Pathology

Question 1

Localised overgrowth of blood vessels in the dermis =

Answer 1

Haemangiomas causes a port wine stain

Question 2

melanoblasts migrate from neural crest to ++_

Answer 2

skin
uveal tract
leptomeninges

Question 3

gene that determines balance of pigment in skin and hair

Answer 3

MC1R (melanocortin 1 receptor)

Question 4

MC1R turns __ to __melanin

Answer 4

phaeo to eu

Question 5

hair colour caused by phaeomelanin

Answer 5

red

Question 6

1 defect in MC1R =

2 defects =

Answer 6

freckles

red hair and freckles

Question 7

ephilides

Answer 7

freckles - patchy increase in melanin pigmentation

Question 8

actinic/solar lentigines

Answer 8

age/liver spots
increased melanin and basal melanocytes
face, forearms and dorsal hands
elongated rete ridges in epidermis

Question 9

acquired naevi in childhood = junctional naevus -

Answer 9

melanocytes proliferate and cluster at DEJ

Question 10

acquired naevi in adolescence = compound naevus -

Answer 10

junctional clusters and groups of melanocytes in dermis

Question 11

acquired naevi in adults = intradermal naevus -

Answer 11

no junctional activity, entirely dermal

Question 12

dysplastic naevi 2 types =

increase in melanoma risk

Answer 12

sporadic - slight risk increase

familial - 100% increase risk

Question 13

dysplastic naevi histological findings

Answer 13

architectuarl and cellular atypia
host-reaction inflam and fibrosis
epidermis not effaced (unlike melanoma)

Question 14

characteristics of halo naevi

Answer 14

peripheral depigmented halo

inflammatory regression and overrun by lymphocytes

Question 15

Blue skin pigmentation is caused by

Answer 15

brown deep in skin scatters light

Question 16

blue naevi characteristics

Answer 16

entirely dermal and consist of pigment rich dendritic spindle cells.

Question 17

Characteristics of spitz naevi

Answer 17

in <20yos
large spindle +/epithelioid cells
most entirely benign

Question 18

rare sites for malignant melanoma

Answer 18

oesophagus
meninges
eye
biliary tract
anus

Question 19

Radial growth phase of melanoma =

Answer 19

macules grow either entirely in situ or with dermal microinvasion

Question 20

Vertical growth phase of melanoma =

Answer 20

invade dermis with formation of expansile mass with mitoses

only VGP metastasise

Question 21

melanomas that have a radial and vertical growth phase (RGP and VGP)

Answer 21

superficial spreading
acral/mucosal lentiginous
lentigo maligna

Question 22

melanoma type that only has a VGP (vertical growth phase)

Answer 22

nodular

Question 23

common site of nodular melanoma

grows quickly in __ causing __ to stretch thin

Answer 23

trunk
dermis
epidermis stretched thin

Question 24

suffix b added to staging of melanoma -

Answer 24

ulceration

Question 25

If have advanced melanoma which is difficult to treat with Sx alone =

Answer 25

chemo, immunotherapy or gene therapy

Question 26

C-kit mutations are usually in ___ melanomas

Rx -

Answer 26

acral

imatinib

Question 27

melanomas on intermittently sun-exposed areas have __ mutation
Rx -

Answer 27

BRAF

dabrafenib + vemurafenib (combo with a MEK inhibitor)

Question 28

benign melanocytic lesions (3)

Answer 28

ephilides (freckles)
lentigines (macule)
naevi

Question 29

classification of congenital melanocytic naevi by size

Answer 29

small <1.5cm diameter
medium 1.5-19.9cm
large 20+cm

Question 30

congenital naevi characteristics that are different from acquired

Answer 30

larger
slightly raised
more rugose and elevated as they age

Question 31

neoplastic melanocytes along the basal layer with can become invasive
usually on ace of elderly with sun damage =

Answer 31

lentigo maligna melanoma

Question 32

macule with irregular border and colour which has a slow RGP and rapid VGP (develops nodule)

Answer 32

superficial spreading melanoma

Question 33

blue-black/red-skin coloured nodule which may be ulcerated/bleed and develops rapidly over months
no surrounding macular pigmentation =

Answer 33

nodular melanoma

Question 34

Hutchinson sign =

in ___

Answer 34

pigmented extension into nail fold

acral lentiginous melanoma

Question 35

multiple black/brown greasy “stuck-on” lesions often on trunk with a regular border

Answer 35

seborrheic keratoses

Question 36

Rx for seborrheic keratoses

Answer 36

reassure
freeze
curette

Question 37

firm nodule of dermal connective tissue, brown/grey
may be caused by insect bites
reassure and excise

Answer 37

dermatofibroma

Question 38

talon noir =

Answer 38

subcorneal haematoma = black heel

due to trauma