Skin Flashcards
lesion is submitted with surrounding margins
excisional biopsy
only a portion of the lesion is excised and there are no margins
incisional biopsy
superficial shave of the lesion and edges of the skin
shave biopsy
lesional tissue is scraped and submitted
curette
small cylinder of skin and soft tissue is removed
punch biopsy
triangular excision that represents the new margin at the apex of an ellipse of skin
dog ear
these should be placed on edge to demonstrate epidermis, lesion, and margin (depth of invasion)
skin shave
you should do this with a skin punch
bisect
ring shaped
annular
half-moon
arcuate
varied non geometric shape
polygonal
varied shape
polymorphic
in the shape of a snake
serpiginous
variegated appearance with mixed pallor, telangiectasia, pigmentation
poikilodermatous
skin coming off in scales
desquamation
large white or silver flakes
psoriasiform
branny powdery scale
pityriasiform
apparent scale is tightly adherent to the skin surface
lichenoid
horny scale
keratotic
peeling skin
exfoliation
moist peeling skin
maceration
warty
verrucous
caused by chronic rubbing resulting in palpably thickened skin with increased skin markings and lichenoid scale
lichenification
the result of plasma exuding through an eroded epidermis; rough on the surface and yellow/brown in color
crusting
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
2
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
