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MSK Exam 1 Spring 2015 > Skin Pathology III > Flashcards

Skin Pathology III Flashcards

1
Q

melanocytic nests at rete ridges bridged at base

with increased fibrosis in papillary dermis

A

in dysplastic nevus

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2
Q

CDKN2A and CDK4

A

mutations in dysplastic nevus syndrome

auto dom

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3
Q

appearance of dysplastic nevus

A

asymmetric
border irregular
color uneven
diameter >6mm

all non-reassuring signs

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4
Q

advanced melanoma

A

vertical growth spread - spread into dermis and vessels

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5
Q

subtypes of malignant melanoma

A

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

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6
Q

acral lentiginous

A

subtype of malignant melanoma
-worse prognosis

on palms and soles
non-caucasian

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7
Q

site of malignant melanoma

A

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

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8
Q

malignant melanoma

A

primarily in adults
originates as isolated lesion
aggressive - significant mortality

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9
Q

risk fx for malignant melanoma

A

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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10
Q

TERT mutation

A

increased telomerase activity

present in 70% of skin melanomas

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11
Q

CDKN2A and CDK4 mutations

A

seen in dysplastic nevus and melanoma familial syndromes

involved in P16 inhibition

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12
Q

melanoma male vs female

A

female - leg

male - trunk

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13
Q

ABCD for melanoma

A

asymmetry
border
color
diamter - >6mm

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14
Q

melanocytic marker

A

HMB-45

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15
Q

distant mets

A

stage 4

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16
Q

mets to lymph nodes

A

stage II/III

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17
Q

breslow level

A

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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18
Q

loss of texture, leathery skin and wrinkling

A

solar elastosis

sailor and farmer skin

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19
Q

neoplastic proliferation of keratinocytes not yet involving full epidermal thickness

scaling and redness

A

actinic keratosis

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20
Q

solar keratosis

A

actinic keratosis

is pre-cancerous lesion

sun exposed areas

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21
Q

lips

A

actinic chelitis

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22
Q

erythematous red brown macule

or minimally elevated papule with overlying scales

A

actinic keratosis

23
Q

cutaneous horn

A

excessive scale formation

in solar keratosis

progression to full thickness atypia - SCC in situ

24
Q

squamous cell carcinoma

A

malignant proliferation of epidermal keratinocyte with potential for mets

long term sun exposure - UVB

25
Q

bowen disease

A

SCC in situ

never kills patient - no mets

26
Q

other causes of SCC

A

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

27
Q

predisposition to HPV

A

epidermodyspalsia verruciformis

28
Q

nucleotide excision repair defect

A

xeroderma pigmentosa

29
Q

second most common cutaneous malignancy

A

SCC

30
Q

organ transplant pt on immunosuppressive therapy

A

prone to SCC

31
Q

characteristics of SCC

A

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

32
Q

rapidly growing neoplasm

A

keratoacanthoma

often involutes and clears spontaneously within 3 to 4 months

histo is SCC - now termed “SCC, keratoacanthoma type”

33
Q

basal cell carcinoma

A

skin neoplasms originating from basal regenerative epithelium of epidermis

virtually never metastasizes**

34
Q

nodular and sclerosing BCC

A

potential for local invasion and destruction of adjacent dermis

preference for hair bearing skin with extensive sun exposure

35
Q

gorlin syndrome

A

nevoid basal cell carcinoma syndrome

auto dominant

multiple BCC before age 20

pits of palms and soles

36
Q

gorlin associations

A

medulloblastoma - brain
ovarian fibroma
odontogenic keratocytes

37
Q

mutations of gorlin

A

SHH
PTCH
SMO

normally - SHH binds PTCH and SMO complex - activating GLI1

mutation in PTCH, less often SMO - allow constitutive activation of GLI1

38
Q

most common cutaneous neoplasm

A

BCC

98% develop after age 40

same male and females

39
Q

rodent ulcer

A

advanced BCC

40
Q

nodular BCC

A

traditional or classic appearance

dome shaped - pearly papule or nodule
surface telangiectasias

may become quite large if neglected

41
Q

pearly telangiectasia nodule

A

nodular BCC

histo - composed of nests of uniformly atypical basaloid cells within dermis

separated by stroma by clefts**

42
Q

clefts

A

in nodular BCC

43
Q

sclerosing BCC

A

morpheaform

  • predominantly on face
  • rodent ulcer**

difficult to excise, high recurrence, disfiguring

44
Q

superficial BCC

A

scaly plaque - eleated rolled edges
-non-sun exposed skin

easily excised
-do recur

45
Q

bednar tumor

A

pigmented dermatofibrosarcoma protuberans

46
Q

dermatofibrosarcoma protuberans

A

superficial fibroblastic neoplasm
-fibrosarcoma of skin

local aggressive - rare mets

47
Q

mutation in dermatofibrosarcoma protuberans

A

translocation of COL1A1 and PDGFB

-increased PDGFB

48
Q

storiform swirling of spindle cells

A

dermatofibrosarcoma protuberans

also see swiss cheese infiltrates

49
Q

cutaneous T cell lymphoma

A

infiltrate of atypical lymphocytes accumulate under epidermis

50
Q

firm nodule arising in ulcerated aggregates in indurated plaque on trunk

A

dermatofibrosarcoma protuberans

51
Q

mycosis fungoides

A

cutaneous T cell lymphoma
-CD4

chronic process

aggressive - survival 8-9 years
more in males

52
Q

sezary syndrome

A

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

CD4 T cells

53
Q

cerebriform nucleus

A

of CD4 T helper cells
-in sezary syndrome

with mycosis fungoides

MSK Exam 1 Spring 2015 (21 decks)

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