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House AMP > The Skin & Its Lesions > Flashcards

The Skin & Its Lesions Flashcards

1
Q

Parts of the skin
• Keratinocytes secrete (soluble or insoluble?) molecules such as _______ and _______ that regulate _______ immune responses

A

soluble ; cytokines

defensins ; cutaneous

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2
Q

Parts of the skin

Melanocytes within the ________ are responsible for the production of ________, a ________ pigment that absorbs and protects against potentially ________ ____________ radiation in ________.

A

epidermis; melanin

brown; injurious

ultraviolet (UV) radiation

sunlight.

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3
Q

Parts of the skin

Dendritic cells:
– one of the first lines of defense against micro-organisms
– Secrete factors that _______ innate immune system
– function as _________________cell

A

augment

an antigen presenting cell

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4
Q

Parts of the skin

• ________cytes
• _______ cells
• Skin __________

A

• Lymphocytes
• Merkel cells
• Skin adnexae

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5
Q

Categories of skin lesions
• Inflammatory
– Acute
– Chronic
• __________
• _________
• __________
• ______________

A

Infectious
Non-infectious
Blistering
Non-blistering

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6
Q

Categories of skin lesions

• Neoplastic
– ___________
– ________
– ___________

A

– Benign
– Premalignant
– Malignant

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7
Q

Categories of skin lesions

Disordersof pigmentation
– ________ ________
– ________ ________
– ________/________ noma

A

– Benign nevus
– Dysplastic nevus
– Melanoma/Melanocarci noma

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8
Q

Categories of skin lesions

List 3

A

Inflammatory
Neoplastic
Disordersof pigmentation

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9
Q

______ is the Largest organ in the body

A

Skin

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10
Q

First line of defense against infections and physical agents is???

A

Skin

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11
Q

Skin

Endocrine functions of synthesizing ________ under sun exposure

A

vitamin D

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12
Q

Classification of malignant skin tumours
• Tumors of ___________

• Tumors of ___________

• Tumors of ___________

• Tumors of ___________

A

• Tumors of keratinocytes

• Tumors of melanocytes

• Tumors of Merkel cells

• Tumors of Langerhans cells

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13
Q

Classification of malignant skin tumors

• Tumors of keratinocytes –___________,_________

• Tumors of melanocytes –_______________

• Tumors of Merkel cells –____________

• Tumors of Langerhans cells –________________

A

Squamous cell carcinoma – Basal cell carcinoma

Malignant melanoma

Merkel cell carcinoma

Langerhans cell histiocytosis

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14
Q

Epidemiology of skin cancers
• Melanoma and nonmelanoma skin cancer (NMSC)
– most common types of cancer in (white or black?) populations.
– _____easing incidence rate worldwide
– ______/_________ mortality rate

A

white

increasing

Stable/decreasing

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15
Q

Most rapidly increasing cancer in white
populations is??

A

Melanoma

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16
Q

Most common skin cancer in Nigeria is ???

A

Melanoma

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17
Q

Melanoma

•___-fold increase in incidence rates over last ____ decades

• More in (males or females?) than (males or females?)

A

5

3

More in males than females

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18
Q

Melanoma

• ________ if detected and treated at it’s earliest stage
• Mainly arises from the _____ and are found in the ____ exposed areas

A

Curable

skin

sun

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19
Q

Most deadly of all skin cancers is??

A

Melanoma

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20
Q

Melanoma: Other Sites of Origin

• ______ and ________ mucosal surfaces
• __________
• ________
• _____ of the eye

A

Oral and anogenital

Oesophagus

Meninges

Uvea

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21
Q

Melanoma: Risk factor
• Mostly ________
• Related to ________ predisposing environmental factor- ________________________________________

A

sporadic

a single ; Ultraviolet Radiation (UVR) damage from sun exposure.

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22
Q

UVR is strongly linked with DNA damage

T/F

A

T

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23
Q

Only ______ to ______ % of melanomas are inherited

A

10- 15

24
Q

Pathogenesis of melanoma

Mutations Disrupting Cell Cycle Control Genes

• A ______________________ gene CDKN2A encodes ____/____, _____/—— and _____/____

• Loss of ______ - clearly implicated in human melanoma.

A

cyclin dependent kinase inhibitor gene

p15/INK4b ; p16/INK4 ; p14/ARF.

p16

25
Q

Pathogenesis of melanoma

• p16 - inhibits _______ and ———
• p14 - enhances _____ by inhibiting _______

A

CDK4 and CDK6

p53

MDM2

26
Q

MDM2

an oncoprotein that ________ the __________ of ______

A

stimulates

degradation

p53

27
Q

Mutations Disrupting Cell Cycle Control Genes

• Any of these ____,____,_____ ,_____,______ genes can be mutated in melanoma

• The net effect is the same:
– increased ___________________
– due to loss of ____________ and escape from oncogenic induced cellular __________

A

p16, p14, CDK4, CDK6, p53

melanocytic proliferation

cell cycle control

senescence

28
Q

Pathogenesis of melanoma

Mutations Activating Pro-growth Signaling Pathways
• Mutations in _______ and _______
– Aberrant increases in ________ and _________ signaling which promote cell growth and survival.
– Additionally, there can be mutation in the _____stream arm of ____ which include _________

A

NRAS and BRAF

RAS and PI3K/AKT

down; RAS

BRAF

29
Q

Pathogenesis of melanoma

Mutations That Activate Telomerase
• The ______ gene is commonly mutated
• Associated with increased ______ mRNA
expression
• this gene encodes the ______ unit of
______
• Reactivation of ______ enzyme activity ______ ______ and protects cells from
______

A

TERT ;TERT

catalytic; telomerase

telomerase

preserves telomeres; senescence

30
Q

Clinical features: ABCDE of melanoma
• —————
• Irregular ________
• Variegated _______
• Increasing ________
• __________ or change over time especially if rapid

A

• Asymmetry
• Irregular borders
• Variegated colour
• Increasing diameter
• Evolution

31
Q

Assumetry of melanoma

One half ______________

A

does not match the other

32
Q

Irregular borders of melanoma

• The edges are ________,________, or _________

A

ragged, notched, or
blurred

33
Q

Colour of melanoma

• The pigmentation is ___________
• Shades of tan, brown, or black are
present.

A

not uniform.

34
Q

Diameter of a melanoma

• Diameter greater than _______ should
raise concern
• Any sudden or continuing ___________ should also be of special concern

A

6mm

increase in size

35
Q

Melanoma: Prognostic factors
• Tumour _______
• Number of _______
• Evidence of _______ _______
• _______ of the overlying skin
• Presence of tumour infiltrating _______
• Gender (_______ >———-)
• Microscopic involvement of the _______ lymph node
• High stage (TNM)

A

depth ; mitoses

tumour regression

Ulceration; infiltrating

(M >F)

sentinel

36
Q

Squamous cell carcinoma (SCC)
• Commonly affects (men or women?) > _____ years

• Less than ____% of these tumors metastasize to regional nodes;
• These lesions are generally deeply _______ and involve the _________.

A

men > 60 years

5%

invasive ;subcutis.

37
Q

Most common skin malignancy seen in LUTH is ??

A

Squamous cell carcinoma (SCC)

38
Q

Squamous cell carcinoma: Risk factors
• _______ damage induced by __________
• Immunosupression, increasing susceptibility to oncogenic virus HPV 5 and 8
• Industrial carcinogen (__________)
• Chronic __________
• __________ __________

A

DNA ; UV light

tars; ulcers

xeroderma pigmentosum

39
Q

Squamous cell carcinoma: Risk factors
• Draining ____________
• _________________
• Ingestion of ____________
• Ionizing radiation
• ____________ and ____________ chewing
• ____________ ____________
• ____________

A

osteomyelitis

Old burn scars

arsenicals; Tobacco ; betel nut

Actinic keratosis; Albinism

40
Q

Squamous cell carcinoma: Pathogenesis

• Most studies on the genetics of squamous cell carcinoma have focused on acquired defects in ______ tumors and their precursors (________ ______), and the relationships between these defects and ___________

A

sporadic tumors

actinic keratoses

sun-exposure

41
Q

Squamous cell carcinoma: Pathogenesis

• The incidence of _____ mutations in _______ ________ found in Caucasians is high, suggesting that _____ dysfunction is an (early or late?) event in the development of tumors induced
by __________.

A

TP53 ; actinic keratoses

p53 ;early

sunlight.

42
Q

Squamous cell carcinoma: Pathogenesis

DNA damage by UV light is sensed by __________ such as ______ and ______ which send out signals that upregulate the expression and stability of ______

A

check point kinases

ATM and ATR

p53

43
Q

Squamous cell carcinoma: Pathogenesis

• P53 in turn arrests cells at the ____ phase and either the DNA is ______ at this point or there is ________ of the cells that are beyond repair

• When these protective function, DNA damage leads to rapid _______ of mutations and eventual _________

A

G1 phase ; repaired

apoptosis; accumulation

carcinogenesis

44
Q

Common sites of squamous cell carcinoma

List 4

A

• Face
• Ears
• Scalp
• Dorsal hands

45
Q

Squamous cell carcinoma: Clinical
features
• May present as ______ or _________

• Thin SCC ((superficially or deep?) _______) may clinically simulate in situ _________ or _______

• Thicker tumors typically present as
__________,_________,________

A

thin plaque ; erythematous scaly papule

superficially invasive

carcinoma ; actinic keratosis

erythematous plaque, nodule, ulcer

46
Q

Grading of SCC
• _______ differentiated
• ______ differentiated
• ______ differentiated
• ___ differentiated

A

• Well differentiated
• Moderately differentiated
• Poorly differentiated
• Undifferentiated

47
Q

Treatment of SCC
•___________ with adequate margins
• ______,________,______ therapy

A

Surgical excision

curettage, electrodessication,
cryotherapy, radiation

48
Q

Basal cell carcinoma
• Patients with ________ _________, who
have a diminished capability for _____________________________ , develop a large number of _________________________ early in life

A

xeroderma pigmentosum,

repairing sun induced mutations

basal cell and squamous cell carcinomas
(SCCs)

49
Q

____________ is the most common nonmelanoma malignancy of skin in Caucasians , constitutes about _______% of NMSC

A

Basal cell carcinoma

75-90

50
Q

Basal cell carcinoma: Epidemiology
• Occurs in ______ races, but much more often in _____ skinned people

• Usually in patients >___ years of age
• Male: Female ___:____

A

all ;fair

40

1.6:1

51
Q

Basal cell carcinoma: risk factors
• Associated with ________ exposure (particularly ____________ exposure)
• History of _______ treatment
• Associated with various syndromes: ___________ syndrome;________ syndrome; __________ __________

A

UV light ; intermittent intense

radiation basal cell nevus syndrome

Bazex syndrome; xeroderma
pigmentosum

52
Q

Basal cell carcinoma: clinical features
• ____________ , ________ , nodule or
plaque, which is often _________, ______ or
_________
• ________ BCC may mimic a _________
neoplasm
• Metastases are exceedingly (common or rare?)
(preferred sites: ____________, _______, ______)

A

erythematous patch; papule,

eroded ; ulcerated ; indurated

Pigmented ;melanocytic

rare ; lymph nodes

lung ; bones

53
Q

Sites of basal cell carcinoma

• Mainly __________ skin, in any ________ area (e.g head and neck)
• Also at sites with ________ or _______ exposure

A

sun exposed ; hair bearing

limited ; no sun exposure

54
Q

Treatment of basal cell carcinoma

• Surgical: __________ , standard __________, __________ surgery,
__________ with or without __________,
__________

• Medical: topical __________, __________

• __________

A

saucerization

full thickness excision

Mohs micrographic surgery

curettage with or without electrodesiccation

cryosurgery

5-fluorouracil; imiquimod

Radiation

55
Q

Examples of malignant skin adnexal
tumours
Sweat glands
-____________ carcionoma
-___________ carcinoma
-__________ carcinoma
-_______________________ carcinoma

Sebaceous glands
-_________ carcinoma

A

-adenoid cystic carcionoma
-myoepithelial carcinoma
-mucinous carcinoma
-microcystic adnexal carcinoma

-sebaceous carcinoma

House AMP (65 decks)

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