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Block 4 > Skin: moles and papules > Flashcards

Skin: moles and papules Flashcards

1
Q

What are the 3 layers of skin?

A

Epidermis

Dermis

Subcutaneous (hypodermis)

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2
Q

What embryological layer is the epidermis derived from?

A

Ectoderm

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3
Q

What type of cells are found in the epidermis?

A

(Keratised) Stratified squamous epithelium

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4
Q

What are the epithelial cells in the epidermis filled with?

What are some of the properties of this substance?

A

Keratin

A protein that is protective and insoluble.

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5
Q

What lies between the epidermis and the dermis?

A

Basement membrane

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6
Q

Which layer are hair follicles and sweat glands found in?

A

Dermis

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7
Q

Name the 2 layers of the dermis

A

Papillary - finger like projections into the epidermis

Reticular

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8
Q

What 5 things can be found in the dermis and not in the epidermis?

A

Collagen fibres

Elastin fibres

Blood vessels

Nerves

Lymphatic vessels

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9
Q

Why is the subcutis important in thermoregulation?

A

It is a rich adipose (fat) layer that acts as a reserve for energy resources

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10
Q

What fibres that can be found in the dermis degenerate with age and cause wrinkles?

A

Collagen

Elastin

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11
Q

Name the 4 layers of the epidermis from basement membrane upwards

A

Basal layer

Spinous layer

Granular layer

Cornified layer

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12
Q

Give some characteristics of the basal layer of the epithelium

A

Single layer of cells

Epidermal stem cells - constantly dividing to form keratinocytes.

Aim of keratinocytes is to form keratin and move up through the epidermis.

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13
Q

Give some characteristics of the spinous layer of the epithelium

A

Variable thickness - usually 3 cell layers

Contains keratin fibrils

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14
Q

Give some characteristics of the granular layer of the epithelium

A

Few cell layers thick

Contains granules that stain in histology

Keratin fibrils become fibres

CELLS LOSE NUCLEUS

Cells get coated by glycophospholipids that makes the cells water-proof

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15
Q

Give some characteristics of the cornified layer of the epithelium

A

Contains keratin

Cells have no nucleus but are waterproof (glycophospholipids)

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16
Q

What is the difference in the epidermis in patients with psoriasis?

A

The amount of time it takes for cells to move from the basal layer to the cornified layer is reduced

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17
Q

How are cells in the basal layer of the epidermis connected to the basement membrane?

A

Hemidesmosomes

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18
Q

What changes keratin fibrils into keratin fibres?

A

Keratohyalin granules

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19
Q

What releases glycophospholipids into the cornified layer of the epithelium?

What does this do to the cells?

A

Lamellar bodies

Makes the cells water-proof

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20
Q

What causes the dark colour of skin?

What is this formed by?

Which layer of the skin is this found in?

A

Melanin

Melanocytes

Basal layer of the epidermis

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21
Q

What is formed in the epidermis during histological preparation?

A

Desmosomes

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22
Q

Where are Merkel cells usually found?

A

In the basal layer of the epidermis

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23
Q

What do Merkel cells do?

A

They are in close proximity to the nerve endings and have a sensory function

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24
Q

Name a difference between ‘thick’ and ‘thin’ skin

A

Thick skin has a thick cornified layer and an additional stratum lucidum

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25
Q

What type of hair is thin and can be found all over the body?

A

Vellus hair

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26
Q

What type of hair can be found on the skull, beard, pubic and axillary regions. What is it for?

A

Terminal hair

Protection

27
Q

What are hair follicles made from?

A

Keratin

28
Q

As a hair follicle grows, what does it associate with?

A

A sebaceous gland

Erector pilli muscles

29
Q

Where is sebum secreted from?

A

Sebaceous glands

30
Q

What 3 things make a pilosebaceous unit?

A

Hair follicle

Sebaceous gland

Smooth muscle

31
Q

Which gland is affected in acne?

A

Sebaceous glands

32
Q

What is the role of the eccrine sweat glands?

A

2 parts - secretory and duct

Take up plasma filtrate and filter out electrolytes e.g. NaCl.

Water is filtered out as sweat

Concentration of sweat depends on hydration status of the patient

33
Q

What is the role of the apocrine glands?

A

Under hormonal control

Associated with hair in the axilla and groin region

Secretion contains fats and proteins.

Secretion does not smell until it comes into contact with bacteria on the skin’s surface

34
Q

What is the nail plate formed from?

A

Keratin

35
Q

Describe the blood supply to the skin

A

Veins and arteries form 2 plexi:

A cutaneous (deep) pleuxus between the subcutis and the dermis
and
A superficial plexus between the dermis and the epidermis

The epidermis itself has no blood vessels going through it

36
Q

If a skin lesion is flat, can be seen but is not palpable, what is it called?

What term would be used to describe a larger area of a flat lesion?

A

Macule

A patch

37
Q

If a skin lesion is flat, can be seen but is not palpable, what is it called?

What term would be used to describe a larger area of a flat lesion?

A

Macule
<5mm

A patch

38
Q

If a skin lesion is raised and solid, and less than 5mm in size, what is it?

A

Papule

39
Q

If a skin lesion is raised and solid, and more than 5mm in size, what is it?

A

Nodule

40
Q

Give an example of a malignant papule/nodule (depending on size)

A

Basal cell carcinoma

41
Q

If a skin lesion is raised, can be felt, but the area is greater than the height, what is it?

A

Plaque

42
Q

Where are plaques normally found?

Give a common example of a plaque

A

Extensor surfaces e.g. elbow/knee region

Psoriasis

43
Q

What happens to the keratinocytes in psoriasis?

And the epidermis in general?

A

They become larger and become nucleated - become porokeratosis

Blood vessels become more superficial

44
Q

If a skin lesion is raised, filled with clear serous fluid, and <5mm, what is it?

A

Vescile

45
Q

If a skin lesion is raised, filled with clear serous fluid, and >5mm, what is it?

A

Bullae

46
Q

If a skin lesion is raised and filled with pus, what is it?

A

Pustule

47
Q

Which conditions can present with vesicles/bullae?

A

Herpes zoster

Shingles

Chicken pox

48
Q

What is a neoplasm?

A

A lesion resulting from the autonomous growth of cells in the absence of a stimulus

49
Q

Describe the appearance of a benign neoplasm

A

Slow expansive growth

Symmetrical

Capsule present

Resembles tissue of origin

Differentiated cells

Smooth surface

50
Q

Describe the appearance of a malignant neoplasm

A

Fast, invasive, metastatic growth

Crab-like appearance

No capsule

Does not resemble tissue of origin

Undifferentiated cells

Irregular surface, may ulcerate and haemorrhage

51
Q

Name the 3 forms of skin cancer

A

Basal cell carcinoma

Squamous cell carcinoma

Malignant melanoma

52
Q

What is the key prognostic factor in skin cancer diagnosis?

A

Depth of invasion

53
Q

Discuss basal cell carcinoma (BCC)

A

Commonest form of skin cancer in the UK

Slow growing

Usually does not metastasise but can become locally destructive

54
Q

Name 3 risk factors for BCC

A

UV radiation exposure

Immunosupression

Inherited conditions e.g. xeroderma pigmentosum

55
Q

Describe the appearance of a BCC

A

Slow growing

Can be superficial or nodular

Rolled edge

Punctum in middle +/- abscess

Associated with blood vessels

Slowly eating away at the skin

Usually located in sites where there is little surplus skin to repair site when removed

56
Q

Identify the risk factors for squamous cell carcinoma (SCC)

A

UV radiation

Male sex

Fair skin

Occupational exposures; tars, oil, radiation

Immunosupression

57
Q

Describe the appearance of a SCC

A

Often still able to produce keratin - may be a crust on top of the lesion

Can present as ‘non-healing ulcer’.

58
Q

Name some histological changes in SCC

A

Hyperchromatism

Pleomorhphism

High nuclear:cytoplasmic ration

Loss of normal tissue architecture

Changes can be seen prior to invasion - ‘carcinoma in situ’

59
Q

Where is a carcinoma in situ contained?

A

Within the epidermis/epithelial layer of a tissue

60
Q

What is the ABCDE criteria of assessing a skin lesion?

A

Asymmetry

Border

Colour

Diameter

Evolving

61
Q

Name some risk factors of malignant melanoma

A

UV radiation exposure - patterns of exposure e.g. childhood exposure

FH of melanoma

Presence of dysplastic or abundant naevi

62
Q

What does the stage of a cancer mean?

A

The size of the tumour and how far it has spread from where it originated

63
Q

What does the grade of a cancer mean?

A

The appearance of the cancerous cells

64
Q

What is the TNM staging for cancers?

A

Tumour size (DEPTH)

Lymph node involvement

Metastases

Block 4 (11 decks)

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