proliferate in the dermis
• Patch stage is early shows atypical rash shape
• Plaque stage shows more bizzare appearing T cells and will show pauterier microabcesses
• Nodule stage late and can become sezeary

Question 29

Complicatoins of CTCL

Answer 29

• Sezeary- extension of malignant cells into the blood stream
• Anaplastic Large CD30 is large nodules that rapidly develop, often involute rapidly

Question 30

CTCL Tx

Answer 30

UVB and PUVA are first line

• Oral retinoids and alpha interferon also
• Can use extracorporeal photophoresis for sezeary

Question 31

DFP

Answer 31

-Malignant tumor of fibroblasts that begins as DF but enlarges and turns purple or blue

Question 32

Hodgkins

Answer 32

-Causes massive pruritis

Question 33

Mets

Answer 33

Most commonly breast Ca, and often appear on the scalp

Question 34

Nevus Sebaceous

Answer 34

-Can lead to BCC rarely