Skin Flashcards by Tenzin Dechen

lesion is submitted with surrounding margins

excisional biopsy

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only a portion of the lesion is excised and there are no margins

incisional biopsy

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superficial shave of the lesion and edges of the skin

shave biopsy

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lesional tissue is scraped and submitted

curette

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small cylinder of skin and soft tissue is removed

punch biopsy

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triangular excision that represents the new margin at the apex of an ellipse of skin

dog ear

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these should be placed on edge to demonstrate epidermis, lesion, and margin (depth of invasion)

skin shave

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you should do this with a skin punch

bisect

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ring shaped

annular

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half-moon

arcuate

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varied non geometric shape

polygonal

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varied shape

polymorphic

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in the shape of a snake

serpiginous

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variegated appearance with mixed pallor, telangiectasia, pigmentation

poikilodermatous

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skin coming off in scales

desquamation

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large white or silver flakes

psoriasiform

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branny powdery scale

pityriasiform

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apparent scale is tightly adherent to the skin surface

lichenoid

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horny scale

keratotic

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peeling skin

exfoliation

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moist peeling skin

maceration

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warty

verrucous

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caused by chronic rubbing resulting in palpably thickened skin with increased skin markings and lichenoid scale

lichenification

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the result of plasma exuding through an eroded epidermis; rough on the surface and yellow/brown in color

crusting

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degeneration or abnormal formation of the skin, usually referring to nail diseases

dystrophy

loss of epidermis and portion of dermis due to scratching or an exogenous injury; may be linear or punctate

excoration

a split, crack, erosion or narrow ulceration of the skin

fissure

sore due to the superficial or partial destruction of surface tissue, not deep as ulcer

erosion

full thickness loss of the epidermis and maybe a portion of the dermis; may extend into the dermis. heals with a scar

ulcer

a large malignant tumor that is erupting like a mushroom or fungus

fungating

made of a mass of new capillaries and fibrous tissue in a healing wound

granulation tissue

type of inflammation characterized by histiocytes

granuloma

how a skin ellipse size should be described

L x W cm, excised to a maximum depth of D cm

how a punch biopsy size should be described

0.5cm circular skin, excised to a maximum depth of D cm

three things you need to have to describe skin

-size -distance from margin -configuration descriptors

if a person with clinical history of alopecia has a punch biopsy, what should you not do

bisect the specimen

punch biopsies may be done for 3 conditions

-inflammatory lesions -alopecia -dermal neoplasms

if the punch/shave biopsy is 0.4 cm you must

bisect

if the punch/shave biopsy is greater than 0.5 cm you must

serially section

if the punch/shave biopsy is less than 0.3 cm you must

submit whole

what two things do you need to note in a shave biopsy

-depth of shave -height of papular lesions above the epidermis

if possible, cut these away from the shave biopsy

small tips

small excisions should be sectioned at these intervals

3mm

if the small excision is unoriented

ink the specimen 1 color, and place both tips in cassette 1

if the small excision is oriented

ink two colors other than black, put the 1st tip in cassette 1, the body in sequential order, then the 2nd tip in the last cassette

if only one stitch is present in a skin ellipse that will be

12 o'clock stitch

in an unoriented skin excisions that are SMALL there must be no more than __ sections per cassette

in an unoriented skin excision, the ends should be submitted in a

cruciate fashion

skin biopsy CPT code

88305

sentinel lymph node biopsy CPT code

88307

if a cross section of skin is too large to fit into one cassette, bisect ___________

eccentrically

if a cross section of skin is too large to fit into one cassette, if necessary, __________

trisect, but avoid cutting through center of tumor

with sentinel lymph nodes, you must carefully dissect this off

fat

section lymph nodes along this axis

longitudinal through the hilum

you must order this at time of grossing and note the type of cancer

IHC

lymph nodes with small localized metastatic deposits detected first by sophisticated sensitive examination

sentinel lymph nodes

to gross ears, do this after inking

breadloaf

surgery to treat most common skin cancers

Mohs surgery

most common skin cancer

BCC

Mohs surgery is useful for cancers that (4)

-have high risk for recurrence -located in areas where healthy tissue needs to be preserved -hard to define borders -large or aggressive

SCC and BCC staging from pT1 to pT2

2-4 cm

SCC and BCC staging pT3

larger than 4 cm, minor bone erosion

SCC and BCC staging pT4

gross cortical bone/marrow invasion

melanoma staging pT1

1.0 mm or less / with or without ulceration

melanoma staging pT2

1.0 - 2.0 mm in thickness / with or without ulceration

melanoma staging pT3

2.0-4.0 mm in thickness / with or without ulceration

melanoma staging pT4

more than 4.0 mm in thickness / with or without ulceration

Merkel cell staging pT1

diameter less than equal to 2 cm

Merkel cell staging pT2

2-5 cm

Merkel cell staging pT3

>5cm

Merkel cell staging pT4

invasion into bone, muscle, fascia, cartilage

nail specimens are softened using this solution

potassium hydroxide

nail biopsies are usually received because of

onchomycosis

melanin in nail plate or melanocytic lesion in matrix

melanonychia

nail bed excisions are done for

biopsy proven neoplasms

nail bed excisions are grossed as this

small skin excisions (serially sectioned, entirely submitted)

nail bed/matrix biopsies are grossed as this

punch/shave biopsy

inclusion cyst, glomus tumor, verruca, keratocanthoma, SCC, onchomatricoma

subungal tumors

do not soften or order GMS upfront if the patient has a clinical history of this

melanoma