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(J2) Skin > Tumors > Flashcards

Tumors Flashcards

1
Q

What is the most common pigmented lesion in lighter skinned individuals?

A

Ephils/freckles

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2
Q

What is the most deadly skin cancer?

A

melanoma

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3
Q

What is the most common malignant skin tumor?

A

basal cell carcinoma

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4
Q

What are ephils?

(appearance and histologic features)

A

Ephils = freckles

hyperpigmented macule, darkens with sun exposure

increased melanosomes** (normal melanocytes)

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5
Q

Where and in what populations are ephils most commonly seen?

A

lighter skin

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6
Q

What is lentigo?

(appearance and histologic features)

A

benign melanocyte hyperplasia

darkened macule/papules (do not change w/ sun exposure)

linear (lentiginous) spread of melanocytes above the basal layer

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7
Q

Where and in what populations is lentigo most commonly seen?

A

No preference for race, gender, or age

frequently begins in childhood and progresses throughout lifetime

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8
Q

What are nevi?

(appearance)

A

nevus = mole

benign melanocyte neoplasm

uniformly darkend macule/papule, well defined borders , typically <6mm (opposite of ABCDE of melanoma)

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9
Q

What are the histologic features/types of nevi?

A

Junctional nevi:

  • nest of cells along dermoepidermal junction in the epidermis
  • macule (flat) > papule
  • most common in children

Compound nevi:

  • growth of nests through junction into dermis
  • papule (raised) > macule

Intradermal nevi:

  • loss of epidermal component, only dermal now; nests -> cords
  • papule (raised) > macule
  • most common in adults

General progression:

junctional -> compound -> intradermal

Blue nevi:

  • black/blue; non-nested; dendritic; fibrosis
  • commonly mistaken as melanoma
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10
Q

What are dysplastic nevi?

(appearance and histologic features)

(significance of frequency)

A

potential precursor of melanoma

  • darkend macules; “pebbly” surface; darker, raised center with lighter irregular periphery
  • more in line with ABCDE of melanoma
  • coalesced nests
  • fibrosis of Rete ridges
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11
Q

How do nevi relate to melanoma?

What non-skin cancer are they also associated with?

A

Dysplastic nevi are less likely to develop into melanoma themselves (although they can) than they are indicative of an increased risk for development of melanoma

Dysplastic nevus syndrome

-autosomal dominant disorder

  • 2 or more atypical nevi -or- >100 typical nevi
  • associated with 50% incidence of melanoma by age 60
  • increased risk of pancreatic cancer
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12
Q

What is melanoma?

(appearance)

A

malignant melanocyte neoplasm

ABCDE:

  • Asymmetry
  • irregular Border
  • non-uniform Color
  • Diameter >6mm
  • Evolution

flat or nodular depending on subtype

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13
Q

What are the histologic features/types of melanoma?

(associated prognosis)

A

Lentigo maligna:

  • lentigious growth (radial growth limited to basal layer)
  • most common on face of older men
  • good prognosis, indolent

Superficial spreading:

-dominant early radial growth

-good prognosis

Acral lentiginous growth:

  • lentiginous growth (unrelated to sun exposure)
  • can affect mucous membranes, nail beds, palms, and soles
  • most common in dark skinned individuals

Nodular:

  • dominant early vertical growth
  • poor prognosis
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14
Q

Where are the different subtypes of melanoma most commonly seen?

A

Superficial spreading/nodular:

  • sun exposed areas
  • backs of men

-extremities of women

Lentigo maligna:

  • sun exposed areas
  • face of older men

Acral lentiginous:

  • independent of sun exposure
  • dark skinned populations
  • palms, soles, nailbeds, mucous membranes
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15
Q

What are the risk factors for developing melanoma?

A
  • UVB exposure (particulalry severe exposures in childhood rather than cumulative exposure)
  • fair skin
  • light colored eyes (green/blue)
  • dysplastic nevus syndrome (>100 typical or at least 2 atypical)
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16
Q

What is the most important prognostic factor of melanoma?

A

Breslow thickness:

  • depth from granular layer to deepest portion of tumor
  • thicker = worse
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17
Q

What is seborrheic keratosis?

(appearance and histologic features)

A

benign squamous proliferation

  • discolored, coin-like, waxy plaques
  • uniform color
  • spontaneously arise
  • keratin pseudocysts
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18
Q

Where and in what populations is seborrheic keratosis most commonly seen?

A

elderly

-trunk, extremities, head, neck

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19
Q

What is Leser-Trélat sign?

A

sudden eruption of multiple seborrheic ketaroses indicating possible GI carcinoma

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20
Q

What is acanthosis nigricans?

(appearance and histologic features)

A

Epidermal hyperplasia

  • thick, hyperpigmented
  • acanthosis (epidermal hyperplasia)
  • papilmatosis (hyperplasia of dermal papilae)
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21
Q

Where and in what populations is acanthosis nigricans most commonly seen?

A
  • interignious/flexor surfaces​ (axila, groin, neck)
  • benign versions typically present in childhood and progress into adulthood; diabetics and obese
  • paraneoplastic typically in middle aged men
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22
Q

What are the causes of acanthosis nigricans?

A

Benign:

  • obsesity/endocrine (diabetes, Cushing syndrome)
  • autosomal dominant inheritance
  • drug related (corticosteroids)

Paraneoplastic:

-GI adenocarcinoma

23
Q

What are fibroepithelial polyps?

A

Acrochordon/skin tags

24
Q

What are epithelial inclusion cysts?

A

Sebaceous cyst/wen

25
Q

What is actinic keratosis?

(appearance and histologic features)

A

premalignant epidermal tumor

-hyperkeratosis, possibly resulting in keratin horn

-rough texture

  • elastosis (abnormal elastic fibers in dermis)
  • parakeratosis (retained nuclei in stratum corneum)
26
Q

Where and in what populations is actinic keratosis most commonly seen?

A
  • sun exposed areas
  • light skinned individuals
  • adults (>50)
27
Q

What are risk factors for deveoloping actinic keratosis?

A

-sun/UV exposure

-arsenic

28
Q

What is the prognosis/treatment for actinic keratosis?

A
  • can spontaneously regress
  • can persist or progress to squamous cell carcinoma
  • cryotherapy or imiquimod to treat (mostly for prevention of progression or aesthetic reasons)
29
Q

What cancer is actinic keratosis most likely to progress to?

A

squamous cell carcinoma

30
Q

What is cutaneous squamous cell carcinoma?

(appearance and histologic features)

A

Malignant squamous cell proliferation in the skin

  • ulcerated nodule, bleeds easily
  • pink keratin pearls
31
Q

Where and in what populations is cutaneous squamous cell carcinoma most commonly seen?

A
  • typically on face (on or below lower lip)
  • sun exposed areas
  • more common in men
  • leg lesions more common in women
  • older adults

-work involves prolonged sun exposure

32
Q

What are risk factors for developing cutaneous squamous cell carcinoma?

A
  • sun/UVB exposure (cumulative)
  • albinism
  • xerderma pigmentosum
  • arsenic
  • immunosupression
33
Q

What is the prognosis/treatment for cutaneous squamous cell carcinoma?

A

Good prognosis

-slow growing, rarely metastasizes

Excision to treat

34
Q

What is Bowden’s disease?

(appearance and histologic features)

A

Cutaneous squamous cell carcinoma in situ

premalignant squamous cell carcinoma

  • erythematous, scaly plaque
  • full thickness of epidermis, but basement membrane intact
35
Q

What is basal cell carcinoma?

(appearance and histologic features)

A

Malignant basal cell proliferation

-“pink pearly papule” with umbilication

-telangectasias

  • palisading (outer cells nuceli are aligned)
  • separation artifact (mass seperates from surrounding tissue when sectioned)
36
Q

Where and in what populations is basal cell carcinoma most commonly seen?

A
  • sun exposed areas (on or above upper lip)
  • most common tumor of eyelid and nose
  • older adults
  • work involves prolonged sun exposure
37
Q

What are risk factors for basal cell carcinoma?

A
  • sun/UVB exposure (cumulative)
  • albinism
  • xerderma pigmentosum
  • immunosupression
38
Q

What is the prognosis/treatment for basal cell carcinoma?

A

Excellent prognosis

-slow growing, rarely metastasizes

excision to treat

39
Q

Mutations in what pathway are associated with basal cell carcinoma?

A

SHH pathway:

  • PTCH (receptor for SHH), complexed with SMO (inactivating SMO) when not bound by SHH
  • SMO, activates transcription enhancing growth and division

Most common mutation is in PTCH preventing it from forming complex with SMO, leading to unregulated cell proliferation

40
Q

What is dermatofibroma?

(appearance and histologic features)

A

Benign fibrous histiocytoma

  • firm, tan/brown papule
  • possibly tender
  • well-defined, non-encapsulated mass in the dermis
41
Q

What is a characterisitc and diagnostic feature of dermatofibroma?

A

Dimple sign:

-central dimple appears when lesions is pinched

42
Q

What is a common feature in the history of those with dermatofibroma?

A

past trauma at the location of the lesion

43
Q

Where and in what populations is dermatofibroma most commonly seen?

A

legs of women

44
Q

What is the prognosis/treatment for dermatofibroma?

A

asymptomatic, slow growing, benign

no treatment requred

45
Q

What is dermatofibrosarcoma protuberans?

(appearance and histologic features)

A

primary fibrosarcoma of the dermis (malignant)

  • firm nodule with possible ulceration
  • “pinwheel” or storiform fibroblasts
  • extends into subcutaneous fat -> “honeycomb” pattern
46
Q

What is the prognosis/treatment for dermatofibrosarcoma protuberans?

A
  • malignant, rarely metastasize
  • extension into subcutaneous fat allows for recurrence
  • wide excision to treat (wide to prevent recurrence)
47
Q

What is mycosis fungoides?

(appearance and histologic features)

A

Cutaneous T-cell lymphoma

  • early pruritic red-brown scaling patches/plaques (resemble psoriasis)
  • progress to fungating nodules
  • small clusters of CD4+ T cells with cerebriform nuclei in the epidermis-> Pautrier microabsesses
48
Q

Where and in what populations is mycosis fungoides most commonly seen?

A
  • initialy located on trunk, can later spread elsewhere
  • adults, over the age of 40
49
Q

What is the prognosis/treatment for mycosis fungoides?

A

Prognosis varies depending on progression

  • more lesions/systemic spread (Sezary syndrome) = bad
  • nodular lesions = bad
  • topical cortiocosteriods, UV therapy (early treatment)
  • chemotheraputics (late treatment)
50
Q

What is mastocytosis?

(appearance and histologic features)

A

proliferation of mast cells in the dermis (urticaria pigmentosa)

-red-brown papule/plaque

51
Q

Where and in what populations is mastocytosis most commonly seen?

A

extremities, trunk, or face (less common in sun exposed places)

cutaneous lesions (90%): children

systemic (infiltration of orans as well) (10%): adults

52
Q

What are common features/signs of mastocytosis?

A

Darier sign:

-formation of wheals (dermal edema and erythema) from rubbing of skin

Dermatographia:

  • wheals from stroking skin with pointed object
  • able to “write” on skin with resulting swelling
53
Q

What is the prognosis/treatment for mastocytosis?

A

Cutaneous (children):

-frequently resolves before puberty; good prognosis

Systemic (adults):

-possible poor prognosis

no cure, only supportive treatment

(J2) Skin (7 decks)

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