Dermatopathology Flashcards
traumatic lesion breaking the epidermis and causing a raw linear area (i.e., deep scratch); often self-induced
excoriation
thickened, rough skin (similar to a lichen on a rock); usually the result of repeated rubbing
lichenification
circumscribed, flat lesion distinguished from surrounding skin by color
macules = 5mm or less
patches = greater than 5mm
macule, patch
separation of nail plate from nail bed
onycholysis
elevated dome-shaped or flat-topped lesion
papules = 5mm or less
nodules = greater than 5mm
papule, nodule
elevated flat-topped lesion, usually greater than 5mm across
plaque
discrete, pus-filled, raised lesion
pustule
dry, horny, platelike excrescence
usually the result of imperfect cornification
scale
fluid-filled raised lesion
vesicle = 5mm or less
bulla = greater than 5mm
blister = common term for either
vesicle, bulla, blister
itchy, transient, elevated lesion with variable blanching and erythema formed as the result of dermal edema
wheal
diffuse epidermal hyperplasia
acanthosis
abnormal, premature keratinization within cells below the stratum granulosum
dyskeratosis
discontinuity of the skin showing incomplete loss of the epidermis
erosion
infiltration of the epidermis by inflammatory cells
exocytosis
intracellular edema of keratinocytes, often seen in viral infections
hydropic swelling
hyperplasia of the stratum granulosum, often due to intense rubbing
hypergranulosis
thickening of the stratum corneum, often associated with a qualitative abnormality of the keratin
hyperkeratosis
linear pattern of melanocyte proliferation within the epidermal basal cell layer
lentiginous
surface elevation caused by hyperplasia and enlargement of contiguous dermal papillae
papillomatosis
keratinization with retained nuclei in the stratum corneum
on mucous membranes = normal
parakeratosis
intercellular edema of the epidermis
spongiosis
discontinuity of the skin showing complete loss of the epidermis revealing dermis or subcutis
ulceration
formation of vacuoles within or adjacent to cells
often refers to basal cell-basement membrane zone area
vacuolization
appear AFTER sun exposure
fade and darken cyclically with season changes
freckle (ephelis)
increase melanin pigment in basal keratinocytes
hyperpigmentation
in neurofibromatosis: similar histology to freckle
larger, arise independently of sun exposure
contain aggregated melanosomes (macromelanosomes) in cytoplasm of melanocytes
café au lait spots
benign localized hyperplasia of melanocytes
initiated in infancy/childhood
do NOT darken when exposed to sunlight
linear melanocytic hyperplasia
restricted to cell layer immediately above basement membrane
lentiginous
lentigo
mutations in RAS or BRAF
p16/INK4a permanent growth arrest
uniformly pigmented
well defined rounded borders
melanocytic nevus (mole)
nests at dermoepidermal junction
junctional nevus
nest in epidermis & dermis
compound nevi
no epidermal nests
usually older lesions
intradermal nevi
superficial: nests, large-rounded cells, increased melanin
deeper: cords or single cells, smaller, decreased pigment
deepest: fusiform, fascicles resembling neural tissue
melanocytic nevus benign histo
AD, >50% chance developing melanoma by age 60
CDKN2A or CDK4 gene
dysplastic nevus syndrome
mutations in NRAS & BRAF
larger than acquired nevi, >5mm, can be hundreds
variegated pigmentation, irregular borders
lentiginous hyperplasia: single nevus cells replace basal cells along E-D junction
atypia: large nuclei, irregular angulated nuclear contour, hyperchromasia
lymphocytic infiltrates, melanin incontinence
linear fibrosis
shouldering: junctional component > 2 rete ridges beyond dermal component
dysplastic nevi
most deadly of all skin cancers
mutations caused by UV radiation in sunlight
melanoma
Light complexion, hair, eyes
History of blistering sunburn(s)
Proximity to the equator
Indoor occupation; outdoor hobbies
Family history of melanoma or dysplastic nevi
Precursor lesions (congenital or dysplastic nevi)
Xeroderma pigmentosum
melanoma risk factors
blacks and Asians
palms, soles, mucous membranes, nail beds
acral melanoma (acral lentiginous melanoma)
Asymmetry
Irregular Borders
Variegated Color
Increasing Diameter
Evolution/changeover time (esp rapid)
Any pigmented lesion with diameter >6mm, any change, itching or pain
ABCDEs of melanoma
disrupt cell cycle control genes: CDKN2A in 40% familial, 10% sporadic → encodes p15, p16, ARF
activate pro-growth signaling: increase RAS & P13K/AKT signaling; BRAF 40-50% of melanomas, 15-20% RAS
activate telomerase: TERT in 70%
mutations in melanoma
horizontal spread
lack capacity to metastasize
lentigo maligna: indolent lesion on face of older men
superficial spreading: most common type, sun-exposed skin
acral/mucosal lentiginous: unrelated to sun exsposure
radial growth melanoma
vertical downward growth into deeper dermis
appearance of nodule correlates with emergence of tumor subclone with metastatic potential
probability of metastasis correlates with depth
vertical growth melanoma
distance from superficial epidermal granular cell layer to deepest intradermal tumor cells
Breslow thickness
thinner tumor depth
NO mitosis
brisk tumor infiltrating lymphocyte response
NO regression
lack of ulceration
favorable melanoma prognosis
metastases
and degree of LN involvement correlates with overall survival
poor melanoma prognosis