Neoplasms of the Skin

Question 1

Seborrheic keratosis age affected

Answer 1

Older individuals

Question 2

Seborrheic keratosis benign or malignant neoplasm

Answer 2

Benign (no malignant potential)

Question 3

Seborrheic keratosis clinical description

Answer 3

Flat-topped to exophytic papules, “warty” and “stuck-on”, range from light tan/pink to dark brown/gray, no true pigment pattern

Question 4

Seborrheic keratosis cell type affected

Answer 4

Keratinocytes

Question 5

Seborrheic keratosis histology

Answer 5

Lesion extends to a uniform depth in a parallel line to the epidermal surface underlying the lesion (String sign), keratinocytes lack atypic and mitoses, prominent horn cysts

Question 6

Nevus definition

Answer 6

AKA “mole” or “birthmark”, any of various congenital or acquired lesions of the skin or oral mucosa that are usually pigmented and raised and may include epidermal, melanocytes, connective types of tissue

Question 7

Nevus histology

Answer 7

Described by which portion of the skin is involved, epidermis (junctional), epidermis and dermis (compound), or dermis (intradermal melanocytic)

Question 8

Nevus benign characteristics

Answer 8

Symmetric lesion, melanocytes mature with descent (superficial cells are larger, pigmented, well-nested, while deeper cells are smaller, nonpigmented, less nested), melanocytes show no or minimal cytologic atypia, mitotic activity rarely present

Question 9

Benign pigmented lesion clinical characteristics

Answer 9

Symmetric, distinct border, homogenous color, small, stable/unchanging

Question 10

Basal cell carcinoma clinical features

Answer 10

On sun exposed skin, “pearly” or shiny appearance, papule with substance, telangectasias, erosion/ulceration, bleed easily with minimal trauma, rolled borders

Question 11

Basal cell carcinoma histology

Answer 11

Nests of basaloid cells (islands) with peripheral stromal clefting, palisading nuclei, mucin

Question 12

Basal cell carcinoma prognosis

Answer 12

Locally aggressive, rarely metastasize

Question 13

Basal cell carcinoma pathogenesis

Answer 13

Related to sun exposure, may be related to genetic factors

Question 14

Actinic keratosis histology

Answer 14

Solar elastosis (blue-gray appearance of epidermis from sun exposure), parakeratosis, atypia of basal keratinocytes (large, occupying lower portions of epidermis)

Question 15

Actinic keratosis prognosis

Answer 15

Premalignant lesion, about 10% progress to squamous cell carcinoma if untreated

Question 16

Squamous cell carcinoma in situ clinical features

Answer 16

Relatively well defined, crusted, erythematous (pink), scaly, thin plaque on sun exposed areas with no erosion, ulceration or marked thickening

Question 17

Squamous cell carcinoma in situ prognosis

Answer 17

Invasive carcinoma in 8% if untreated, spontaneous regression possible

Question 18

Squamous cell carcinoma in situ other names

Answer 18

SCCIS, Bowen’s disease

Question 19

Squamous cell carcinoma in situ histology

Answer 19

Parakeratosis, acanthuses, atypical keratinocytes (full thickness involvement of the epidermis and sometimes pilosebaceous epithelium), pale or vacuolated keratinocytes possible, disorderly maturation of epidermis, loss of granular layer, intraepidermal mitoses, perivascular lymphocytes

Question 20

Squamous cell carcinoma clinical characteristics

Answer 20

Red papule, nodule or plaque, scaly, often ulcerated, may have hemorrhagic crusting

Question 21

Squamous cell carcinoma prognosis

Answer 21

More likely to metastasize, especially if left untreated

Question 22

Squamous cell carcinoma predisposition

Answer 22

Sun damaged areas, scars, irradiated or chronically infected/irritated sites, lichen sclerosis, lichen planus, discoid lupus, xeroderma pigmentosum, organ transplant recipients

Question 23

Melanoma histology

Answer 23

Asymmetric, abnormal maturation, mitoses present, atypia of cells (melanocytes large with prominent nuclei and increased cytoplasm, located in all layers of epidermis), pagetoid spread

Question 24

Melanoma clinical characteristics

Answer 24

Asymmetric lesion with uneven borders, multiple colors, larger than pencil eraser, changing in size, share, and/or color

Question 25

Nevus vs melanoma histology - symmetry

Answer 25

Nevus - symmetric, melanoma - asymmetric

Question 26

Nevus vs melanoma histology - cell maturation

Answer 26

Nevus - matures with depth, melanoma - does not mature with depth

Question 27

Nevus vs melanoma histology - mitoses

Answer 27

Nevus - rare or absent mitoses, melanoma - mitoses present

Question 28

Nevus vs melanoma histology - atypia

Answer 28

Nevus - absent cytologic atypia, melanoma - cytologic atypia

Question 29

Nevus vs melanoma histology - pagetoid spread

Answer 29

Nevus - absent pagetoid spread, melanoma - prominent pagetoid spread

Question 30

Most important histopathologic feature for melanoma prognosis

Answer 30

Depth of invasion (Breslow level)

Question 31

Breslow depth vs prognosis

Answer 31

The lower the depth the lesion, the lower the survival rate

Question 32

Melanoma mutation

Answer 32

BRAF V600E (proto-oncogene, normally makes B-Raf, important in signal transduction)

Question 33

Melanoma possible treatment

Answer 33

Targeted therapy by inhibiting BRAF kinase in metastatic or unresectable melanoma

Question 34

Skin cancer etiology

Answer 34

Formation of thymine dimers from UVB radiation exposure (consequence of DNA damage)

Question 35

Xeroderma pigmentosum definition

Answer 35

Rare, autosomal recessive genodermatosis

Question 36

Nevoid basal cell carcinoma syndrome

Answer 36

AKA Gorlins, PTCH mutation, develop extensive basal cell carcinomas, need to avoid radiation, odontogenic keratocyts and skeletal abnormalities associated

Question 37

Dysplastic nevus syndrome

Answer 37

AKA atypical mole syndrome, cutaneous condition characterized by unusual nevi and multiple inherited melanomas, CDKN2A gene mutations

Question 38

Squamous cell carcinoma histology

Answer 38

Squamous differentiation evident with keratinocytes pearls