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Medical Derm Revision > Skin appendages Dan > Flashcards

Skin appendages Dan Flashcards

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USMLE® Step 1 flashcards Dermatology Board Prep flashcards
1
Q

IFK may be caused by infection of the hair follicles with HSV

A

False

HPV

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2
Q

Pilar sheath acanthoma is most commonly found on the cutaneous upper lip in the elderly

A

True

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3
Q

Trichoadenoma microscopically resembles a tumour of the infundibular portion of the hair follicle turned at 90 degrees

A

True

‘Turnadeniner’

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4
Q

Comedo naevus is always present at birth

A

False

can be at birth or can appear duirng adult life

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5
Q

Pilar cyst is another name for a sebaceous cyst

A

False

Pilar cyst is a trichilemmal cyst

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6
Q

Pilar cysts can be inherited in a recessive manner

A

False

AD

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7
Q

Females get trichilemmal cyst more than males

A

True

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8
Q

Trichilemmal cysts are relatively common and usually occur on the scalp

A

True

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9
Q

A proliferating trichilemmal cyst is a rapidly enlarging lesion which arises from a trichilemmal cyst

A

True

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10
Q

Proliferating trichilemmal cyst commonly becomes malignant

A

False

malignancy rare but often dysplastic on histo and should be completely excised otherwise tend to recur

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11
Q

A trichilemmoma is a tumour of the external root sheath

A

True
The outer root sheath is the ‘trichilemma’ Tumours include;
Trichilemmoma
Proliferating/normal Trichilemmal (Pilar) cyst
Trichilemmal carcinoma

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12
Q

Trichilemmomas have clear cells which are PAS +ve and diastase labile

A

True

contain glycogen

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13
Q

Trichilemmoma is seen on the face in elderly pts

A

False

On face usually in young-middle age

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14
Q

A hair follicle naevus is a plaque composed of a cluster of vellus hair follicles

A

True

may just look like dense patch of vellus hairs

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15
Q

Faun-tail naevus is the same as a Becker’s naevus

A

False

It is a hair follicle naevus on the sacrum

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16
Q

Eruptive vellus hair cysts are a feature of pachyonychia congenita

A

True

can also be sporadic or a familial trait

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17
Q

Eruptive vellus hair cysts develop on the back in the second decade of life

A

False

on chest in second decade but rarely elsewhere including face

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18
Q

Eruptive vellus hair cysts pathologicallly strongly resemble epidermoid cysts but with hairs

A

False

strongly resemble steatocystoma but with hairs Epithelial lined cyst located in the mid dermis

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19
Q

Eruptive vellus hair cysts are due to occlusion and cystic dilatation of vellus hair follicles

A

True

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20
Q

A trichofolliculoma is a flat leison with a single protruding hair

A

Falses

mall raised nodule with several gairs protruding from a single orifice

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21
Q

Trichofolliculoma is a tumour of the external root sheath

A 
False
Trichofolliculoma is a hamartoma of the pilosebaceous follicle - it is in the hair germ tumour group;
o	Trichofolliculoma
o	Trichoepithelioma
o	Desmoplastic trichoepithelioma
o	Trichoblastoma
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22
Q

Trichofolliculomas occur in young adults esp on the face and can also occur on the vulva

A

True

Vulval trichofolliculoma is rare but is associated with VIN

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23
Q

Trichoepithelioma is a variant of trichofolliculoma

A

False

Trichoepithelioma is a variant of trichoblastoma

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24
Q

Trichoepithelioma is a small slightly raised pearly lesion on the face

A

True

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25
Q

Trichoepithelioma occurs singly or multiply usually in young people

A

True

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26
Q

Trichoepithelioma is a sporadic lesion without associations

A

False
can be sporadic or familial AD trait
some familial cases have Brooke-Spiegler syndrome
Occur on the genitals in Bazex-Dupre-Christol

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27
Q

Epithelioma adenoides cysticum is a syndrome of multiple angiofibromas

A

False

Rare syndrome of multiple large, yellow-pink or bluish trichoepitheliomas

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28
Q

Desmoplastic trichoepithelioma (DTE) occurs in young people and clinically may resemble a BCC

A

True

Plaque with raised rolled edge - often looks even more BCC like than standard trichoepitheliomas do

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29
Q

Histologically DTE resemble a nodular BCC

A

False
Can resemble sclerosing (morphoeic) BCC
Alos closely resembles Microcystic adnexal carcinoma (MAC)

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30
Q

DTE conatins Merkel cells which stain with CK20 and can be used to differentiate it from MAC

A

True

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31
Q

Trichoepithelioma is the most common tumour arising in a naevus sebaceous

A

FalseTrichoblastoma is

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32
Q

There are reports of trichoblastoma arising after low dose depilatory Xray treatment (as used to be used for tinea corporis)

A

True

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33
Q

Trichoblastoma can be difficult to differentiate histologically from follicular BCC

A

True

Merkel cells in trichoblastoma can help differentiate

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34
Q

Basaloid follicular hamartomas are associated with endocrine diseases

A

False

with autoimmune disease e.g. alopecia, LE, MG

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35
Q

A pilomatrixoma is a hamartoma of the hair matrix

A

True

main inner root sheath or matrix tumour

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36
Q

Pilomatrixoma accounts for 60% of hair follicle tumours

A

False
20%
most common hair follicle related tumour

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37
Q

Pilomatrixoma occurs in children and young adults affecting both sexes equally

A

False

F>M otherwise true

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38
Q

Pilomatrixoma is associated with Rubenstein-Taybi and Turners syndromes

A

True
also;
Gardner’s syndrome and variant MYH-associated polyposis (MAP syndrome)
Myotonic dystrophy

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39
Q

Pilomatrixoma is a hard, 3-30mm subcutaneous lesion on the head, neck or arms

A

True

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40
Q

Pilomatrixoma should be completely excised as malignant change is common

A

False
Malignancy rare but can recur if not completely excised
Pilomatrocarcinoma tends to occur in older people (>70) who have long-standing lesions

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41
Q

A fibrofolliculoma is a tumour of the hair follicle mesenchyme (perifollicular connective tissue)

A

True
along with;
trichodiscoma
perifollicular fibroma

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42
Q

Trichodiscomas occur as multiple small flat-topped papules on the lateral face

A

False

ocur on central face

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43
Q

Familial trichodiscomas is pathognomonic of Birt-Hogg-Dube syndrome

A

False

familial cases can occur other than in BHD

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44
Q

Acrochordons in BHD show differentiation into either fibofolliculoma type or trichodiscoma type

A

True

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45
Q

Birt-Hogg-Dube syndrome is due to mutation in the hamartin gene

A

False

Folliculin gene FLCN

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46
Q

Fobrofolliculoma is arare lesion with multiple small, poorly-formed pilosebaceous folllicles in a striking fibrous stroma

A

True

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47
Q

Sebaceous adenoma and sebaceoma are easily disitnguished

A

False

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48
Q

Sebaceous adenoma and sebaceoma occur in elderly pts on sun damaged skin

A

False

elderly pts but no association with UV damage

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49
Q

Muir-Torre accounts for 1-2% of Lynch syndrome (HNPCC)

A

True

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50
Q

Sebaceous adenoma and sebaceoma most often occur on the face and scalp and may be sessile, pedunculated or papilliferous

A

True
often yellowish lesions resembling large firm sebaceous hyperplasias
esp appear around the eyes

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51
Q

Sebaceous carcinoma accounts for

A

True

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52
Q

Sebaceous carcinoma mainly occurs in children and young adults

A

False

mainly elderly, also middle agerare reports in children

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53
Q

smoking and UV predispose to Sebaceous carcinoma

A

Falsebut immunosuppression, arsenic and XRT may be aetiological factors in rare cases

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54
Q

Sebaceomas with high mitotic activity may be wrongly diagnosed as ebaceous carcinoma on histo

A

True

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55
Q

Sebaceous carcinoma is a slow growing, yellow-orange tumour that favours the eyelids

A

True

usually head and neck esp eyelids but away in Muir-Torre

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56
Q

Sebaceous carcinoma in Muir-Torre usually occur on head and neck sites

A

False

Usually occur away from the normal head and neck sites

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57
Q

Sebaceous carcinoma occuring in the immunosupressed may show microsatellite instability

A

True

Not always Muir-Torre

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58
Q

Sebaceous carcinoma may grow rapidly, invade early and metastasise frequently

A

False

usually slow but can be rapid growth and invasion esp if on eyelid but metastasis very rare

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59
Q

Sebaceous carcinoma can show pagetoid spread on histo

A

True

Often does esp in the more invasive ones around the eye

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60
Q

Mohs can be used for sebaceous carcinoma

A

True

Rx of choice if availableother wise complete excision

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61
Q

Apocrine hydrocystoma occurs in men 3x more than women

A

False

M=F, adults any age

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62
Q

Apocrine hydrocystoma is more most common lateral to the lateral canthus

A

True

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63
Q

Apocrine hydrocystoma has no syndromic associations

A

False
multiple lesions occur in the rare ecotdermal dysplasia
Schöpf–Schulz–Passarge syndrome

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64
Q

Apocrine hydrocystoma can occur away from the perioccular region

A

True

reported on axillae, digits and penis

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65
Q

Apocrine hydrocystoma with cytological atypia and mitotic activity and fibrous papillary projections should be designated syringocystadenoma papilliferum

A

False

these are called apocrine cystadenomashould be completely excised

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66
Q

Topical phenol is suitable for multiple apocrine hydrocystomas

A

False

TCA

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67
Q

Syringocystadenoma papilliferum (SCAP) occurs on the face and scalp of young adults

A

True
can also be present at birth or develop in childhoodcan be asociated with an organoid naevusalso reported on vulva, breast, ear, leg

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68
Q

Melanoma can arise in an existing Syringocystadenoma papilliferum (SCAP)

A 
False
BCC
SCC
verrucous carcinoma
ductal carcinoma
69
Q

Apocrine carcinoma arising from Syringocystadenoma papilliferum (SCAP) is a major concern

A

False

exceptionally rare

70
Q

Hidradenoma papilliferum is an apocrine gland tumour

A 
True
Includes;
Apocrine hydrocystoma
Apocrine tubular adenoma
Apocrine carcinoma
Syringocystadenoma papilliferum (SCAP)
Hidradenoma papilliferum
71
Q

Hidradenoma papilliferum occurs mainly in the anogenital area of young caucasian women

A

True

most commonly on labia majorum

72
Q

Hidradenoma papilliferum is 4x more common in the perianal region than the vulva

A

False

4x more common on the vulva

73
Q

Hidradenoma papilliferum presents as a 1-40mm mobile lump just below the skin surface, usually in the perineum

A

True

74
Q

Apocrine carcinoma is a rare tumour with similarities to breast carcinoma

A

True
may be posiitve for Oe, Prog and androgen receptors
grading follows same system as breast carcinoma

75
Q

Eccrine hydrocystoma occurs aorund the eyes but is much rare than apocrine hydrocystoma

A

True

76
Q

The presence of decapiation secretion cannot distinguish apocrine hydrocystoma from eccrine hydrocystoma

A

False

The presence of decapitation secretion is the key differentiating feature

77
Q

Hidroacanthoma simplex presents as a pedunculated erythematous lesion

A

False

A verucous plaque with a warty brown surface mimicking seb K

78
Q

Hidroacanthoma simplex affects the limbs more than other sites

A

True

79
Q

Hidroacanthoma simplex is composed of largish lobules of blue cells hanging down from epi

A

True

looks like seb k without pseudo horn cysts or other features

80
Q

All poromas are eccrine

A

False

this is the old view but some lesions may show apocrine differentiation

81
Q

The acrosyringium is the epithelium of the eccrine ducts

A

True

82
Q

The poroma group of eccrine tumours arise from the acrosyringium and dermal eccrine ducts

A 
True
Poroma group includes;
Hidroacanthoma simplex - acrosyringium 
Eccrine poroma - acrosyringium 
Eccrine hydrocystoma - ductal
Dermal duct tumour - ductal
NB can see apocrine differentiation in these tumours as the ducts of apocrine and eccrine glands are identical
83
Q

Eccrine poromas can occur anywhere but are commonly seen on the palms and soles

A

True

84
Q

Eccrine poromas is a skin coloured papule

A

False
moist, red-pink papule
resembles melanoma, BCC or SCCcan be pigmented

85
Q

Eccrine poromas can arise after XRT

A

Truer

are reports though

86
Q

Porocarcinoma can rarely arise from eccrine poroma

A

True

malignant change well recognised

87
Q

Eccrine dermal duct tumour is a tumour of the ducts arising in the papillary dermis

A

True

88
Q

Syringomas occur equally in males and females

A

False

more common in females

89
Q

Syringomas are uusually multiple and bilateral with onset is at adolesence

A

True

sufferers often develop more lesions in adult life

90
Q

Syringomas are associated with Turner’s syndrome

A

False
Downs syndrome
No familial type

91
Q

Syringomas often occur on the cheeks and eyelids but can be elsewehere

A

True

also chest, neckeruptive syringomas tend to appear on chest, neck, abdo and pubic area or buttocks (less commonly)

92
Q

Laser is Rx of choice for Syringomas

A

False

can use ablative laser but respond wel to diathermy

93
Q

Hidradenoma can show eccrine or apocrine differentiation

A

True

94
Q

Hidradenoma is a solitary tumour more common in women and often on face or upper body

A

True

95
Q

Hidradenoma mesures 2-6cm

A

False

0.5-3cm

96
Q

Cylindroma is also called Turban tumour or Spiegler’s tumour

A

True

97
Q

Spiradenoma is also called Brooke’s tumour

A

False

Trichoepithelioma is also called Brooke’s tumour

98
Q

Cylindromas can be inherited in a dominant fasion

A

True

99
Q

AD cylindromatosis, AD trichoepitheliomas and Brooke-Spiegler are phenotypic variants of the same genetic disease

A

True

all due to mutation in cylindromatosis CYLD gene

100
Q

Cylindromas occur mainly on the scalp and nearby skin but 25% occur on the trunk and limbs

A

False

101
Q

Trichilemmal cyst is the main clinical DD for cyclindroma

A

True

as both prefer scalpesp when multiple present

102
Q

Spiradenoma and cylindroma can overlap esp in Brooke-Spiegler and both commonly have apocrine diff

A

True

103
Q

Spiradenomas are painless, firm, bluish dermal nodules 3-5cm in diameter

A

False
painfull - otherwise all true
Called eccrine spiradenoma in Blue ANGEL mnemonic but the eccrine is usually dropped these days

104
Q

Ischaemic necrosis in a spiradenoma can obscure the histological features

A

True

105
Q

Mixed tumour of the skin is an eccrine tumour

A

False

Mixed tumour of the skin (chondroid syringoma) is derived from folliculosebaceous and apocrine structures

106
Q

Mixed tumour of the skin occurs in middle aged men and usualy measures up to 5mm

A

False
can measure 5-10cm
middle aged men, manly on head and neck

107
Q

Merkel cells are a feature of follicular differentiation

A

True

108
Q

Malignant tumours of skin appendages are in general not aggressive and local recurrence is more common than metastasis

A

True

esp if incompletely excisedWLE is usually Rx of choice. Staging is important as mets can occur

109
Q

Malignant chondroid syringoma is the most common example of malignant change in a pre-existing benign sweat gland tumour

A

False

it is Porocarcinoma arising from eccrine poroma

110
Q

Porocarcinoma (malignant eccrine poroma) usually arises from an existing benign eccrine poroma

A

False

only 18% do. Most are de novo malignnat lesions

111
Q

Porocarcinoma is relatively common, accounting for up to 0.01% of all skin malignancies

A

True

112
Q

Porocarcinoma occurs mainly on the legs in elderly people

A

True

women more than men

113
Q

In porocarcinoma cases, both local recurence and LN mets ocur in almost one 5th of cases each

A

True

and systemic mets in 10%WLE and follow up required

114
Q

Aggressive digital papillary adenocarcinoma is a rare tumour of the hands and feet with a high risk of local recurrence and mets

A

True

amputation usually recommended

115
Q

Microcystoc adnexal carcinoma (MAC) is a malignant type of DTE

A

False

MAC is a malignant syringoma

116
Q

Microcystoc adnexal carcinoma (MAC) affects young adults esp on upper lip or elsewhere in central face

A

True

117
Q

Perineural invasion is an important complication of Microcystoc adnexal carcinoma (MAC)

A

True

Mohs recommended

118
Q

Can differentiate Pilar sheath acanthoms from Dilated pore of Wiener as the follicle opening is small - not large with multiple projections - and the lobules are larger and more rounded

A

true

119
Q

Pilomatrxoma is the most comon tumour of the inner root sheath (matrix)

A

True

all others are rare and not covered in detail in most books

120
Q

Mucinous carcinoma is a rare deep tumour of the head and neck which resembles mucinous carcinoma of the salivary gland

A

False
resembles mucinous carcinoma of the breast or GIT
otherwise all true

121
Q

Paget’s disease of the nipple is most common in women in their 60s and 70s

A

False
40s and 50s most common (5th and 6th decades)rare before age 30. Rarely seen in men (worse prognosis)
mainly in caucasians

122
Q

For Paget’s disease with no evidence of underlying breast cancer, breast conserving surgery is a good option

A

True (although this is rare)
with or without XRTwhere there is underlying cancer treat as usually appropriate
Must always completely excise nipple-areola complex

123
Q

Clinically Pagets’s disease can resemble psoriasis of the nipple, IEC or erosive adenomatosis

A

True

Rarely looks like eczema/ contact dermatitis which is usually bilateral

124
Q

The main histological DD for Paget’s (nipple) is SCC

A

False

Its melanoma

125
Q

Paget’s disease of the nipple is positive for CEA, EMA, CAM 5.2 and negative for S100

A

False

positive for CEA, EMA, CAM 5.2 and usually positive for S100

126
Q

Paget’s disease is thought to originate in the intraduct carcinoma of the breast that frequently accompanies the condition

A

True
This is the epidermotropic theory
The alternative theory is that Paget’s cells are a type of transformed malignant keratinocyte

127
Q

Paget’s disease accounts for fewer than 1% of breast cancers

A

False

fewer than 3%

128
Q

> 90% of paget’s disease (nipple) is associated with in situ or invasive ductal carcinoma

A

True

129
Q

A subjacent or distal mass can be clinically palpated in

A

False

Up to 50%

130
Q

Paget’s cells do not establish intercellular bridges with the adjacent normal keratinocytes but appear both as individual cells in Pagetoid pattern and in nest-like clusters

A

True

131
Q

The cytoplasm of Pagets cells stains with PAS and is diastase labile

A

False

PAS positive and diastase resistant due to neutral polysaccharides

132
Q

Paget’s cells are round with a large round hyperchromatic nucleas and thin rim of clear cytoplasm

A

True

133
Q

S100 is helpful in disitnguishing Paget’s disease from melanoma

A

False

both S100 positiveMelan A may be helpful

134
Q

CD23 is positive in both mammary and extra-mammary Pagets disease

A

True

135
Q

Extra mammary Paget’s disease (EMPD) is a type of intraepithelial adenocarcinoma

A

True

136
Q

Extra mammary Paget’s disease (EMPD) accounts for 20% of Paget’s disease

A

False

6.5%

137
Q

Extra mammary Paget’s disease (EMPD) accounst for 6.5% of vulval malignancies

A

False

1-5%

138
Q

EMPD is most common on the vulva in women and perianal region in men

A

True

Rare reports of; Axilla, buttocks, thighs, eyelids, external auditory canal (‘ectopic EMPD’ if non apocrine sites)

139
Q

EMPD is more common in women worldwide

A

False

in Japan it is more common in men

140
Q

EMPD has a later average age of onset than mammary Paget’s

A

True

50-80, peak at 65Mammary peak age is 57

141
Q

Primary EMPD arises from the epidermis with no associated neoplasmand account for 2/3-3/4 of cases

A

True

142
Q

Secondary EMPD arises either from an underlying cutaneous adnexal carcinoma (most often) or an internal maligancy

A

True

Visceral malignancy usually has a contiguous epithelium with the affected site

143
Q

About 10% of all EMPD cases are secondary to an internal malignancy

A

True

144
Q

Perianal EMPD has a 10x higher risk than vulval or penoscrotal disease for having a visceral malignancy associated

A

False

5x higher risk

145
Q

Pruritus is uncommon in EMPD

A

False

common and may be intractableoften is presenting symptom

146
Q

In EMPD the vulval area is most commonly afected in women and the scrotum most common in men

A

False

vulva most common in women, perianal most common in men

147
Q

Elevated serum CEA is a marker of poor prognosis in EMPD

A

True

148
Q

Unlike mammary Pagets, EMPD is usually negative for S100

A

True

149
Q

Wide local excision and a hunt for visceral neoplasms are the mainstay of Rx for EMPD

A

True

XRT for cases where surgery in appropriate or refused

150
Q

Local recurrence rates are high for EMPD

A

Yes

often related to incomplete excision

151
Q

Inguinal LN involvement in EMPD with an underlying skin neoplasm portends a poor prognosis

A

True

zero 5 year survival

152
Q

A Merkel cell carcinoma is a primary neuroendocrine carcinoma of the skin

A

True

153
Q

Merkel cell carcinoma is a rare tumour occuring in elderly people

A

True

154
Q

Merkel cell carcinoma occurs more often in sun exposed sites in pts with dark skin types

A

False

sun exposed skinmainly occurs in caucasians - rare in dark skin

155
Q

Merkel cell polyoma virus is unrelated to Merkel cell carcinoma

A

False

Merkel cell polyoma virus thought to play an aetiological role in MCC

156
Q

Merkel cell carcinoma is a rapidly growing, red-blue nodule up to 2cm in diameter

A

True

157
Q

Immunosuppression may play a role in the deveopment of Merkel cell carcinoma

A

True

158
Q

Mitotic figures and apoptotic cells are rare in Merkel cell carcinoma

A

False

abundant

159
Q

Merkel cell carcinoma cells have dark blue hyperchromatic basophilic nuceli and scanty cytoplasm

A

True

160
Q

Merkel cell carcinoma cells demonstrate moulding of nuceli and paranuclear dot posiitvyt on staining with CAM 5.2 or CK7

A

False

CK20 and CAM 5.2 (low MolWt keratin markers)all else true

161
Q

Other than Merkel cell carcinoma the only other neuroednocrine tumour posiitve for CK20 is neuroendocrine carcinoma of the salivary glands

A

True

162
Q

What are poor prognostic histo features for Merkel cell carcinoma?

A 
5HED
tumour 5mm or larger
Heavy mononuclear inflammatory cell infiltrate
Extension into subcutis
Diffuse growth pattern
163
Q

Metastasis are a late feature of Merkel cell carcinoma

A

False

aggressive - mets occur early

164
Q

30-50% of pts with Merkel cell carcinoma die from metastases

A

True

165
Q

Pts with Merkel cell carcinoma should undergo staging including SLNB with CK20 IHC

A

True

166
Q

Merkel cell carcinoma is treated with WLE + XRT and lymphadenctomy if SLNB +ve

A

True

167
Q

Merkel cell carcinoma is sensitive to chemotherpay but not radiotherapy

A

False

Radiosensitive but not sensitive to chemo

168
Q

What are the clinical features of Merkel cell carcinoma?

A 
AEIOUA
symptomatic (non-tender)
Expanding rapidly 
Immunosuppressed
Older than 50
UV-exposed site

Medical Derm Revision (51 decks)

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