Ch 24: Neoplasms Continued Flashcards
An African-American middle aged woman comes into your office with an irregular brownish/blackish patch on part of her palm. You notice there is also some pigment changes under her thumb as well. You are pretty sure it’s cancerous…
What do you think she has?
Acral Lentiginous Melanoma
*most common form of melanoma in dark-skinned people; generally limited to palms, soles, subungual regions
______ is unusually widespread compared to other neoplasms (virtually any organ involved) and may remain undetectable after successful excision for years, only to reappear years later…
Metastatic melanoma
Staging and prognosis of melanoma is based on what attributes?
tumor thickness, ulceration, dermal mitotic rate, lymphocyte response, location, sex, regression, levels of invasion, lymphatic invasion, and stage
Describe the measurement taken to determine the “Breslow Thickness” of a melanoma
The most superficial aspect of the stratum granulosum to the point of deepest penetration of the tumor into the dermis
*note: this is the STRONGEST prognostic indicator for melanomas confined to stage 1/2
Determine if these properties about melanomas have better or worse survival rates:
1) Ulceration
2) Increased dermal mitotic rate
3) Presence of tumor-infiltrating lymphocytes (TILs)
4) Melanomas on extremities
5) Melanomas on sole of foot/subungual regions
6) Men with melanomas (compared to women)
1) worse survival rate
2) worse survival rate
3) better survival rate
4) better survival rate
5) worse survival rate
6) worse survival rate
Considered the most important factor influencing patient survival; determined by biopsy of lymph nodes lying in the regional drainage pattern
Staging
What does TNM stand for
T = primary tumor (thickness, mitogenicity, etc) N = node (numbers of lymph nodes involved) M = metastasis (distant; at various sites)
What is a micrometastasis? Macrometastasis?
Micrometastases are nodal metastases diagnosed after sentinel/ ELECTIVE lymphandenectomy.
Macrometastases are detectable by THERAPEUTIC lymphadenectomy
A 10 year old boy comes in to see you because his mother is concerned about a nodule on his neck. It appears elevated, spheroid, pink and smooth. You mention there is an uncertain prognosis, and exclaim “It’s just a MELTUMP.”
What are we dealing with here?
Spitz tumor (benign)
*common in adolescents; progression to melanoma rare (but more posible in adults).
MELTUMP = MElanocytic Tumor of Uncertain Malignant Potential
A benign, dark blue/gray/or black firm, well demarcated papule or nodule
Blue Nevus
What is an ephelides?
A freckle! (brown macule often on people w/fair, sun-exposed skin; pigment deepens w/light exposure)
Discrete brown macule w/out dependence on sun exposure; sometimes called “liver spots”
Lentigo (“liver spots” = solar lentigo)
Underlying cause of verrucae
HPV
Elevated papules with papillomatous surface; common on dorsum of hands or face, with presence of kilobytes in upper epidermis
Verruca vulgaris (common wart) – cause: HPV types 2 and 4
Benign but painful hyperkeratotic nodules on soles of feet
Plantar warts – cause: HPV type 1
Name two types of warts associated with HPV that appear around the genitalia
1) Condyloma acuminatum (HPV types 6 and 11)
2) Bowenoid papulosis (HPV types 16 and 18)
Most common type of keratoses, have a “pasted on” appearance composed of “horn cysts” (small cysts of keratin)…
And, why should you worry if a bunch of these appear suddenly?
Seborrheic keratosis.
Sudden appearance associated with internal malignancies like gastric adenocarcinoma
Most common malignant tumor in persons with pale skin and freckles; usually due to sun-damage but can also occur on areas of skin not exposed to the sun
Basal Cell Carcinoma
A 65 year old former surfing aficionado comes to you with several small pearly papules on his face that are laced with tiny little veins. Biopsy reveals deeply basophilic epithelial cells protruding into the papillary dermis. What’s the diagnosis?
Basal cell carcinoma
A 45 year old caucasian woman who loves the outdoors presents to you with a scaly, ulcerated papule on the back of her hand that is very red. She says it’s also really itchy. Biopsy reveals atypical basal keratinocytes with a thickened epidermis. What’s the diagnosis?
Squamous cell carcinoma
An aggressive, rare tumor composed of solid nests of undifferentiated cells resembling small cell carcinoma of the lung; may be due to a relatively common polyomavirus
Merkel Cell Carcinoma
due to Merkel cell polyoma virus in 80% of cases
Describe Adnexal Tumors and list a few types
Adnexal tumors are small elevated skin nodules that often occur in people w/a familial history of similar tumors; commonly appear at puberty, typically benign.
Types: Cylindroma, Syringoma, Poroma, Trichoepithelioma
How can you differentiate between a dermatofibroma and dermatofibrosarcoma protuberans (both fibrohistiocytic tumors with varied spectrum of differentiation)?
Positivity for CD34 is present in dermatofibrosarcoma protuberant and absent in dermatofibroma.
A 68 year old male comes in presenting with a long history of erythematous, scaly patches around the buttocks. Biopsy reveals atypical lymphocytes expanding into the epidermis (epidermotropism) with large numbers of atypical lymphocytes displaying cerebriform nuclei. What is the diagnosis? And, what would you call this diagnosis if you knew it had spread systemically?
Mycosis Fungoides
Systemic spread of lymphocytes is called Sezary syndrome
