Mucocutaneous/Dermatopathology Flashcards
1
Q
Lentigo
Solar vs Simple Lentigo
- Sun exposure
- Melanocyte proliferation
- Size
A
Solar Lentigo
- Sun exposure
- No melanocyte proliferation, just more melanin released
- Can be >10mm
Simple Lentigo
- Unrelated to sun exposure
- Melanocyte proliferation
- <5mm
2
Q
Melanocytic Nevus
- Age of appearance
- 3 subtypes of acquired
- Malignant potential
A
Congenital
- Present at birth
- No malignant potential (except really large lesions)
Acquired
- Superficial (flat), Dermal (dome shaped), Compound (uniformly raised)
*
3
Q
Seborrheic Nevus
- Age of appearance
- Malignant potential
- Sudden appearance of hundreds of lesions ominous of what
A
- 4th decade and later
- No malignant potential
- Sudden appearance of hundreds of lesions (Lesser-Trelat Sign) ominous for internal malignancy
4
Q
Actinic Keratosis
- Locations
- Appearance
- Histology
- Malignant potential
- Treatment
A
- Sun exposed areas
- Rough, erythematous papules with white/yellow scales
- Atypical keratinocytes
- Malignant transformation 5-25% SCCa
- Topical chemo or cryosurgery
- 5-FU
- Imiquimod
- Diclofenac
5
Q
Dysplastic Melanocytic Nevus
- Location
- Appearance
- Malignant potential
- Histo
- Tx
A
- Back and trunk
- Larger than common nevus, irregular borders, macular/papular
- Single lesion 2x risk of melanoma
- >10 lesions has 12x risk of melanoma
- Atypical melanocytes
- Excision 0.5mm margin
6
Q
Basal Cell Carcinoma
- Mutation
- % of all skin cancers
- Age
- Risk factors
A
- PTCH gene
- 80% of all skin cancers
- 6-7 decades
- Fitzpatrick 1-3, arsenic, radiation, immunosupression, HPV
7
Q
SCCa
- Mutation
- % of all skin cancers
- Age
- Risk factors
A
- p53
- 10% of all skin cancers
- 6-7 decades
- Fitzpatrick 1-3, arsenic, radiation, immunosupression, HPV
8
Q
BCCa / SCCa clinical presentation
- BCCa nodular
- BCCa superficial
- BCCa morpheaform
- SCCa
A
BCCa / SCCa clinical presentation
- BCCa nodular = firm papule, central depression
- BCCa superficial = Erythema plaque, mostly trunk
- BCCa morpheaform = Looks like scar
- SCCa = Erythema nodule, indurated, ulcerated
9
Q
BCCa subtype incidence
Nodular
Superficial
Morpheaform
Others
A
80% Nodular
15% Superficial
5% Morpheaform
Others <1%
10
Q
BCCa / SCCa mets and tx
- Metastatic rate
- Treatment
- Prognosis
A
Metastatic
- BCCa 1%
- SCCa 5%
Treatment
- 4mm margin low risk
- >4mm margin low risk
- Essentially no margin with Mohs
Prognosis
- BCCa - good
- SCCa - good unless mets
11
Q
BCCa / SCCa recurrence
Recurrence rate and factors
A
BCCa
- Positive margin 40%
- Negative margin 14%
SCCa
- 8%
Any lesion >2cm, long duration, “H” portion of face
12
Q
Melanoma
- % of skin cancers
- Risk factors
- Clinical presentation (ABCDE)
- Early growth pattern
- Later growth pattern
A
- 4% of skin cancers
- Risk factors: Fitzpatrick 1-3, sun exposure
- Clinical presentation (ABCDE): Asymmetry, Border irregular, Color variation, Diameter >6mm, Evolution of mole color/size
- Early growth pattern: Radial
- Later growth pattern: Vertical
13
Q
Melanoma types
- Most common
- Occurs on palm/soles
- Least common, radial growth only, best prognosis
- Second most common, vertical growth only, Red-blue-black nodule that doesn’t follow ABCDE rule
A
Melanoma types
- Superficial = Most common
- Acral lentiginous = Occurs on palm/soles
- Lentigo Maligna = Least common, radial growth only, best prognosis
- Nodular = Second most common, vertical growth only, Red-blue-black nodule that doesn’t follow ABCDE rule
14
Q
Melanoma staging
Breslow
Clark
A
Breslow = depth in mm, stages 1-5
Clark = depth in skin layers, stage 1-5
15
Q
Melanoma treatment
- Margins based on depth/stage
- When is sentinal lymph node biopsy indicated?
A
Margins
- 1cm = 1mm depth
- 2cm = all others
Sentinal lymph node biopsy
- ulceration
- >1mm depth
16
Q
Keratoacanthoma
- Low grade variant of what skin cancer?
- Unique growth rate
- Clinical appearance
A
- Variant of SCCa, can progress to invasive SCCa
- Grows quickly (weeks)
- Red, dome, central keratin pit
