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MSS > Cutaneous Neoplasms > Flashcards

Cutaneous Neoplasms Flashcards

1
Q

WHat are the relevant epithelial (epidermal) tumors?

A
  • Seborrheic keratoses
  • actinic keratosis
  • squamous cell carcinoma
  • keratoacanthoma
  • basal cell carcinoma
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2
Q

What is seborrheic keratosis/what does it look like? who gets it? where is it most common?

A
  • 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
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3
Q

What is the Leser-Trelat sign?

A

sudden onset of multiple seborrheic kertoses associated with internal malignancy (usually stomach cancer)

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4
Q

what is visible on this histology slide?

A

seborrheic keratoses

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5
Q

What is actinic keratoses? what is it also known as? what is it a result of?

who gets it? what d they look like?

A
  • 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
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6
Q

what is seen on this histology slide?

A

Actinic Keratosis

retention of nuclei in the corneum and loss of granular layer. lower 1/3 of epidermis is very irregular.

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7
Q

who gets squamous cell carinoma and what are predisposing factors?

A
  • 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
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8
Q

How does SCC in situ present? How does Invasice SCC present?

WHat is the risk of metastasis of insitu?

A
  • 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
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9
Q

What is this?

A

SCC in situ

full thikness (thicker) basal layer to top and you lose the granular layer

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10
Q

what is this?

A

Invasive SCC

no longer is contained to the epidermis it is almost down to the fat in this image

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11
Q

What is a Keratoacanthoma? How does it grow? what causes it?

A
  • 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
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12
Q

What is shown on this histology slide?

A

Keratoacanthoma

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13
Q

WHat is the most comon human cancer?

A

Basal Cell Carcinoma

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14
Q

What causes basal cell carcinoma? How does it grow? What is it associated with?

A
  • 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%)
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15
Q

What do basal cell carcinomas look like?

A

pink, pearly papules with prominent arborizing subepidermal blood vessels (telangiectasia). Ulceration and erosion are common

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16
Q

What doe sit mean to say that a basal cell carcinoma has retracted?

A

it broke away from surrounding stroma

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17
Q

What are the common melanocyti tumors?

A
  • melanocytic nevi
  • acquired melanocytic nevus
  • congenital melanocytic nevus
  • dysplastic nevi
  • melanoma
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18
Q

Where are melanocytes usually seen and what do they increase with? WHat are the 3 classifications melanocytic nevi can be histologically?

A
  • 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)
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19
Q

What do acquired melaocytic nevi usually look like?

A
  • pink, tan or brown uniformly pigmented papules and macules
  • small (usually < .5cm) well-defined, smooth borders
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20
Q

what classification is this melanocytic nevi?

A

Junctional nevus: just in the epidermis, not in the dermis

21
Q

What classification is this acquired melanocytic nevus?

A

intradermal

22
Q

what classification is this nevus?

A

compound (epidermis and dermis)

23
Q

What does this lil babe have?

A

A very large congenital melanocytic nevus

24
Q

What are displastic nevi?

A
  • 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
25
Q

What is dysplastic nevus syndrome? What do they have an increased incidence of?

A
  • 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)
26
Q

Compare and contrast sporadic dysplastic nevi syndorme and familial dysplastic nevi syndrome

A
  • 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****

27
Q

What do dysplastic nevi often resemble

A

melanoma

28
Q

Dysplastic nevi may be ______ or ______

A

junctional or compound

29
Q

What are the histological features of Dysplastic nevi?

A
  • lentiginous hyperplasia
  • irregular nests
  • briding of rete ridges
  • cytologic atyia
  • lamellar fibroplasia of capillary dermis
  • inflammatory response
30
Q

Who typically gets melanoma and where on the body is it most common?

A

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

31
Q

What are the risk factos for melanoma?

A
  • 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
32
Q

What are the clinical features of melanoma?

A

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

33
Q

Why is it important to recognize melanoma ealy? and what ae the 2 growth phases?

A
  • 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****
34
Q

What is the most important prognostic indicator for melanoma?

A

depth of invasion (Breslow thickness)

when <1mm rarley metastasize

when >1.7mm have greater otential to metastasize

35
Q

How do we measure invasion?

A

Clark level

I Intraepidermal

II in papillary dermis

III Fills papillary dermis

IV Reticular dermis

IV Enters fat

36
Q

Besides level of invsion (clarks level) what are some indicators of metastatic potential for melanoma?

A

ulceration, mitotic rate, angioinvasion

37
Q

What are the 4 type of melanoma?

A
  • 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)
38
Q

What kind of melanoa is this?

A

Lentigo type

39
Q

What kind of melanoma is this?

A

Supeficial spreading type

40
Q

What kind of melanoma is this?

A

Nodular type

41
Q

What kind of melanoma is this?

A

Acral lentiginous type

42
Q

What are the cutaneous lymphomas?

A

Mycosis fungoides

Sezary syndrome

43
Q

How does mycosis fungoides present? What are the 3 stages? When does it usually occur?

A
  • 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
44
Q

What is Sezary syndrome? how does it present and what is the prognosis?

A
  • blood involvement of T cell lymphoma
  • erythrodermaskin is diffusely red and scaly
  • poor prognosis
  • survival 1-3 years
45
Q

What do you see histologically for mycosis fungoides?

A

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

46
Q

besides CDKNA2 9p21 mutation what activatin gmutations are associated with melanoma?

A

NRAS and BRAF

47
Q

what 2 new drugs arebeing used for melanoma and what do they target?

A

vemurafenib-inhibit mutant BRAF

trametinib- influence the MEK pathway

48
Q
A

MSS (26 decks)

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