Cutaneous Neoplasms Flashcards
What are seborrheic keratoses?
- one of the most common cutaneous neoplasms
- develop in middle age or older patients
- brown/tan waxy papules and plaques with a “stuck on” warty appearance most commonly on face/trunk/upper extremities
What is the Leser-Trelat sign?
Sudden onset of multiple seborrheic keratoses associated with internal malignancy (most commonly stomach cancer)
What do seborrheic keratoses look like on histology?
- Hyperkeratotic, papillomatous and verrucous epidermis
- Horn and pseudo horn cysts (invaginations of keratin)
- Variable melanin pigmentation is present, accounting for the brown coloration seen clinically
What is actinic keratosis?
- also known as solar keratosis; common lesions that develop as a result of chronic sun damage
- middle aged to elderly onset (esp with fair complexion)
- red or tan/brown macues with “gritty” sandpaper like scales
- some lesions regress or may remain stable
- 0.1-10% become malignant squamous cell carcinoma
What does actinic keratosis look like on histology?
- Atypia of the basal layer of the epidermis
- Corneal layer is thickened with retained nuclei (parakeratosis)
- Loss of granular layer in some places
- Dermis contains thickened, blue-gray elastic fibers (solar elastosis), the result of chronic sun damage
Describe the etiology/prevalence of squamous cell carcinoma
- common neoplasm in older individuals (40+); 20% of all skin cancers
- UV radiation is the most common cause (DNA damage)
- Other predisposing factors include;
- chronic ulcers
- old burn scars
- HPV (esp in head and neck)
- toxic exposure (radiation, arsenic)
- immunosuppression (esp in solid organ transplant)
- 1-5% risk of metastasis in low risk area (~20% in high risk area such as lip/mucosa)
What are the clinical symptoms of squamous cell carcinoma?
- red scaly plaque
- risk of metastasis is related to the location and degree of invasion
- ~2-4% higher risk in immunosuppressed patients
How does SCC differ when it becomes invasive?
- invasive lesions (5% of SCCs) tend to be nodular and may ulcerate
- roughly 30% of invasive SCCs have metastatic potential
- classified as invasive when the neoplastic cells break through the basement membrane
What does SCC look like on histology?
- full-thickness dysplasia (characteristically involves the entire epidermis)
- disorganization of the epidermal architecture
- loss of maturation
- lack of polarity of cells
What is keratoacanthoma?
- variant of squamous cell carcinoma
- pink papule/nodule with a central keratin plug that grows rapidly (period of 2-10 weeks)
- can cause extensive local destruction
- occurs mainly on sun damaged skin
- some lesions will resolve spontaneously (or can become very aggressive)
- multiple lesions may be present in immunocompromised patients
What do keratoacanthomas look like on histology?
- exophytic lesions with an invaginating mass of keratinizing, well-differentiated squamous epithelium at the sides and bottom
- central keratin-filled crater that enlarges with the maturation and evolution of the lesion
- epidermis on either side of the lesion is thrown up into a well-formed collarette
- epithelium is typically characterized by well-differentiated, often pale-staining, eosinophilic, glassy cytoplasm showing a striking tendency towards keratinization
Describe basal cell carcinoma
- most common human cancer
- secondary to chronic sun exposure/UV radiation
- slow growing tumor that rarely metastasizes (unless immunocompromised)
- can be locally destructive
- associated with dysregulation of the sonic hedgehog or PTCH pathway (30-40%)
What does basal cell carcinoma look like on histology?
- several histologic variants
- multifocal growths originating from the epidermis (superficial type)
- nodular lesions growing downward into the dermis (nodular type) of variably basophilic cells with peripheral palisading.
- tumor cells are small and uniform with round, darkly staining nuclei and minimal cytoplasm
- characteristic clefting artifact between the tumor nodules and the stroma
What are melanocytic nevi?
- An above normal amount of melanocyte in the epidermis
- acquired from sun exposure
- congenital at birth (can be severe/widespread and increase risk of melanoma)
What are the histological classifications of nevi?
- junctional (epidermis only)
- compound (epidermis and dermis)
- intradermal (dermis only)