Skin Pathology II

Question 1

skin tag

Answer 1

fibroepithelial polyp

neck, trunk, face, intertriginous zones

benign - middle aged and older individuals

fibrovascular stalk covered in benign epidermis

areas of rubbing**

Question 2

lesion filled with keratin and lipid and other debris

Answer 2

epithelial cyst of wen

subclassified based on cyst wall

Question 3

epithelial inclusion cyst

Answer 3

aka wen, follicular cyst

face, scalp, upper trunk - lots of hair follicles

obstruction of hair follicle
-filled with keratinous debris

lined by granular cell layer**

Question 4

granular cell layer

Answer 4

lines epithelial inclusion cyst

Question 5

foreign body giant cell rxn

Answer 5

with rupture of epithelial inclusion cyst

painful

Question 6

seborrheic keratosis

Answer 6

middle aged older pts
-on trunk

postage stamp**
-proliferation of epidermal basal cells

B9

Question 7

proliferation of epidermal basal cells

• looks like postage stamp
• forms pseudocyst

Answer 7

seborrheic keratosis

Question 8

pseudocyst

Answer 8

seborrheic keratosis

keratin filled horn cyst composed of benign basal cells with keratin filled horn - communicate with surface (pseudohorn cyst)

Question 9

FGFR3

Answer 9

mutation of suborrheic keratosis

Question 10

onset of suborrheic keratosis and GI malignancy

Answer 10

leser trelat

tumor elaborating TGF-a

Question 11

hyperpigmentation of flex regions

Answer 11

acanthosis nigricans

epidermal hyperplasia of stratum spinosum

Question 12

acanthosis nigricans prognosis

Answer 12

80% B9 - childhood

20% - underlying malignant adenocarcinoma - middle age and older individuals - GI malignancy

Question 13

adnexal neoplasms

Answer 13

99% benign

from ductal or glandular epithelial cells

Question 14

B9 adnexal tumors

Answer 14

symmetrical
small <1cm
superficial
vertical in orientation

Question 15

malignant adnexal tumors

Answer 15

asymmetrical, large, deep, wide

Question 16

cowden syndrome

Answer 16

multiple tricholemmomas with dominant inheritance

family history**

PTEN mutation

Question 17

tricho-

Answer 17

hair follicle

Question 18

sebaceous adenoma with associated colorectal malignancy

Answer 18

muir torre syndrome

Question 19

massive confluent cylindroma on forehead

Answer 19

turban tumor

inactivation mutations in CYLD tumor suppressor gene

Question 20

lower eyelid

Answer 20

syringoma

Question 21

forehead and scalp

Answer 21

cylindroma

Question 22

palmar and plantar regions

Answer 22

poroma

Question 23

cylindroma

Answer 23

eccrine duct tumor

lined with membranous eosinophilic cuticles

Question 24

perinasal papules and small nodules

Answer 24

trichoepithelioma

buds of basaloid cells that resemble primitive hair follicles

Question 25

anucleate ghost cell

Answer 25

with pilomatrixoma

Question 26

red dermal bump

Answer 26

hemangioma

Question 27

yellow dermal bump

Answer 27

xanthoma

Question 28

tan dermal bump

Answer 28

fibrohistiocytic lesion

Question 29

hemangioma

Answer 29

can regress over time in children

Question 30

multiple eruptive xanthomas

Answer 30

think hypercholesterolemia

Question 31

dermatofibroma

Answer 31

benign fibrous histiocytoma

Question 32

firm tan papule on leg of women -proliferation of benign spindle cells epidermal hyperplasia with fibroblasts surrounding collagen bundles

Answer 32

dermatofibroma compress in and get fold in middle**

Question 33

increased melanin in keratinocytes, no change number of melanocytes

Answer 33

sun tan freckles cafe au lait spots melasma

Question 34

with increased estrogen - lesion on face

Answer 34

melasma | -increased melanin in keratinocytes

Question 35

ephelis

Answer 35

freckles

Question 36

increased melanin in keratinocytes and slight increased in number of melanocytes

Answer 36

solar lentigo

Question 37

loss of melanin in keratinocytes

Answer 37

vitiligo - acute | albinism

Question 38

tyrosine kinase deficiency

Answer 38

albinism involved in melanin synthesis

Question 39

loss of melanocyte, permanent

Answer 39

chronic vitiligo

Question 40

suntan

Answer 40

increased melanin in keratinocytes reversible increased protection against solar radiation (UVB) UVB - increases melanosome production chronic - skin aging

Question 41

mask of pregnancy

Answer 41

melasma aka chloasma hypermelanosis characterized by sharply demarcated blotchy brown macules on face cheek and forehead -pregnancy, women taking oral contraceptives, and menopause

Question 42

hyperpigmented macules on chronically sun exposed skin in adults

Answer 42

solar lentigo -B9 increased melanin in keratinocytes and variable increase in number of melanocytes** old people hands brown spotty

Question 43

lentiginous

Answer 43

proliferation of melanocytes

Question 44

in situ melanom arising in sum exposed skin of face

Answer 44

lentigo maligna

Question 45

permanent loss of melanocytes

Answer 45

chronic vitiligo

Question 46

acute transient vitiligo

Answer 46

tx people with normally dark pigmented skin with keratinolytic agent -results are dramatic

Question 47

melanocytic nevi

Answer 47

aka nevocellular acquired moles -uniform tan brown papule 6mm or less B9 neoplasm of melanocytes** mutation in NRAS and BRAF

Question 48

NRAS and BRAF mutations

Answer 48

melanocytic nevi B9

Question 49

melanocytic nevi stages

Answer 49

1 junctional - dermoepidermal junction 2 compound - nests or cords of melanocytes into underlying dermis / also in junction 3 dermal - epidermal component lost 4 neurotization - maturation as enter dermis - mature and become smaller/nonpigmented, resembling neural tissue melanomas - no maturation**

Question 50

junctional nevus

Answer 50

flat | -nevus cells at dermoepidermal junction

Question 51

compound nevus

Answer 51

rounded nevus cells at junction and into dermis

Question 52

intradermal nevus

Answer 52

smooth stretched surface on rounded nodule no nests in dermalepidermal junction** do not shave biopsy

Question 53

variants of nevocellular nevi

Answer 53

``` congenital blue spindle and epithelioid halo dysplastic ```

Question 54

congenital nevus

Answer 54

present at birth -deep dermal and subQ growth around adnexa, neurovasculature, and blood vessels large and hairy - risk for melanoma

Question 55

blue nevus

Answer 55

flat and blue completely B9 dermal infiltration, associated fibrosis highly dendritic often confused with melanoma

Question 56

spindle and epitheliod cell nevus

Answer 56

spitz nevus fascicular growth large plump cells with pink blue cytoplasm fusiform cells often confused with hemangioma and melanoma

Question 57

halo nevus

Answer 57

lymphocytic infiltration around nevus cells host immune response against nevus cells

Question 58

dysplastic nevus

Answer 58

clark nevus parker for precursor of melanoma has cytologic atypia** in intraepidermal nests