Week 1: Skin Pathology Flashcards
What are BK moles? What is their appearance? What can result of the condition progresses?
Dysplastic Nevi
Nevi larger and irregular, may have pigmentation variation. Dysplastic nevus syndrome = multiple dysplastic nevi. Increased risk of melanoma.
What do the letters stand for in the ABCD rule? What does the test indicate?
Asymmetry Irregular borders Varied coloration Diameter greater than 6 mm above indicate a nevus could be dysplastic
Most common type of melanoma
Primarily horizontal growth, somewhat vertical
Superficial Spreading Melanoma
What is a desmosome and what is its function?
Anchors cells - “spot weld”
Increased skin pigmentation is found in which skin disorder(s)? A. Benign Lentigo B. Vitiligo C. Melasma D. Ephelides
All but B.
Vitiligo presents as areas devoid of melanocytes.
Light brown macules could indicate _________ or _________. If you find melanocytic hyperplasia and stability with sun exposure, it would point to ___________.
Ephelides (freckles) or Benign Lentigo
Benign Lentigo (because freckles increase in sun and are a result of increased melanin content, not increased number of melanocytes)
A dark-skinned patient comes in with what appears to be a nail fungus on his big toe, which is becoming necrotic. Your first thought is that it might be _______________. What other areas of the body are commonly affected in this disease? What part of the name is misleading?
Acral-lentiginous melanoma (malignant)
Also affects palms, soles, and mucosal surfaces (such as sublingual areas)
Lentiginous = flat but this melanoma is not really flat
What are nevi?
“Nests,” refers to involvement of multiple skin layers including the basal layer.
Which of these have increased risk of developing into melanoma? A. Congenital nevi (birthmark) B. Nevocellular nevi C. Dysplastic nevi (atypical) D. A and C
D. A and C are correct
B is usually benign unless the nevi change
Which of these does NOT follow the ABCD rule? What other evaluation is used? A. Nevocellular nevus B. Dysplastic nevi C. Superficial spreading melanoma D. Nodular melanoma
D. Nodular melanoma. Are symmetrical, regular border, uniform color. Evaluate using "EFG" E= Elevated F= Firm to the touch G= Growing
T or F: Sun exposure is involved in the development of A. Actinic keratosis B. Nevocellular nevi C. Pemphigus D. Malignant melanoma
A. True
B. True
C. False
D. True
Melasma or Vitiligo? A. Hormone related B. Irregular areas devoid of melanocytes C. Familial predisposition D. Irregular patches of hyperpigmentation on the face E. Can be self-limiting
A. Melasma B. Vitiligo C. Vitiligo D. Melasma E. Melasma
Which of these are risk factors for malignant melanoma? A. Age 40-70 B. Fair skin C. Genetic predisposition D. Chronic sun exposure, sunburns E. Dysplastic nevus syndrome
All are risk factors
What does “lentigo” (plural lentigines) mean?
Small, pigmented spot on the skin
Clearly defined edge, surrounded by normal skin.
Harmless (benign) hyperplasia of melanocytes
Linear in its spread.
What area(s) of the body are typical affected by: A. Face or neck of older individuals B. Palms and soles C. Upper back D. Back and legs E. Knees, elbows, scalp
A. Lentigo Maligna melanoma B. Ichthyosis Vulgaris or Acral-Lentiginous melanoma C. Malignant melanoma (in males) D. Malignant melanoma (in females) E. Psoriasis
What condition is characterized by:
A. Tan/brn coin shaped plaques; look waxy, “stuck on”
B. Well-defined erthyematous plaque with silvery scale.
C. Vesicular, erythematous rash that becomes dry, thickened, hyperkeratotic
D. Thickened, hyperpigmented skin in axillae and groin
A. Seborrhric Keratosis
B. Psoriasis
C. Excema
D. Acanthosis Nigricans
In general, how is the malignant potential of melanoma assessed?
Staging is by depth of invasion (vertical growth). Clark and Breslow scales are measurements of the depth of penetration of the melanoma and correspond to survival rates.
What is the sign of Leser-Trelat?
Sudden development of multiple lesions of Seborrheic Keratosis may accompany an underlying malignancy
T or F: Pathophysiology of Psoriasis
A. Subepidermal blister formation
B. Patchy hyperkeratinization with parakeratosis
C. Thinning of rete ridges
D. Thinning of epidermis over dermal papillae
E. Munro microabscesses
A. False. Epidermal hyperplasia B. True C. False. Uniform elongation and thickening of rete ridges; friable D. True E. True
T or F: Pathophysiology of Pemphigus Vulgaris
A. Production of autoantibodies that attack keratinocyte desmosome
B. Loss of cellular adhesions (acantholysis)
C. Uncommon but nonfatal
A. True
B. True
C. False. Rare and potentially fatal
Xerosis or Eczema?
A. Can be inherited – tendency to develop other allergic conditions, such as asthma and hay fever (atopic)
B. Skin can be rough, scaly, itchy, flaky or cracked
C. Inflamed or irritated reddened patches
D. Tends to develop in the elderly
A. Excema
B. Xerosis
C. Excema
D. Xerosis
What is the basis of the butterfly rash of Cutaneous Lupus Erythematous?
Epidermal atrophy
Deposition of DNA-anti DNA immune complexes in basement membrane of epidermis.
Erythematous maculopapular eruption on nose and cheeks (“butterfly rash”)
Is Pityriasis Rosea a dangerous condition?
It is benign but may inflict substantial discomfort in certain areas.
Erythema Nodosum or Erythema Multiforme?
A. Typically on anterior shins. Common in 12-20 yo.
B. Hypersensitivity rxn to infections or drugs
C. Vesicles, bullae, “targetoid” erythematous lesions
D. Raised red painful nodules of subQ adipose tissue
A. Nodosum
B. Multiforme
C. Multiforme
D. Nodosum.
What is the significance of actinic keratosis?
Precursor to squamous cell carcinoma. Sun-induced dysplasia of keratinocytes. Freeze superficial lesions with liquid nitrogen so will not progress to SCC.
BCC, SCC, or Melanoma?
A. Involves basal cell layer of epidermis
B. Involves stratum granulosum
C. Involves melanocytes in basal cell layer of epidermis
D. Involves keratinocytes of epidermis
A. BCC
B. None of these
C. Melanoma
D. SCC
What are the characteristics of Congenital Nevi?
Present at birth (birthmark)
Giant congenital nevi have increased risk of developing melanoma.
T or F: Skin disorder involves an immune reaction. A. Psoriasis B. Erythema Multiforme C. Dermatitis Herpetiformis D. Pemphigus Vulgaris
A. True. Autoimmune.
B. False
C. True. Immune rxn to gliadin
D. True. Autoimmune
Tests used in diagnosis: Pemphigus or Psoriasis? A. Auspitz sign B. Nikolski's sign C. Darier's sign D. Asboe Hansen sign
A. Psoriasis. Auspitz = removal of scale–> pinpoint bleeding
B. Pemphigus. Top skin layers slip away from lower layers when slightly rubbed.
C. Neither
D. Pemphigus. Extension of blister to adjacent unblistered skin when pressure is put on top of bulla.
Name the antibody associated with each disorder?
A. Pemphigus
B. Dermatitis Herpetiformis
C. Excema
A. IgG
B. IgA
C. IgE
What disease is linked to each of these?
A. Celiac Sprue
B. Upper respiratory tract (viral) infection 1-2 wks prior
C. Obesity & hyperinsulinemia, rarely internal malignancy (i.e. GI)
D. Sign of Leser-Trelat
A. Dermatitis Herpetiformis
B. Pityriasis Rosea
C. Acanthosis Nigricans
D. Seborrheic Keratosis
Put the following in order of least to most malignant: A. Typical Nevocellular Nevus B. Nodular Melanoma C. Lentigo Maligna Melanoma D. Melasma
D. Melasma not malignant
A. Nevocellular nevus - only risk of malignancy if atypical
C. Lentigo Maligna Melanoma - flat spreading growth
B. Nodular Melanoma - Worst prognosis of melanomas. Nodular tumor with rapid vertical growth pattern - can be invasive in months.
Pemphigus Vulgaris or Bullous Pemphigoid?
A. Basement membrane disrupted –> subepiderm. bullae
B. Big, flaccid blisters; easily ruptured
C. Tense bullae that do not rupture easily
D. Epid. squamous cells disrupted –> superficial, intraepidermal bullae
A. Bullous Pemphigoid
B. Vulgaris
C. Bullous Pemphigoid
D. Vulgaris
