Skin Pathology III Flashcards by Matt Stanton

melanocytic nests at rete ridges bridged at base

with increased fibrosis in papillary dermis

in dysplastic nevus

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CDKN2A and CDK4

mutations in dysplastic nevus syndrome

auto dom

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appearance of dysplastic nevus

asymmetric
border irregular
color uneven
diameter >6mm

all non-reassuring signs

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advanced melanoma

vertical growth spread - spread into dermis and vessels

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subtypes of malignant melanoma

1 - lentigo maligna
2 - superficial spreading - horizontal growth
3 - nodular - vertical growth
4 - acral lentiginous

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acral lentiginous

subtype of malignant melanoma
-worse prognosis

on palms and soles
non-caucasian

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site of malignant melanoma

mucous membrane, eye, genital, anus, oral cavity, etc.

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malignant melanoma

primarily in adults
originates as isolated lesion
aggressive - significant mortality

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risk fx for malignant melanoma

caucasian with fair skin
male
3 episodes of peeling or severe sunburn before age 20
prolonged UVB exposure

10-15% familial

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TERT mutation

increased telomerase activity

present in 70% of skin melanomas

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CDKN2A and CDK4 mutations

seen in dysplastic nevus and melanoma familial syndromes

involved in P16 inhibition

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melanoma male vs female

female - leg

male - trunk

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ABCD for melanoma

asymmetry
border
color
diamter - >6mm

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melanocytic marker

HMB-45

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distant mets

stage 4

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mets to lymph nodes

stage II/III

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breslow level

thickness of melanoma

from epidermal granular layer to deepest penetration of tumor

gives mortality

<1mm thick 92% 10 year
1-2mm thick 80% 10 year

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loss of texture, leathery skin and wrinkling

solar elastosis

sailor and farmer skin

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neoplastic proliferation of keratinocytes not yet involving full epidermal thickness

scaling and redness

actinic keratosis

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solar keratosis

actinic keratosis

is pre-cancerous lesion

sun exposed areas

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lips

actinic chelitis

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erythematous red brown macule

or minimally elevated papule with overlying scales

actinic keratosis

cutaneous horn

excessive scale formation

in solar keratosis

progression to full thickness atypia - SCC in situ

squamous cell carcinoma

malignant proliferation of epidermal keratinocyte with potential for mets

long term sun exposure - UVB

bowen disease

SCC in situ never kills patient - no mets

other causes of SCC

HPV chronic ulcers burns and radiation chemical exposure - tar in chimney sweep scrotum, arsenic, tobacco, betel nut

predisposition to HPV

epidermodyspalsia verruciformis

nucleotide excision repair defect

xeroderma pigmentosa

second most common cutaneous malignancy

SCC

organ transplant pt on immunosuppressive therapy

prone to SCC

characteristics of SCC

in areas of greatest cumulative sun exposure early invasion - small firm erythematous nodule surface granular and bleed older SCC - large, invasive, ulcerated mortality quite low

rapidly growing neoplasm

keratoacanthoma often involutes and clears spontaneously within 3 to 4 months histo is SCC - now termed "SCC, keratoacanthoma type"

basal cell carcinoma

skin neoplasms originating from basal regenerative epithelium of epidermis virtually never metastasizes**

nodular and sclerosing BCC

potential for local invasion and destruction of adjacent dermis preference for hair bearing skin with extensive sun exposure

gorlin syndrome

nevoid basal cell carcinoma syndrome auto dominant multiple BCC before age 20 pits of palms and soles

gorlin associations

medulloblastoma - brain ovarian fibroma odontogenic keratocytes

mutations of gorlin

SHH PTCH SMO normally - SHH binds PTCH and SMO complex - activating GLI1 mutation in PTCH, less often SMO - allow constitutive activation of GLI1

most common cutaneous neoplasm

BCC 98% develop after age 40 same male and females

rodent ulcer

advanced BCC

nodular BCC

traditional or classic appearance dome shaped - pearly papule or nodule surface telangiectasias may become quite large if neglected

pearly telangiectasia nodule

nodular BCC histo - composed of nests of uniformly atypical basaloid cells within dermis separated by stroma by clefts**

clefts

in nodular BCC

sclerosing BCC

morpheaform - predominantly on face - rodent ulcer** difficult to excise, high recurrence, disfiguring

superficial BCC

scaly plaque - eleated rolled edges -non-sun exposed skin easily excised -do recur

bednar tumor

pigmented dermatofibrosarcoma protuberans

dermatofibrosarcoma protuberans

superficial fibroblastic neoplasm -fibrosarcoma of skin local aggressive - rare mets

mutation in dermatofibrosarcoma protuberans

translocation of COL1A1 and PDGFB | -increased PDGFB

storiform swirling of spindle cells

dermatofibrosarcoma protuberans also see swiss cheese infiltrates

cutaneous T cell lymphoma

infiltrate of atypical lymphocytes accumulate under epidermis

firm nodule arising in ulcerated aggregates in indurated plaque on trunk

dermatofibrosarcoma protuberans

mycosis fungoides

cutaneous T cell lymphoma -CD4 chronic process aggressive - survival 8-9 years more in males

sezary syndrome

seeding of blood by malignant T cells with diffuse erythema and scaling - erythroderma** CD4 T cells

cerebriform nucleus

of CD4 T helper cells -in sezary syndrome with mycosis fungoides