Skin Disorders - Benign Neoplasms And Pigment Disorders

Question 1

Vitiligo

Answer 1

• Loss of melanocytes and pigment

* white patches

Question 2

Albinism

Answer 2

• loss of pigment with normal appearing melanocytes

* Clinical absence of pigment in skin, hair and eyes

Question 3

Melasma

Answer 3

• ”mask of pregnancy”
• pigment in epidermis and /or dermis
• diffuse patchy pigment on face
• hormonal

Question 4

Lentigo

Answer 4

• liver spot or age spot
• pigmented macule produced from hyperplasia of melanocytes in basal layer of epidermis
• excess sum exposure

Question 5

Cafe au lait macules

Answer 5

• increased pigment at basal layer
• 2-4 cm light brown patches
• multiple lesions associated with neurofibromatosis (Von Recklinghausen’s Disease)

Question 6

Angioma

Answer 6

• benign neoplasm
• Histology: capillary blood vessels in the dermis
• cherry - red dots
• strawberry - larger red plaques, spontaneously resolve in children
• port wine - larger erythematous patches

Question 7

Hypertrophic Scar

Answer 7

• enlarged scar, does not extend beyond original wound
• more common in areas of skin tension
• Histology: increased fibrous tissue in dermis with vertical vessels which occur during granulation of wound, mainly Type II collagen in regular array
• Principles of Therapy: early injection of corticosteroid can flatten these during the evolution of scar formation, but not as effective a year or later with mature scar

Question 8

Keloid

Answer 8

• hypertrophic scar that extends beyond original wound
• Histology: broad bands of Type I and Type III collagen in irregular bundles
• African Americans
• Principles of Therapy: Intro lesión al corticosteroid, early; excision may result in a larger keloid

Question 9

Melanocytic Nevus: Junctional

Answer 9

• nests of melanocytes at DE junction
• macular lesions
• Histology:symmetry, maturation with descent, nests rather than single cells, no pagetoid migration upwards, small uniform nuclei, small or inconspicuous nucleoli, mitotic figures are rare
• Principles of Therapy: focus is on deciding whether pigmented macules are benign or malignant
• ABCDE

Question 10

Melanocytic Nevus: Compound

Answer 10

• nests of melanocytes at DE junction and within the dermis
• macular and papular lesions
• Histology:symmetry, maturation with descent, nests rather than single cells, no pagetoid migration upwards, small uniform nuclei, small or inconspicuous nucleoli, mitotic figures are rare
• Principles of Therapy: focus is on deciding whether pigmented macules are benign or malignant
• ABCDE

Question 11

Melanocytic Nevus: Intradermal

Answer 11

• nests of melanocytes within dermis
• papular lesions
• Histology:symmetry, maturation with descent, nests rather than single cells, no pagetoid migration upwards, small uniform nuclei, small or inconspicuous nucleoli, mitotic figures are rare
• Principles of Therapy: focus is on deciding whether pigmented macules are benign or malignant
• ABCDE

Question 12

Melanocytic Nevus: Blue

Answer 12

• deeper melanin pigment results in blue color (Rayleigh scattering of shorter wavelength light)
• Histology:symmetry, maturation with descent, nests rather than single cells, no pagetoid migration upwards, small uniform nuclei, small or inconspicuous nucleoli, mitotic figures are rare
• Principles of Therapy: focus is on deciding whether pigmented macules are benign or malignant
• ABCDE

Question 13

Melanocytic Nevus: Congenital

Answer 13

• large lesions (bathing trunk nevus)
• increased risk of melanoma (smaller not at as much risk)
• Histology:symmetry, maturation with descent, nests rather than single cells, no pagetoid migration upwards, small uniform nuclei, small or inconspicuous nucleoli, mitotic figures are rare
• Principles of Therapy: focus is on deciding whether pigmented macules are benign or malignant
• ABCDE

Question 14

Melanocytic Nevus: Atypical/Dysplastic Nevus 1

Answer 14

• irregular pigment pattern and often larger than most moles - could be confused with melanoma
• associated with “heritable melanoma syndrome” but can be sparse and low risk
• Heritable Melanoma Syndrome: >100 nevi, larger irregular nevi, family history of same plus melanoma
• atypical melanocytes in junctional nests with architectural disorder (horizontal bridging of nests)
• controversial diagnosis - synonyms = atypical nevus and Clark’s nevus
• Histology:symmetry, maturation with descent, nests rather than single cells, no pagetoid migration upwards, small uniform nuclei, small or inconspicuous nucleoli, mitotic figures are rare
• Principles of Therapy: focus is on deciding whether pigmented macules are benign or malignant
• ABCDE

Question 15

Seborrheic Keratosis

Answer 15

• appear with age
• ”stuck on” lesions - keratotic and brown, “velvety”, frequently confused with other lesions
• Histology: epidermal hyperplasia, orthokeratosis (no retained nuclei), horn pseudocysts - cysts connect with surface
• Principles of Therapy: liquid nitrogen