Derm/Path Flashcards by Ali Kiernan

Pigmented lesions caused by increase in melanocytes?

Melanocyte hyper plasmia (lentigo simplex) or melanocytic neoplasmia (nevi, melanoma)

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What causes a solar lentigo?

Increased melanin, normal number of melanocytes, due to chronic sun exposure!

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What is lentigo simplex?

An increase in the NUMBER of melanocytes, not sun related.

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What is a neoplasm?

Unregulated cell growth- cells originating from one cell that does not obey the laws of cell growth. These come from stem cells and differentiate to look like a specific type of cell.

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Melanocytic neoplasm

A neoplasm of the melanocytes

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Stromal neoplasm

A neoplasm of the dermis- mesenchymal cells

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Hematopoietic neoplasm

T/B cells

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Metastasis/non cutaneous origin neoplasm

From visceral cell type

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How is benign neoplasm different from a malignant one?

Benign has NO CAPABILITY TO METASTASIZE, whereas malignant HAS THE CAPACITY TO METASTASIZE.

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How are epithelial neoplasms classified?

By the presence/absence of invasion bast the basement membrane into foreign tissue, must get to dermis to get to the blood

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What do you call a benign vs malignant melanocytic neoplasm?

Nevi vs melanoma

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What do you call a benign vs malignant epithelial neoplasm?

adenomas vs carcinoma

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What do you call a nevus that is difficult to characterize? Why are they clinically important?

Spitz- ALL SHOULD BE EXCISED may have significant histologic overlap with melanoma.

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If a nevus is raised what layer is it in?

DERMIS

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What is a blue nevus?

A nevus that starts in the dermis (unlike most in epidermis)

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Why are dysplastic nevus clinically significant?

They serve as a marker for risk of melanoma- hereditary significant higher risk in your lifetime if you have many dysplastic nevi.

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What does melanoma arise from?

Nevi (dysplastic) or can occur randomly

Evaluation for melanoma is based on (ABCD):

symptoms: itchy, changing mole
A- asymmetry
B- border
C- color
D- diameter

How to differentiate between melanoma in situ and malignant melanoma?

Depth- if below BM then it is melanoma malignant, if above in situ

What is significant about desmoplastic melanoma?

Spindle cell morphology, with LESS RISK OF METASTASIS. Though it is deep it is unlikely to metastasize leading to a good pronosis

How can we estimate the probability of metastasis of melanoma?

BRESLOW DEPTH measures in mm is our best prognostic indicator!
If >1mm do a sentinel lymph node biopsy

What factors influence melanoma staging?

breslow depth, ulcerations (bad- tell us these behave more poorly than other melanomas of same depth) and mitotic figures

What is a seborrheic keratosis?

A benign, squamous proliferation caused by increased melanin– stuck on appearance of papule

What is a skin tag?

A non-neoplastic cutaneous lesion- could be melanoma though so send to lab. Increased with pregnancy, diabetes and obesity

What is actinic keratosis (AK)?**

A benign, squamous neoplasm that is a PRECURSOR to squamous cell carcinoma - Induced by sunlight - looks like red, scaly plaques - Located in EPIDERMIS- shave biopsy

Squamous cell carcinoma of the skin

Red, scaly plaques on sun-exposed skin - LOW metastatic risk! - often raised - depth here doesn't matter! shave is OK

What is the most common human malignancy?

Basal cell carcinoma, RARELY metastasize but locally destructive! CUT OUT. - risk due to sun exposure and fair complexion - named because it can resemble the basal layer of the epidermis

What are the most common types of basal cell carcinoma? Are they likely to metastasize?

Superficial (plaque- often scaly and red- shave biospsy) and nodular BCC, NO!

What are the adnexal proliferations/neoplasms that are associated with hereditary tumor syndromes?

Cowden syndrome and | Muir torre syndrome

What are the key features of cowden syndrome

- AD - Multiple trichilemmomas (face, cobblestone tongue)-- a hair follicle like benign tumor - Often have a visceral carcinoma like BREAST - Mutation in the PTEN gene (a tumor suppressor)

What is clinically significant about sebaceous carcinoma?

It is malignant, metastasis is not common but you need to get this out- lower part tells that it is cancer CANNOT SHAVE.

What are they key features of muir torre syndrome

- Hereditary germline mutation in DNA mismatch repair proteins, MLH1, MSH2, MSH6 and PMS2 - Lead to multiple sebaceous adenoma and carcinomas (extraocular!) - Often have an internal colorectal cancer!

What are merkel cell carcinomas clinically significant?

They are a rare, aggressive epithelial neoplasm that are caused by polyomaVIRUS.

What is a dermatofibroma?

A benign, fibrous dermal proliferation common to the legs- possibly neoplastic PUNCH BIOPSY

What is a hemangioma?

A solitary purple/red papule, congenital or acquired --> shave is fine

What is kaposi sarcoma?

A malignant vascular neoplasm caused by HHV-8, found often in immunosuppresed

What is angiosarcoma?

An aggressive malignant vascular neoplasm- head/neck of elderly- or post radiation

Cutaneous T-cell lymphoma? What is one important type

A slowly progressive disease NON-SUN EXPOSED skin --> bathing suit distribution If cells circulate in blood --> sezary sydrome (red all over) -Mtcisus fungoides, most common CTCL of neoplastic CD4+ T cell. Infiltrate the epidermis leading to redness! PUNCH.

Cutaneous B cell lymphoma?

A few solitary nodules, rather than multiple like CTCL. Head or face often (sun exposed!) involving the deep dermis (vs epidermis in CTCL). PUNCH BIOPSY.

Benefits of shave biopsy? Used for?

Better cosmetics, fast, no sutures | Used for BCC, AK, SCC in situ, pigmented macules

Benefits of punch biopsy? Used for?

Bigger sample but requires sutures | Used for nodular BCC, SCC, melanoma and most rashes