Dermatopathology 1 Flashcards
Name a hypopigmentation disorder
Vitiligo
define: Vitiligo
complete loss of epidermal melanocytes
what autoimmune diseases is Vitiligo associated with
pernicious anemia
Hashimoto’s thyroiditis
Vitiligo has an antibody against what
melanin-concentrating hormone receptor 1 in serum
during what decades does Vitiligo occur
2nd
3rd
what race has has higher incidence of Vitiligo
African American
where does Vitiligo usually occur
acral areas
orifaces
Along with skin, what can also loose pigmentation
hair
if repigmentation occurs with Vitiligo where does it usually occur
around hair follicle
looks like freckle
what is Ephelis
freckle
in what layers skin does Ephelis occur and what happens there
basal layer hyperpigmentation
Is there risk of malignancy with Ephelis
no
What does Lentigo look like
small circumscribed brown macular lesions
Where in the skin does Lentigo have a problem
hyperpigmentation of cells just above the basement membrane
what is the difference between Ephelides and Lentigo
lentigines does not darken with sun exposure
what is a more common name for Lentigo
“liver or age spots”
what does the histology pic for Lentigo
Rete ridges
name 5 features for Melanocytic nevi
- color?
- size?
- tan to brown
- uniformly pigmented
- small
- flat to elevated
- well-defined, rounded borders
what are some histological features for Melanocytic nevi
- dermal-epidermal junction
- no deep mitosis
- melanocytes mature as they descend in dermis
- no deep pigment in melanocytic nests
what are the 3 steps in melanocytic nevi progression of maturation
junctional
compound
intradermal
what is happening in Junctional for Melanocytic Nevus
Melanocytic nests @ dermal-epidermal junction
- nests at tips and sides of rete
what is happening in compound for Melanocytic Nevus?
- clinical?
- histological?
- 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
what is happening in Intradermal ( dermal) for Melanocytic Nevus?
epidermal nests are lost completely
name two kinds of Melanocytic Nevi
Spitz nevus
Dysplastic melanocytic nevus
Spitz nevus have what type of cells and contain what else
spindle and/or epithelioid cells
Kamino bodies
what are Kamino bodies
dyskeratotic melanocytes : eosinophilic bodies along dermal-epidermal junction
who usually gets Spitz Nevus
children
what does Spitz Nevus look like
deep red color
symmetrical
in Spitz Nevus what separates nests of melanocytes within the epidermis
epidermis by clefts
Clinically what does Dysplastic (atypical) melanocytic nevus look like?
- pigment?
- shape?
large, oval, many
irregular pigment
fried-egg appearance
central papule, surrounding macule
histology what does Dysplastic ( atypical) melanocytic nevus look like
- nest horizontally orientated
- bridge retes
- hyperchormatic
- enlarged nuclei
Define melanoma
malignancy of pigment-producing cells
melanocytes are derived from what
nerual crests
what is the number one cause of skin cancer deaths worldwide
Melanoma
what are 5 subtypes of Meloma
- superficial spreading
- lentigo maligna
- nodular
- acral
- amelanotic
what are the growth phases of meloma
radial and vertical
what determines tumor stage of meloma
vertical phase
Melanoma is third most common metastatic tumor where
brain after lung and breast cancer
what is the number risk factor for Meloma
changing mole
what familial disease is a risk factor for Melanoma
- Xeroderma pigmentosum
- familial dysplastic nevus syndrome
what pneumoic do you use for melanoma
ABCDE asymmetry border irregularity color variation diameter > 6mm evolving
If a patient has Melanoma what should you not do them on their body
avoid shaving, scissors excision or curettage
For melanoma where is radial growth phase and characterize the tumor cells
- horizontal spread of melanoma cells within epidermis and superficial dermis
- tumor cells lack ability to metastatsize
Superficial spreading Melanoma:
why does it occur
talk about growth phases
clinical presentation
sun-exposed skin
- radial growth phase of uncertain length before vertical growth phase develops
- multiple colors
histologic features of Superficial spreading malignant melanoma
- fails to mature top to bottom
- deep mitosis may be present
- not symmetrical
Lentigo Maligna: who usually gets its
face of old men
Lentigo Maligna:
describe radial growth phase
color
- long 10-50 years
- starts brown gets darker
intraepidermal lesions evolve to become clinically palpable and turn into
lentigo maligna melanoma
what is the difference between lentigo maligna and lentigo maligna melanoma
lentigo maligna has a vertical growth phase
where in the skin does lentigo maligna occur
poorly nested melanocytes at dermal-epidermal jucntion
Acral lentiginous melanoma
- occurs in who
- where on the body
African Americans
Asians
- palms, soles, beneath nail plate (hutchinsons sign)
What is the most common and least common type of Melanoma
most: superficial spread
least: acral
Nodular melanoma
- color
- location
- growth phases
- amelanotic
- anywhere on body
- vertical yes, no radial growth phase
- mitosis
what are two ways to report tumor thickness
Breslow
Clark level
Breslow
measurement from skin surface
Clark level
not based on measurement, but on number of layers of skin that tumor has penetrated
which method of tumor thickness most closely correlates with survival statistics
Breslow’s
If a tumor is
in situ
4 mm
.5 cm 1cm 1-2cm 2cm at least 2cm
Sentinel node biopsy
surgical procedure used to determine if cancer has spread beyond a primary tumor into your lymphatic system.
what instruments are used for sentinel node biopsy
lymphoscintigraphy
radioactive tracer
gamma probe
what is the number one prognostic factor for Melanoma
tumor thickness
what gender has a better prognosis for Melanoma
females
there are 5 stages of melanoma: what happens to the 5 year survival rate as you progress through the stages
decreases
In sentinel node biopsy, if metastatic disease is present what procedures are done
Full lymph node dissection
And interferon alpha
what is the most common benign tumor in older individuals
Seborrheic keratosis
clinically what does Seborrheic keratosis look like
light brown, flat macules
- velvety/waxy to rough ( verrucous) surface
- crumble with scraping
what is Leser-Trelat sign
multiple eruptive seborrheic keratoses with internal malignancy
name a subtype of seborrheic keratosis
dermatosis papulosa nigra
what does dermatosis papulosa nigra look like and who gets it
brown to black, smooth, dome-shaped papules
African Americans
key histological features for seborrheic keratosis
- keratin production at surface
- horn cysts ( keratin-filled)
- “shreaded-wheat” or “ onion skin”
where is Acanthosis nigricans found
folds of neck, axilla, and groin
the Benign acanthosis nigricans occurs in who and is associated with what
- childhood/puberty
- endocrine abnormalities
Malignant Acanthosis Nigricans occurs in who and associated with what
middle-aged and older
visceral malignancy
what happens in the skin for Acanthosis Nigricans
- hyperpigmentation at first sign
- hyperplasia of stratum spinosum
- makes skin think and velvety
histologically what does Epidermal (inclusion) cyst look like
cyst wall resembles normal epidermis, filled with strands of keratin
what is the earliest identifiable lesion that can develop into squamous cell carcinoma
Actinic keratosis
what are risk factors for actinic keratosis
years of sun exposure
fair skin
immunosuppression
what key for early diagnosis for actinic keratosis? what can you find
palpitation
“ gritty skine”
“broken glass”
- poorly demarcated, slightly erythematous papule or plaque
histologically for actinic keratosis what is found in each of the layers
stratum corneum: parakeratosis (retained nucleus)
basal cell layer: hyperplasia
Superficial dermis: solar elastosis
how does one distinguish between actinic keratosis and melanoma
biopsy
what is the most common cancer in the US
nonmelanoma skin cancer (NMSC)
what are two types of nonmelanoma skin cancers
basal cell carcinoma
squamous cell carcinoma
Squamous cell carcinoma arises in what layer of the skin
epithelium
who is more likely to get squamous cell carcinoma
middle-aged
elderly population
what is the most important risk factor for squamous cell carcinoma
DNA damaged induced by UVB (1) and UVA (2)
clinically what does squamous cell carcinoma look like
scaly pink patch or thin keratotic papule
what is a subtype of SCC
what does it look like
- where can it arise of skin
Bowen disease
- sharply demarcated pink plaque
- can arise from non-sun-exposed skin
Bowen’s disease of glans penis, which manifests as one or more velvety red plaques
Erythroplasia or Queyrat
Bowen vs. squamous cell carcinoma: basement memebrane
Bowen: no invasion
SCC: invades
Bowen nucleus
atypical
-involve ALL levels of epidermis
what does invasive SCC look like
raised, firm, pink-to-flesh colored keratotic papule or plaque arising on sun-exposed skin
what must be done if you want a definitive diagnosis of NMSC
biopsy,
- must reach mid dermis
if regional lymphadenopathy is present, how does diagnose SCC
lymph node biopsy and FNA ( fine needle aspiration)
how does one treat SCC
- mohs micrographic surgery
what is keratocanthoma
benign epithelial tumor might progress into SCC
clinically describe Keratocanthoma
red to flesh colored dome-shaped papule with a central crater filled with keratinous plug
what is the most common malignancy
basal cell carcinoma
where in the skin does BCC occur
pluripotential cells in basal layer of epidermis or follicular structures
what is the most important risk factor for BCC
UV radiation
how does BCC present clinically
non-healing lesions that bleeds
Nodular BCC presentation
common site?
Telangiectasias
face most common location
translucency
most common site for superficial BCC
trunk
- light red color
- atrophic center with fine translucent micropapules
talk about the nests of BCC for histology
basaloids cells and palisade at border of nest
- nests in fibromyxoid stroma
what does Keratoacanthoma look like in histology
large, red, glassy, squamoid cells
- neutrophil microabscesses
- eosinophils and lymphocytes
histo: what separates the tumor nodules for basal cell carcinoma
stroma
how often does metastases occur in basel cell carcinoma
rare
Mohs surgery is the removal of what
tumor and a thin rim of normal-appearing skin around defect
for Mohs surgery what is the frozen-section technique allows for what?
examination of tissue while patient is in office
Which nonmelanoma skin cancer metastasizes to the lymph nodes
squamous cell carcinoma
what nonmelanoma skin cancer is the most common
basal cell carcinoma
