Derm Flashcards
1
Q
premalignant/malignant epidermal tumors
A
actinic (solar) keratosis, SCC, BCC, merkel cell carcinoma
2
Q
most common premalignant/malignant epidermal tumor caused from sun exposure
A
BCC, SCC is second most common
3
Q
Blue palisading nests …
A
BCC
4
Q
Squamous “pearls” intercellular bridges
A
SCC
5
Q
actinic keratosis can convert to…
A
SCC
6
Q
Actinic cheilitis
A
keratosis on lips (increased cornified layer keratinocytes)
7
Q
Parakeratosis seen in what epidermal tumor?
A
characteristic HALLMARK of actinic keratosis- nucleus retained in corneum layer of cells
8
Q
Thickened stratum corneum, nuclei here as well. Fair skinned individual that works in chemical plant. Tan brown lesion less than 1 m. Rough sandpaper like.
A
Actinic keratosis
9
Q
causes of actinic keratosis
A
sun damage, ionizing radiation, arsenicals, industrial hydrocarbons (working in chemical plants)
10
Q
What med used in actinic keratosis
A
Imipuimod- activates immune system by stimulating toll like receptors- destroy atypical cells
11
Q
squamous cell In-situ referred to as
A
bowen’s disease- no invasion yet through dermatoepidermal junction
12
Q
What layers of epidermis involved in SCC
A
ALL
13
Q
Red, scaling plaques. Sharply defined, variable keratin, may ulcerate. squamous “pearls”, intercellular bridges
A
SCC
14
Q
WHich gene mutated in SCC?
A
p53 caused by DNA damage from UV light
15
Q
How does sun damage cause SCC?
A
DNA damage causing mutation in P53. Also suppresses immune system by suppressing langerhans cells and dendrocytes- less processing of antigens.
16
Q
Which strands of HPV associated with SCC?
A
5 and 8
17
Q
What is most common invasive cancer in humans?
A
BCC
18
Q
2 types of growth in BCC
A
multifocal growth patter, or nodular lesions (start out in follicular epithelium and go downward into dermis_
19
Q
Pearly nodular appearance, telengiectasias, blue palisading nests
A
BCC
20
Q
Gorlin syndrome associated with..
A
aka nevoid basal cell carcinoma syndrome- BCC!
21
Q
Other tumors associated with BCC
A
medulloblastomas, ovarian fibromas
22
Q
in what age population would you expect to see BCC
A
younger- under age 20
23
Q
Mutations involved in SCC vs. BCC
A
SCC- p53. BCC- Chromosome 9, PTCH gene in NBCCS. If Non-NBCCS- 30% have PCTH mutation, 50% have p53 mutation.
24
Q
Defects in xeroderma pigmentosum
A
PTCH and P53 mutations both. often manifest with BCC
25
Nevus of Ota involves what nerves
trigeminal nerve, 1st and 2nd- opthalmic and maxillary
26
Nevus of Ito involves what nerves
posterior supraclavicular and lateral brachiocutaneous nerves
27
Tyndall effect
blue color resulting from scattering of shorter wavelengths by dermal melanin
28
3 types of issues in skin pathology
inflammation, degernation, neoplasma
29
Mitosis limited to what layer in epidermis
stratum basale
30
Pathology of stratum spinosum
Acantholysis- desmosomes not connecting keratinocytes together. so get separation of cells, can lead to fluid accumulation
31
What kind of cells are keratinocytes and what is function
basal cells- upward migration into stratum corneum layer. and squamous cells- produce keratin and produce cytokines
32
PKU
phenylketone urea- disorder in which can't metabolize phenylalanine
33
Where are merkel cells located?
specialized regions, like lips, oral cavity, and palmar skin
34
In what layers are hair follicles in?
originate in epidermis, grow into dermis
35
Function of erector pili muscle
SNS response- when contract, straighten out hair follicle
36
eccrine vs. apocrine gland locations
eccrine- face, chest, back. apocrine- axilla, scalp, face, abdomen, genital area
37
WHich sweat gland is fewer in number and has foul odor?
apocrine
38
Dermis components
collages, elastin, gelatinous protein, hair follicles, sebaceous glands, sweat glands, BLOOD VESSELS, lymphatic vessels, nerves, FIBROBLASTS, mast cells, macrophages, (dendrocytes)
39
subcutaneous layer components
adipocytes
40
layers of dermis
papillary- LOOSE CT. right beneath epidermis. reticular- DENSE. fibroblasts here
41
4 units of nail
nail BED (hyponychium), nail plate, nail matrix, proximal nail fold
42
what is responsible for nail FORMATION
nail matrix
43
nail growth
1 mm. or less per day
44
What layer produces NEW keratinocytes
Squamous cells do this in stratum SPINOSUM
45
Dermal epidermal junction between what 2 specific layers?
papillary layer of dermis and stratum basale of epidermis
46
Granular layer with keratohyaline granules, Dark demarcation here
stratum granulosum
47
Order layers of epidermis starting from outside
corneum, lucidum, granulosum, spinosum, germinativum, basale
48
Where is parakeratosis normal?
on mucous membranes- mouth, vaginal epithelium
49
Acanthosis vs. papillomatosis
acanthosis- hyperplasia of epidermis, papillomatosis- hyperplasia of both dermis and epidermis. surface ELEVATION.
50
spongiosis vs. hydropic swelling
spongiosis- intracelluar edema of epidermis. hydropic swelling- intracellular edema of keratinocytes
51
in what infection is hydropic swelling seen?
viral infections
52
lentiginous vs. nested
lentiginous- linear pattern of melanocyte proliferation in epidermal BASAL layer. nested- melanocyte proliferation occurs clumbed in basal layer
53
Which manifestations associated with RUBBING
Lichenification- thickeded rough skin (chronic dermatitis). Hypergranulosis- hyperplasia of stratum granulosum
54
causes of vitiligo
autoimmune, genetic, oxidative stress
55
dermatomal pattern of vitiligo in what form?
SEGMENTED
56
Is lentigo linear pattern or nested pattern of melanocyte proliferation in epidermal basal layer?
its in the name- LINEAR
57
what cells associated with terminal neuronal axon?
merkel cells
58
2 types of neurofibromatoses
neurofibromas- develop on skin. And tumors on auditory nerves- acoustic neuroma
59
Cafe au lait different from what commonly related lesion?
becker's nevus
60
melanocytes come from...
neural crest cells
61
dermal melanocytosis
mongolian spots, nevus of oto and ito
62
dermal melanocytosis have blue color due to
tyndall effect- scattering of shorter wavelengths by dermal melanin
63
similarites of nevus of ito and ota
apparent within 1st year of life, mottled blue appearance, and in asians and AA
64
melanocyte or pigmented nevus acquired or congenital
acquired most common
65
what makes nevus cells different?
melanocyte cells that are CLUSTERED and don't have dendritic processs
66
epidermal melanocytes linear or clustered?
linear- evenly dispersed
67
which type of pigmented nevus most associated with melanoma?
junctional
68
pigmentation disorders
problems with melanocytes- vitiligo, freckles, lentigo, cafe au lait spot, dermal melanocytosis (mongolian spot, nevus of ota/ito), melasma, melanocytic nevi, dysplastic nevus, melanoma
69
what does BRAF encode
serine/threonine kinase
70
waht does p16 inhibit
cdk4 and 6
71
when you think about any NEVUS (melanocyte nevus, dysplastic nevi syndrome), think...
NESTED melanocyte cells
72
dysplastic nevus syndrome is precursor for...
melanoma. probability of dev melanoma is more than 50% over age 60
73
what kind of nevus in dysplastic nevi syndrome?
COMPOUND usually
74
dysplastic nevi syndrome mode of inheritance
autosomal dominant
75
do malignant melanomas metastasize
YES, VERY QUICKLY!
76
Primary skin cancers that can KILL you
malignant melanoma and merkel cell tumor
77
types of malignant melanomas with RADIAL growth
superficial spreading, acral/mucosal lentiginous (unrelated to sun exposure), and lentigo maligna
78
NODULAR-- RAISED--means what kind of growth?
into dermis...VERTICAL
79
lesion over ____ concerning
6 mm. (in malignant melanoma)
80
breslow thickness measures from
granular layer of epidermis to deepest intradermal melanoma cells- gets closer to bloodstream- metastasize
81
what vertical depth is good prognosis for malignant melanoma
less than 1.7 mm
82
p16 aka
CDKN2A
83
p14 aka
PRF
84
Besides p14-p16, what other gene mutations involved in malignant melanoma in fair skinned ppl?
MCIR, ASIP, TYR
85
Name BENIGN epidermal tumors
SAAFE- seborrheic keratosis, acanthosis nigricans, adnexal tumors, fibroepithelial polyp, epidermal (inclusion) cyst
86
how are epidermal tumors different from pigmentation disorders?
pigmentation disorders- involve melanin. epidermal tumors- involve KERATINOCYTES
87
Flat, waxy plaques, velvety to granular suface. keratin filled horn cysts. increased in ppl of color, middle aged.
seborrheic keratosis
88
what helps distinguish seborrheic keratosis from melanoma?
hands lens
89
location of seborrheic keratosis
trunk, extremitis, hands and neck
90
dermatosis papulosa nigra
multiple small lesions on face. seen with seborrheic keratosis
91
Lesar trelat sign
explosive dev of keratosis in seborrheic keratosis d/t mutation in FGFR3
92
velvet like texture, thickened hyperpigmented skin in creased areas
acanthosis nigricans
93
acanthosis nigricans locations
flexed, creased areas: axilla, neck, groin, anogenital regions
94
distinguish between benign and malignant acanthosis nigricans
benign- MOST cases, occurs in young kids or puberty. AUTOSOMAL dominant with variable penetrance. associated with obesity or endocrine abnormalities. malignant- middle aged, older. associated wiht underlying CANCERS (GI adenocarcinoma)
95
cause of acanthosis nigricans
familial associated with mutation in FGFR3. seen with skeletal deformitis (achondroplasia, thanatophoric dysplasia)
96
numerous repeated "peaks and valleys" in epidermis
acanthosis nigricans
97
Acrochordon aka
fibroepithelial polyp, skin tag, or squamous papilloma
98
Wen aka
epidermal or inclusion cyst
99
skin tag vs. wen
skin tag- SOFT. wen- FIRM
100
location of acrochordon
face, neck, trunk
101
benign epidermal tumor that is soft, attached by slendear stalk on face. Has fibrovascular core.
fibroepithlial polyp
102
fibroepithelial polyp associations
diabetes, obesity, intestinal polyposis. increase in pregnancy (because hormonally driven)
103
what is wen filled with
cyst filled with keratin and lipid debris from sebaceous secretions
104
what layers of skin does epidermal cyst involve?
epidermal benign tumor, so obvisouly epidermis but also dermis and subcutaneous can be involved depending on type
105
types of epidermal/inclusion cysts:
epidermal inclusion cyst, pilar or trichilemmal cyst (more in dermis and subcutaneous area), dermoid cyst, steatocystoma simplex
106
steacystoma simplex vs multiplex
multiplex- missense mutation in keratin
107
adnexal tumors can be confused with
BCC
108
benign adenexal tumors can involve
sweat glands, sebaceous glands, and hair follicles
109
name benign adnexal tumors
SECTS- syringoma, eccrine poroma, cylindroma, trichoepithelioma, sebacous adenoma
110
cylindroma caused by
mutation in TSG CYLD- autosomal dominant
111
acne vulgaris vs. cylindroma-
acne vulgaris- reddened, tender to touch. cylindroma- nodular, not very painful
112
muir torre syndrome
sebacous adenoma plus hereditary nonpolyposis carcinoma syndrome
113
small TAN PAPULES in lower eyelid
syringomas
114
location of eccrine poroma
palms and soles
115
location of cylindroma
forehead and scalp
116
bowens dz associatd with..., xeroderma pigmentosum associated with...
SCC, BCC
117
merkel tumor looks like..
small cell cancer of lung
