Primary Neoplasms of the Skin

Question 1

BRAF oncogene activation and p16 inactivation are common occurrences in what kind of skin disorders?

Answer 1

Melanocytic nevi and melanomas

Question 2

List 3 stages of melanocytic nevus development.

Answer 2

Junctional nevus (nests in epidermis, retain pigment) - compound nevus (nests in epidermis and dermis) - dermal nevus (dermis only, lose pigment)

Question 3

Are common acquired melanocytic nevi and/or dysplastic/atypical nevi risk markers for melanoma?

Answer 3

Yes for both

Question 4

2 features of melanocytic dysplasia?

Answer 4

Architectural disorder & cytologic atypia

Question 5

2 phases of superficial spreading melanoma? Which phase has less pigment, larger cellular aggregates, less inflammation, and more cell cycle progression markers?

Answer 5

Radial growth phase and vertical growth phase; VGP has all the characteristics listed

Question 6

What kind of skin disease presents as circumscribed, elevated, spheroidal nodules that expand in the dermis, skip the radial growth phase, and are a high risk for metastasis?

Answer 6

Nodular melanoma

Question 7

What kind of skin disease, also known as a Hutchinson melanotic freckle, presents as a large, pigmented macule on sun-damaged fair skin?

Answer 7

Lentigo maligna melanoma

Question 8

What kind of skin disease involves spindle-shaped lentigo maligna melanoma cells that have provoked a connective tissue response to form a firm plaque, and may mimic a scar or neuroma?

Answer 8

Desmoplastic melanoma

Question 9

What is the most common melanoma in dark-skinned people? It is usually limited to the palms, soles, and subungual regions.

Answer 9

Acral lentiginous melanoma

Question 10

Metastatic melanomas arise from melanocytes in what phase?

Answer 10

Vertical growth phase

Question 11

What kind of melanoma measurement extends from the most superficial aspect of the stratum granulosum to the point of deepest tumor penetration into the dermis, and is the strongest prognostic variable for confined melanomas?

Answer 11

Breslow thickness

Question 12

Which of the following tumors is malignant: congenital melanocytic nevus, Spitz tumor (spindle and epitheoiloid cell nevus), blue nevus, freckle/ephelides, lentigo, liver spot.

Answer 12

None; they are all benign

Question 13

Verrucae refer to warts that share what common cause?

Answer 13

HPV

Question 14

Which forms of HPV have malignant potential: verruca vulgarism, plantar carts, verruca plana, condyloma acuminaturm, bowenoid papulosis, and/or epidermodysplasia verruciformis?

Answer 14

Condyloma acuminaturm, bowenoid papulosis, and epidermodysplasia verruciformis

Question 15

Which forms of HPV are found primarily around the genitalia: verruca vulgarism, plantar carts, verruca plana, condyloma acuminaturm, bowenoid papulosis, and/or epidermodysplasia verruciformis?

Answer 15

Condyloma acuminaturm and bowenoid papulosis

Question 16

Which form of HPV is related to a rare, autosomal recessive disease of impaired cell-mediated immunity and thus enhanced susceptibility to HPV infection? It first appears in childhood with flat patches of warts similar to verruca plana.

Answer 16

Epidermodysplasia verruciformis

Question 17

The sudden appearance of what papules has been associated with internal malignancies, especially gastric adenocarcinoma?

Answer 17

Seborrheic keratoses

Question 18

What benign skin disease appears as scaly, pigmented, elevated and “pasted on” papules with scales that are easily rubbed off? They have broad anastomosing cords of mature stratified squamous epithelium and with small keratin cysts (horn cysts).

Answer 18

Seborrheic keratosis

Question 19

What benign skin disease appears grossly as circumscribed, keratotic patches or plaques; microscopically as dense, parakeratotic stratum corneum and atypical basal keratinocytes; and can sometimes evolve into squamous cell carcinoma?

Answer 19

Actinic keratosis

Question 20

What benign skin disease presents grossly as rapidly growing keratotic papules on sun-exposed skin that develop over 3-6 weeks into crater-like nodules? It usually regresses in 6-12 months, but sometimes can cause considerable damage during that time or fail to regress.

Answer 20

Keratoacanthoma

Question 21

What benign skin disease presents microscopically as cup shaped lesions with overhanging “buttressing” epidermal edges and keratinocytes with eosionophilic “glassy” cytoplasm? Some people consider it to be a variant of squamous cell carcinoma.

Answer 21

Keratoacanthoma

Question 22

What is the most common malignant tumor in persons with pale skin? It is locally invasive in the epidermis but usually does not metastasize, and usually develops on sun-damaged skin but can also arise on areas not directly exposed to intense sunlight.

Answer 22

Basal cell carcinoma

Question 23

What skin neoplasm is characterized by pearly papules and rodent ulcers, and has subtypes including nevoid, superficial multicentric, nodulocystic, morpheaform, and pigmented? Which subtype, named for its resemblance to localized scleroderma, has ill-defined borders and is the most difficult to eradicate?

Answer 23

Basal cell carcinoma; morpheaform BCC

Question 24

Syndrome related to mutations of the PTCH tumor suppressor gene where basal cell carcinoma originates on skin that has had little light exposure. The BCCs appear at a young age and may number in the hundreds, and there is a predisposition to other tumors including medulloblastoma.

Answer 24

Nevoid BCC syndrome

Question 25

What is the 2nd most common skin tumor, which always arises in sun-exposed skin but can be caused by chronic scarring (ex. osteomyelitis or burns) as well as by UV light?

Answer 25

Squamous cell carcinoma

Question 26

What skin neoplasm is characterized by mutated p53, a resemblance to stratum spinosum cells, a variably thickened epidermis with parakeratosis, and basal keratinocytes with significant atypia?

Answer 26

Squamous cell carcinoma

Question 27

What rare but dangerous skin neoplasm is an aggressive tumor of neurosecretory cells positive for chromogranin and synaptophysin? It usually presents as a solitary, dome-shaped, red-purple nodule on head and neck of elderly patients.

Answer 27

Merkel cell carcinoma

Question 28

Name the skin appendages which each of the following adnexal tumors resemble and where on the body they are found: cylindroma, syringoma, poroma, trichoepithelioma.

Answer 28

Cylindroma - sweat glands, on the head
Syringoma - eccrine sweat glands, on eyelid and upper cheek
Poroma - eccrine sweat glands, on feet and hands
Trichoepithelioma - hair structures, on head, neck, and upper trunk

Question 29

Trichoepithelioma and seborrheic keratosis share what distinctive structures with keratinized centers surrounded by basophilic epithelial cells?

Answer 29

Horn cysts

Question 30

Rank the following fibrohistiocytic tumors (involving fibroblasts and macrophages) from least malignant to most malignant: atypical fibroxanthoma, dermatofibroma, dermatofibrosarcoma protuberans.

Answer 30

Dermatofibroma - dermatofibrosarcoma protuberans - atypical fibroxanthoma

Question 31

What skin tumor is a variant of cutaneous T-cell lymphoma marked by lymphocyte epidermotropism, atypical lymphocytes with cerebriform nuclei, Pautrier microabscesses, and a progression from patch to plaque to tumor?

Answer 31

Mycosis fungoides / Sezary syndrome if disseminated

Question 32

What underlying condition is associated with occurrences of Kaposi sarcoma following HHV-8 infection, bacillary angiomatosis in capillaries following Bartonella infections, and eosinophilic folliculitis?

Answer 32

HIV infection