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D & T exam 2 > Dermatopathology 1 > Flashcards

Dermatopathology 1 Flashcards

1
Q

Name a hypopigmentation disorder

A

Vitiligo

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2
Q

define: Vitiligo

A

complete loss of epidermal melanocytes

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3
Q

what autoimmune diseases is Vitiligo associated with

A

pernicious anemia

Hashimoto’s thyroiditis

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4
Q

Vitiligo has an antibody against what

A

melanin-concentrating hormone receptor 1 in serum

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5
Q

during what decades does Vitiligo occur

A

2nd

3rd

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6
Q

what race has has higher incidence of Vitiligo

A

African American

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7
Q

where does Vitiligo usually occur

A

acral areas

orifaces

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8
Q

Along with skin, what can also loose pigmentation

A

hair

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9
Q

if repigmentation occurs with Vitiligo where does it usually occur

A

around hair follicle

looks like freckle

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10
Q

what is Ephelis

A

freckle

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11
Q

in what layers skin does Ephelis occur and what happens there

A

basal layer hyperpigmentation

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12
Q

Is there risk of malignancy with Ephelis

A

no

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13
Q

What does Lentigo look like

A

small circumscribed brown macular lesions

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14
Q

Where in the skin does Lentigo have a problem

A

hyperpigmentation of cells just above the basement membrane

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15
Q

what is the difference between Ephelides and Lentigo

A

lentigines does not darken with sun exposure

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16
Q

what is a more common name for Lentigo

A

“liver or age spots”

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17
Q

what does the histology pic for Lentigo

A

Rete ridges

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18
Q

name 5 features for Melanocytic nevi

  • color?
  • size?
A
  • tan to brown
  • uniformly pigmented
  • small
  • flat to elevated
  • well-defined, rounded borders
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19
Q

what are some histological features for Melanocytic nevi

A
  • dermal-epidermal junction
  • no deep mitosis
  • melanocytes mature as they descend in dermis
  • no deep pigment in melanocytic nests
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20
Q

what are the 3 steps in melanocytic nevi progression of maturation

A

junctional
compound
intradermal

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21
Q

what is happening in Junctional for Melanocytic Nevus

A

Melanocytic nests @ dermal-epidermal junction

- nests at tips and sides of rete

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22
Q

what is happening in compound for Melanocytic Nevus?

  • clinical?
  • histological?
A
  • more Raised and Domed shaped than Junctional
  • dermal-epidermal nevus cell nests and nests and cords of nevus cell in underlying dermis
  • invasion of dermis–> mature and get smaller
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23
Q

what is happening in Intradermal ( dermal) for Melanocytic Nevus?

A

epidermal nests are lost completely

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24
Q

name two kinds of Melanocytic Nevi

A

Spitz nevus

Dysplastic melanocytic nevus

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25
Q

Spitz nevus have what type of cells and contain what else

A

spindle and/or epithelioid cells

Kamino bodies

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26
Q

what are Kamino bodies

A

dyskeratotic melanocytes : eosinophilic bodies along dermal-epidermal junction

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27
Q

who usually gets Spitz Nevus

A

children

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28
Q

what does Spitz Nevus look like

A

deep red color

symmetrical

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29
Q

in Spitz Nevus what separates nests of melanocytes within the epidermis

A

epidermis by clefts

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30
Q

Clinically what does Dysplastic (atypical) melanocytic nevus look like?

  • pigment?
  • shape?
A

large, oval, many
irregular pigment
fried-egg appearance
central papule, surrounding macule

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31
Q

histology what does Dysplastic ( atypical) melanocytic nevus look like

A
  • nest horizontally orientated
  • bridge retes
  • hyperchormatic
  • enlarged nuclei
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32
Q

Define melanoma

A

malignancy of pigment-producing cells

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33
Q

melanocytes are derived from what

A

nerual crests

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34
Q

what is the number one cause of skin cancer deaths worldwide

A

Melanoma

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35
Q

what are 5 subtypes of Meloma

A
  1. superficial spreading
  2. lentigo maligna
  3. nodular
  4. acral
  5. amelanotic
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36
Q

what are the growth phases of meloma

A

radial and vertical

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37
Q

what determines tumor stage of meloma

A

vertical phase

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38
Q

Melanoma is third most common metastatic tumor where

A

brain after lung and breast cancer

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39
Q

what is the number risk factor for Meloma

A

changing mole

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40
Q

what familial disease is a risk factor for Melanoma

A
  • Xeroderma pigmentosum

- familial dysplastic nevus syndrome

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41
Q

what pneumoic do you use for melanoma

A 
ABCDE
asymmetry 
border irregularity 
color variation 
diameter > 6mm 
evolving
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42
Q

If a patient has Melanoma what should you not do them on their body

A

avoid shaving, scissors excision or curettage

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43
Q

For melanoma where is radial growth phase and characterize the tumor cells

A
  • horizontal spread of melanoma cells within epidermis and superficial dermis
  • tumor cells lack ability to metastatsize
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44
Q

Superficial spreading Melanoma:
why does it occur
talk about growth phases
clinical presentation

A

sun-exposed skin

  • radial growth phase of uncertain length before vertical growth phase develops
  • multiple colors
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45
Q

histologic features of Superficial spreading malignant melanoma

A
  • fails to mature top to bottom
  • deep mitosis may be present
  • not symmetrical
46
Q

Lentigo Maligna: who usually gets its

A

face of old men

47
Q

Lentigo Maligna:
describe radial growth phase
color

A
  • long 10-50 years

- starts brown gets darker

48
Q

intraepidermal lesions evolve to become clinically palpable and turn into

A

lentigo maligna melanoma

49
Q

what is the difference between lentigo maligna and lentigo maligna melanoma

A

lentigo maligna has a vertical growth phase

50
Q

where in the skin does lentigo maligna occur

A

poorly nested melanocytes at dermal-epidermal jucntion

51
Q

Acral lentiginous melanoma

  • occurs in who
  • where on the body
A

African Americans
Asians
- palms, soles, beneath nail plate (hutchinsons sign)

52
Q

What is the most common and least common type of Melanoma

A

most: superficial spread
least: acral

53
Q

Nodular melanoma

  • color
  • location
  • growth phases
A
  • amelanotic
  • anywhere on body
  • vertical yes, no radial growth phase
  • mitosis
54
Q

what are two ways to report tumor thickness

A

Breslow

Clark level

55
Q

Breslow

A

measurement from skin surface

56
Q

Clark level

A

not based on measurement, but on number of layers of skin that tumor has penetrated

57
Q

which method of tumor thickness most closely correlates with survival statistics

A

Breslow’s

58
Q

If a tumor is
in situ
4 mm

A 
.5 cm
1cm
1-2cm
2cm 
at least 2cm
59
Q

Sentinel node biopsy

A

surgical procedure used to determine if cancer has spread beyond a primary tumor into your lymphatic system.

60
Q

what instruments are used for sentinel node biopsy

A

lymphoscintigraphy
radioactive tracer
gamma probe

61
Q

what is the number one prognostic factor for Melanoma

A

tumor thickness

62
Q

what gender has a better prognosis for Melanoma

A

females

63
Q

there are 5 stages of melanoma: what happens to the 5 year survival rate as you progress through the stages

A

decreases

64
Q

In sentinel node biopsy, if metastatic disease is present what procedures are done

A

Full lymph node dissection

And interferon alpha

65
Q

what is the most common benign tumor in older individuals

A

Seborrheic keratosis

66
Q

clinically what does Seborrheic keratosis look like

A

light brown, flat macules

  • velvety/waxy to rough ( verrucous) surface
  • crumble with scraping
67
Q

what is Leser-Trelat sign

A

multiple eruptive seborrheic keratoses with internal malignancy

68
Q

name a subtype of seborrheic keratosis

A

dermatosis papulosa nigra

69
Q

what does dermatosis papulosa nigra look like and who gets it

A

brown to black, smooth, dome-shaped papules

African Americans

70
Q

key histological features for seborrheic keratosis

A
  • keratin production at surface
  • horn cysts ( keratin-filled)
  • “shreaded-wheat” or “ onion skin”
71
Q

where is Acanthosis nigricans found

A

folds of neck, axilla, and groin

72
Q

the Benign acanthosis nigricans occurs in who and is associated with what

A
  • childhood/puberty

- endocrine abnormalities

73
Q

Malignant Acanthosis Nigricans occurs in who and associated with what

A

middle-aged and older

visceral malignancy

74
Q

what happens in the skin for Acanthosis Nigricans

A
  • hyperpigmentation at first sign
  • hyperplasia of stratum spinosum
  • makes skin think and velvety
75
Q

histologically what does Epidermal (inclusion) cyst look like

A

cyst wall resembles normal epidermis, filled with strands of keratin

76
Q

what is the earliest identifiable lesion that can develop into squamous cell carcinoma

A

Actinic keratosis

77
Q

what are risk factors for actinic keratosis

A

years of sun exposure
fair skin
immunosuppression

78
Q

what key for early diagnosis for actinic keratosis? what can you find

A

palpitation
“ gritty skine”
“broken glass”
- poorly demarcated, slightly erythematous papule or plaque

79
Q

histologically for actinic keratosis what is found in each of the layers

A

stratum corneum: parakeratosis (retained nucleus)
basal cell layer: hyperplasia
Superficial dermis: solar elastosis

80
Q

how does one distinguish between actinic keratosis and melanoma

A

biopsy

81
Q

what is the most common cancer in the US

A

nonmelanoma skin cancer (NMSC)

82
Q

what are two types of nonmelanoma skin cancers

A

basal cell carcinoma

squamous cell carcinoma

83
Q

Squamous cell carcinoma arises in what layer of the skin

A

epithelium

84
Q

who is more likely to get squamous cell carcinoma

A

middle-aged

elderly population

85
Q

what is the most important risk factor for squamous cell carcinoma

A

DNA damaged induced by UVB (1) and UVA (2)

86
Q

clinically what does squamous cell carcinoma look like

A

scaly pink patch or thin keratotic papule

87
Q

what is a subtype of SCC
what does it look like
- where can it arise of skin

A

Bowen disease

  • sharply demarcated pink plaque
  • can arise from non-sun-exposed skin
88
Q

Bowen’s disease of glans penis, which manifests as one or more velvety red plaques

A

Erythroplasia or Queyrat

89
Q

Bowen vs. squamous cell carcinoma: basement memebrane

A

Bowen: no invasion
SCC: invades

90
Q

Bowen nucleus

A

atypical

-involve ALL levels of epidermis

91
Q

what does invasive SCC look like

A

raised, firm, pink-to-flesh colored keratotic papule or plaque arising on sun-exposed skin

92
Q

what must be done if you want a definitive diagnosis of NMSC

A

biopsy,

- must reach mid dermis

93
Q

if regional lymphadenopathy is present, how does diagnose SCC

A

lymph node biopsy and FNA ( fine needle aspiration)

94
Q

how does one treat SCC

A
  • mohs micrographic surgery
95
Q

what is keratocanthoma

A

benign epithelial tumor might progress into SCC

96
Q

clinically describe Keratocanthoma

A

red to flesh colored dome-shaped papule with a central crater filled with keratinous plug

97
Q

what is the most common malignancy

A

basal cell carcinoma

98
Q

where in the skin does BCC occur

A

pluripotential cells in basal layer of epidermis or follicular structures

99
Q

what is the most important risk factor for BCC

A

UV radiation

100
Q

how does BCC present clinically

A

non-healing lesions that bleeds

101
Q

Nodular BCC presentation

common site?

A

Telangiectasias
face most common location
translucency

102
Q

most common site for superficial BCC

A

trunk

  • light red color
  • atrophic center with fine translucent micropapules
103
Q

talk about the nests of BCC for histology

A

basaloids cells and palisade at border of nest

- nests in fibromyxoid stroma

104
Q

what does Keratoacanthoma look like in histology

A

large, red, glassy, squamoid cells

  • neutrophil microabscesses
  • eosinophils and lymphocytes
105
Q

histo: what separates the tumor nodules for basal cell carcinoma

A

stroma

106
Q

how often does metastases occur in basel cell carcinoma

A

rare

107
Q

Mohs surgery is the removal of what

A

tumor and a thin rim of normal-appearing skin around defect

108
Q

for Mohs surgery what is the frozen-section technique allows for what?

A

examination of tissue while patient is in office

109
Q

Which nonmelanoma skin cancer metastasizes to the lymph nodes

A

squamous cell carcinoma

110
Q

what nonmelanoma skin cancer is the most common

A

basal cell carcinoma

D & T exam 2 (27 decks)

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