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Pathology II > Skin Neoplastic Conditions > Flashcards

Skin Neoplastic Conditions Flashcards

1
Q

Malignant tumors

A
  • Squamous Cell Carcinoma (SCCA)
  • Basal Cell Carcinoma (BCCA)
  • Malignant Melanoma
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2
Q

Squamous cell carcinoma (SCCA)

A
  • 2nd most common tumor of sun-exposed sites in older people
  • Higher incidence in men > women
  • Invasive / Metastasize
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3
Q

Morphology of noninvasive SCCA lesions

A
  • Sharply defined / red / scaling plaques
  • No invasion through the basement
  • Termed carcinoma in situ (CIS)
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4
Q

Morphology of invasive SCCA lesions

A
  • Nodular
  • Variable keratin production
  • Ulceration
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5
Q

Morphology of SCCA (CIS)

A
  • Atypical nuclei

- Enlarged and hyperchromatic

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6
Q

Morphology of invasive SCCA (CIS)

A
  • Polygonal cells in lobules (large areas of keratinization)

- Necrosis / anaplasia (exhibit dyskeratosis)

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7
Q

Pathogenesis of malignant tumors

A
  • UV induced DNA damage to squamous cells
  • Ionizing radiation
  • Old burn scars
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8
Q

UV induced DNA damage to squamous cells

A
  • Incidence is proportional to lifetime sun exposure
  • UV rays attack Langerhans cells
  • Defects in p53 / RAS
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9
Q

SCCA association with chronic immunosuppression

A
  • Chemotherapy

- Organ transplantation (Reduced host surveillance, HPV subtypes 5 and 8)

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10
Q

Basal cell carcinoma (BCCA)

A
  • Most common invasive cancer in humans
  • 1 million estimated cases per year in US
  • Slow-growing tumors
  • Rarely metastasize
  • Occur at sun-exposed sites
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11
Q

BCCA incidence

A
  • Increased immunosuppression

- Increased xeroderma pigmentosum

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12
Q

BCCA presentation

A
  • Present as pearly papules
  • Prominent subepidermal blood vessels (telangiectasias)
  • Melanin production
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13
Q

BCCA advanced lesions

A
  • Ulceration

- Extensive local invasion

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14
Q

Extensive local invasion of BCCA

A
  • After many years of neglect

- Aggressive tumors (bone, facial sinuses)

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15
Q

BCCA morphology

A
  • Tumor cells resemble the normal basal cell
  • Arise from the epidermis or follicular epithelium
  • Do not occur on mucosal surfaces
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16
Q

2 patterns of BCCA

A
  • Multifocal growths

- Nodular lesions

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17
Q

Multifocal growths of BCCA

A
  • Originate from epidermis
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18
Q

Nodular lesions of BCCA

A
  • Downward growth deep into dermis as cords
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19
Q

BCCA morphology (histology)

A
  • Multifocal growths
  • Nodular lesions
  • Palisading
  • Retraction
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20
Q

Molecular pathogenesis of BCCA (gene mutations)

A
  • PTCH signaling pathway
  • SMO activating mutations
  • Mutations in p53
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21
Q

Disorders of pigmentation and melanocytes

A
  • Melanocytic Nevus (moles)
  • Dysplastic Nevus
  • Malignant melanoma
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22
Q

Melanocytic nevus (moles)

A
  • Neoplasm of Melanocytes

- Most are Acquired (activating mutations in RAS or BRAF pathways)

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23
Q

Common acquired melanocytic nevi

A
  • Junctional
  • Compound
  • Intradermal
24
Q

Characteristics of commonly acquired melanocytic nevi

A
  • Tan –> brown
  • Uniformly pigmented
  • Small (usually <6 mm across)
  • Flat (macules) –> elevated skin (papules)
  • Well-defined / rounded borders
25
Q

Series of morphological progression of melanocytic nevi

A
  • Juntional –> compound –> intradermal
26
Q

Junctional nevi (earliest lesion) morphology

A
  • Nests of round cells that grow along the dermoepidermal junction
  • Nuclei are uniform and round
  • Inconspicuous nucleoli
  • Little or no mitotic activity
27
Q

Melanocytic nevus progression

A
  • Growth into underlying dermis (matures with depth)

- Nests and cords (compound nevi)

28
Q

Intradermal nevi

A
  • Epidermal nests form pure intradermal nevi
29
Q

Intradermal nevi undergo maturation into

A
  • Fusiform cells

- Melanomas (show little or no maturation)

30
Q

Congenital nevus distinguishing features

A
  • Deep dermal / sub Q
  • Multiple growth patterns
  • Large variants
31
Q

Growth patterns of congenital nevus

A
  • Adnexa
  • Blood vessels
  • Neurovascular bundles
32
Q

Large variants of congenital necus

A
  • Increased risk of skin cancer
33
Q

Variants of melanocytic nevi

A
  • Congenital nevus
  • Blue nevus
  • Spitz nevus
  • Halo nevus
34
Q

Blue nevus distinguishing features

A
  • Non-nesting / dermal infiltration / fibrosis
  • Heavily pigmented
  • Clinically confused with melanoma
35
Q

Spitz nevus distinguishing features

A
  • Fasicular growth pattern
  • Plump and fusiform cells with pink-blue cytoplasm
  • Clinically confused hemangiomas
36
Q

Halo nevus distinguishing features

A
  • Lymphocytic infiltration surrounding nevus

- Host Immune Response (nevus cells, melanocytes)

37
Q

Dysplastic nevi

A
  • Precursors of melanoma

- Most are clinically stable with no progression

38
Q

Dysplastic nevus characteristics

A
  • > 5 mm across
  • Flat macules –> slightly raised plaques
  • Pebbly surface
  • Cytological atypia
39
Q

Dysplastic nevus important recognition patterns

A
  • Size
  • Variability in pigmentation (variegation)
  • Irregular borders
  • Sun-exposed areas
  • Protected body surfaces
40
Q

Dysplastic nevus nuclei

A
  • Large
  • Irregular
  • Angulated
  • Hyperchromatic
41
Q

Dysplastic nevus microscopic morphology

A
  • Cytologic Atypia
  • Cells are enlarged
  • Coalescence with adjacent nests
  • Lentiginous hyperplasia
  • Superficial dermis
42
Q

Superficial dermis involvement with dysplastic nevi

A
  • Lymphocytic infiltrates
  • Melanin incontinence
  • Fibrosis surrounding the rete ridges
43
Q

Gene associations with dysplastic nevi pathogenesis

A
  • CDKN2A
  • CDK4 (cyclin-dependent kinase 4)
  • NRAS
  • BRAF genes
44
Q

Pathogenesis of dysplastic nevi

A
  • Inherited genes

- Sun exposure

45
Q

Important pathways in dysplastic nevus pathogenesis

A
  • Regulate cell survival
  • Proliferation
  • PI-3K/PTEN/AKT
  • BRAF/ERK
46
Q

Malignant melanoma associated conditions

A
  • Melanocytic Nevi

- Dysplastic Nevi (precursors of Melanoma)

47
Q

Malignant melanoma

A
  • Deadly if not diagnosed in early stages

- Preponderance

48
Q

Preponderance to malignant melanoma

A
  • Skin
  • Oral
  • Anogenital mucosal surfaces
  • Esophagus
  • Meninges
  • Eye
49
Q

Clinical features of malignant melanoma

A
  • Aggressive metastatic tumors

- Resistant to therapy

50
Q

Presentation of malignant melanoma

A
  • Asymptomatic
  • Itching / pain
  • > 10mm
51
Q

Important warning signs of malignant melanoma

A
  • Asymmetry
  • Borders (Irregular)
  • Color (Variegated color)
  • Diameter (> 6 mm)
  • Elevation
  • Change in appearance
  • New onset of itching or pain
52
Q

Progression of melanoma

A
  • Radial growth phase –> vertical Growth Phase
53
Q

Radial growth phase of melanoma

A
  • Horizontal Spread (epidermis, superficial dermis)

- Lack the capacity to metastasize

54
Q

Vertical growth phase of malignant melanoma

A
  • Downward invasion
  • Appearance of a nodule
  • Cells lack maturity (Regression)
55
Q

Probability of metastasis of malignant melanoma

A
  • Proportional to depth of invasion

- Distance / Granular cell layer –> deepest intradermal tumor cells (Breslow Thickness)

56
Q

Prognostic factors (metastasis of malignant melanoma)

A
  1. Tumor depth (the Breslow thickness)
  2. Number of mitoses
  3. Evidence of tumor regression
  4. Tumor infiltrating lymphocytes (TILs)
  5. Gender
  6. Location (central body or extremity)
57
Q

Favorable determinants (malignant melanoma)

A
  • Depth of less than 1.7 mm
  • None / very few mitoses
  • TIL response
  • Absence of regression
  • Female gender
  • Location on an extremity

Pathology II (7 decks)

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