Cutaneous Neoplasms Flashcards
WHat are the relevant epithelial (epidermal) tumors?
- Seborrheic keratoses
- actinic keratosis
- squamous cell carcinoma
- keratoacanthoma
- basal cell carcinoma
What is seborrheic keratosis/what does it look like? who gets it? where is it most common?
- very common cutaneous neoplasm
- common in middle age or older patients
- brown or tan waxy papules and plaques with a “stuck on” or warty appearance
- most common on face, trunk, and upper extremeties
- Leser-Trelat sign
What is the Leser-Trelat sign?
sudden onset of multiple seborrheic kertoses associated with internal malignancy (usually stomach cancer)
what is visible on this histology slide?
seborrheic keratoses
What is actinic keratoses? what is it also known as? what is it a result of?
who gets it? what d they look like?
- aka solar keratosis
- common lesiosn that develop as a result of chronic sundamage
- predilection for sun-exposed areas
- middle-age to elderly
- red tan-brown macules with “gritty” sandpaper like scale
- may regress or remain stable
- .1-10% become malignant
what is seen on this histology slide?
Actinic Keratosis
retention of nuclei in the corneum and loss of granular layer. lower 1/3 of epidermis is very irregular.
who gets squamous cell carinoma and what are predisposing factors?
- common neoplas in older individulas, 20% of all skin cancers
- UV radiation is most common cause (DNA damage)
- also chronic ulcers, old burn scars, HPV, radiation, arsenic, immunosuppression
How does SCC in situ present? How does Invasice SCC present?
WHat is the risk of metastasis of insitu?
- SCC in situ presents as red scaly plaque
- Invasive SCC lesions are nodular and may ulcerate
- 5% of insitu become invasive, and risk of metastasis is 2-4%, but even higher if immunosuppressed
- likelihood of metastasis is related to location and degree of invasion
What is this?
SCC in situ
full thikness (thicker) basal layer to top and you lose the granular layer
what is this?
Invasive SCC
no longer is contained to the epidermis it is almost down to the fat in this image
What is a Keratoacanthoma? How does it grow? what causes it?
- variant of squamous cell carcinoma with pink papule or nodule with a central keratin plug
- grows rapidly over 2-10 weeks
- usually occurs due to sun damage and may resolve spontaneously, but treatment is usually advocated bc can cause extensive local destruction
- in immunosuppresed patients, mulitple lesions may be present
What is shown on this histology slide?
Keratoacanthoma
WHat is the most comon human cancer?
Basal Cell Carcinoma
What causes basal cell carcinoma? How does it grow? What is it associated with?
- secondary to chronic sun exposure/UV radiation
- can be locally destructive, and is slow growing/rarely metastasizes
- When it metastasizes, patient is often immunocompromised
- associated with dysregulation of sonic hedgehog or PTCH pathway (30-40%)
What do basal cell carcinomas look like?
pink, pearly papules with prominent arborizing subepidermal blood vessels (telangiectasia). Ulceration and erosion are common
What doe sit mean to say that a basal cell carcinoma has retracted?
it broke away from surrounding stroma
What are the common melanocyti tumors?
- melanocytic nevi
- acquired melanocytic nevus
- congenital melanocytic nevus
- dysplastic nevi
- melanoma
Where are melanocytes usually seen and what do they increase with? WHat are the 3 classifications melanocytic nevi can be histologically?
- melanocytes are normally seen in epidermis, and increase with sun exposure (acquired nevi), also present aat birth (congenital nevi)
- histologically melanocytic nevi can be:
- junctional (dermal epidermal junction)
- compound (epidermis and dermis)
- intradermal (in dermis only)
What do acquired melaocytic nevi usually look like?
- pink, tan or brown uniformly pigmented papules and macules
- small (usually < .5cm) well-defined, smooth borders
what classification is this melanocytic nevi?
Junctional nevus: just in the epidermis, not in the dermis
What classification is this acquired melanocytic nevus?
intradermal
what classification is this nevus?
compound (epidermis and dermis)
What does this lil babe have?
A very large congenital melanocytic nevus
What are displastic nevi?
- clinically and histologically distinctive
- dysplastic nevi may occur sporadically or in a familial form
- ppl with mulitpile dysplastic nevi have increased risk of melanoma
- clinically, larger than acquired nevi (>.5cm), irregular in shpe and uneven color
What is dysplastic nevus syndrome? What do they have an increased incidence of?
- familial or sporadic
- large # of dysplastic nevi (80) or more
- increased incidence of melanoma
- familial variant is inherited as autosomal dominant (mutations CDKN2A gene 9p21-21 in 40% of cases)
- patients can develop other malignancies (pancreatic carcinoma)
Compare and contrast sporadic dysplastic nevi syndorme and familial dysplastic nevi syndrome
- sporadic
- lower number of dysplasti nevi (usually 2-10)
- lifetime risk of melanoma in the sporadic form is approximately 10%
- Familial
- hundreds of dysplastic nevi
- lifetime risk of melanoma approaches 100%
****note, they have identical histological features****
What do dysplastic nevi often resemble
melanoma
Dysplastic nevi may be ______ or ______
junctional or compound
What are the histological features of Dysplastic nevi?
- lentiginous hyperplasia
- irregular nests
- briding of rete ridges
- cytologic atyia
- lamellar fibroplasia of capillary dermis
- inflammatory response
Who typically gets melanoma and where on the body is it most common?
more common in white population, affects men and women equally, typically a disease of adulthood and most common eon back in men and on legs in women
What are the risk factos for melanoma?
- Multifactorial disease
- UVexposure at early age (more important risk factor)
- fair complexion and older age
- dysplastic nevus syndrome
- history of melanoma in the family
- tanning bed use
- xeroderma pigmentosum
What are the clinical features of melanoma?
ABCDEs
A=Assymetry
B= Borders (notched, uneven or blurred)
C= Color (uneven; shades of brown, tan, red, and black may be present. 3 or more colos)
D= diameter (>6mm)
E=eveolving-change in color andn size of the lesion
Why is it important to recognize melanoma ealy? and what ae the 2 growth phases?
- early/superficial melanomas are cured surgically
- Radial growth phase: melanocytes will proliferate within the epidermis (in situ) NO metastatic potential
- Vertical growth phase: dermal invasion and potential for metastasis
- ****extent of vertical growth phase determines the biologic behavior of melanomas****
What is the most important prognostic indicator for melanoma?
depth of invasion (Breslow thickness)
when <1mm rarley metastasize
when >1.7mm have greater otential to metastasize
How do we measure invasion?
Clark level
I Intraepidermal
II in papillary dermis
III Fills papillary dermis
IV Reticular dermis
IV Enters fat
Besides level of invsion (clarks level) what are some indicators of metastatic potential for melanoma?
ulceration, mitotic rate, angioinvasion
What are the 4 type of melanoma?
- Supreficial spreading type
- most common type (70%) located on trunk (men) legs (women)
- Nodular type
- NO radial growth phase, high vertical growth phase poor prognosis. men>women
- Lentigo maligna type
- most commonly located on the head and neck (sun exposed areas)
- Acral lentiginous type
- located on palm, sole, or beneath nail
- most common type in African Americans (and other non-whites)
What kind of melanoa is this?
Lentigo type
What kind of melanoma is this?
Supeficial spreading type
What kind of melanoma is this?
Nodular type
What kind of melanoma is this?
Acral lentiginous type
What are the cutaneous lymphomas?
Mycosis fungoides
Sezary syndrome
How does mycosis fungoides present? What are the 3 stages? When does it usually occur?
- most common cutaneous lymphoma
- occurs in late adulthood with male predominance
- usually presents as red or pink scaly patches
- stages of patch, plaque and nodules
- usually hronic course although may become aggressive
What is Sezary syndrome? how does it present and what is the prognosis?
- blood involvement of T cell lymphoma
- erythrodermaskin is diffusely red and scaly
- poor prognosis
- survival 1-3 years
What do you see histologically for mycosis fungoides?
infiltration of the epidermis and upper dermis b¥ neoplastic ˇ cells, which have often have a ceribriform nucleus characterized by marked infolding of the nuclear membrane
**cerebriform lymphocytes
**invasion of blood vessels
besides CDKNA2 9p21 mutation what activatin gmutations are associated with melanoma?
NRAS and BRAF
what 2 new drugs arebeing used for melanoma and what do they target?
vemurafenib-inhibit mutant BRAF
trametinib- influence the MEK pathway
