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Skin/Musculoskeletal System > Disorders of Pigmentation & Melanocytes, Benign Epithelial Tumors, Malignant Epidermal Tumors > Flashcards

Disorders of Pigmentation & Melanocytes, Benign Epithelial Tumors, Malignant Epidermal Tumors Flashcards

1
Q

Macule

A

Definition
A flat, circumscribed region of skin with different color or texture (example: freckle)

Subtypes:
Patch: A large macule (> 1 cm) or a coalescence of macules (example: vitiligo)

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2
Q

Papule

A

Definition
A palpable, circumscribed change in consistency or contour of the skin (example: acne vulgaris)

Subtypes:
Nodule: A papule larger than 1 cm in diameter
(example: neurofibroma)
Tumor: A large nodule (example: lymphoma)
Plaque: A coalescence of papules (example:
psoriasis) (remember this one)
Cyst: An encapsulated nodule filled with soft
material (example: epidermal cyst)

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3
Q

Vesicle

A

Definition
A circumscribed, clear fluid filled lesion; a blister (example: Herpes simplex)

Subtypes:
Bulla:	A large vesicle (example: bullous
		pemphigoid)
Pustule:	A vesicle filled with inflammatory cells
		(example: acne vulgaris)
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4
Q

Wheal

A

Definition
A palpable, circumscribed, area of edema with central pallor and peripheral erythema (example: hives) that usually disappears relatively quickly

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5
Q

Purpura

A

Definition
Discoloration of the skin due to the presence of blood in the tissue, outside of blood vessels; will not blanch with pressure (example: vasculitis)

Subtypes:
Petechiae A punctate region of purpura (tiny dots)

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6
Q

Comedo

A

Definition

A plug within a hair follicle canal which is composed of keratin and sebum; a blackhead (example: acne vulgaris)

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7
Q

Milium

A

Definition

A white papule composed of whorls of keratinized epidermal cells beneath the skin surface (example: milia)

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8
Q

Burrow

A

Definition

A horizontal tunnel in the stratum corneum produced by a parasite (example: scabies)

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9
Q

Scaly

A

Definition:
Characterized by exfoliation of surface keratin cells (example: psoriasis)
Subtypes:
Hyperkeratotic: Having very thick scale (example: icthyosis)

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10
Q

Crusted

A

Definition:
Displaying dried exudate of fluid and/or cellular components on the skin surface.
Subtypes:
Serous: Composed of serum or tissue fluid
(example: contact dermatitis)
Purulent: Containing pus (example: infection)
Hemorrhagic: Containing red cells; a scab (example: healing herpes zoster)

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11
Q

Eroded

A

Definition

Showing a superficial defect in the skin surface which does not penetrate through the epidermis (example: abrasion)

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12
Q

Ulcerated

A

Definition

Showing a skin defect which penetrates through the epidermis (example: diabetic foot ulcer)

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13
Q

Excoriated

A

Definition

Eroded or ulcerated, often in a linear fashion, due to scratching (example: dermatitis factitia)

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14
Q

Fissured

A 
Definition
Split horizontally (example: chronic dermatitis)
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15
Q

Erythematous

A

Definition

Reddened; due to vasodilation with increased blood flow. Blanches with pressure (example: viral exanthem)

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16
Q

Edematous

A

Definition

Swollen; due to extravasation of serum and lymph into tissue (example: urticaria)

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17
Q

Pigmented

A 
Definition:
	Showing changes in color due to melanin pigment
Subtypes:
Hyperpigmented:	Dark; due to increased 
		amount of melanin (example: nevus)
Hypopigmented:	Light; due to decreased 	
		amount of melanin (example: vitiligo)
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18
Q

Lichenified

A

Definition
Showing thickening with accentuation of the normal skin markings; usually a sign of chronicity associated with scratching or rubbing (example: atopic dermatitis)

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19
Q

Verrucous

A

Definition

Characterized by velvety or roughened wart-like change (example: verruca vulgaris)

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20
Q

Telangiectatic

A

Definition

Showing dilated small arterioles or capillaries coursing parallel to the skin surface (example: spider telangiectasia)

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21
Q

Atrophic

A

Definition

Emaciated or thinned (example: striae)

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22
Q

Scarred

A

Definition

Showing fibrous connective tissue replacement; a result of dermal injury (example: keloid)

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23
Q

Vitiligo

A

Partial or complete loss of melanocytes
Well demarcated macules/patches
Hand/wrist, axillae, perioral/periorbital, anogenital
Pathogenesis: autoimmune

24
Q

Albinism

A

No melanin produced (or decreased)

Inherited defect in tyrosinase

25
Q

Vitiligo vs Albinism

A

Vitiligo is autoimmune lymphocyte mediated melanocyte destruction – normal enzyme
associated with other autoimmune disorders: pernicious anemia, thyroiditis

Albinism is congenital absence of enzyme and melanin is not made or is decreased
Enzyme loss of defect in transport to melanosomes

26
Q

Pigmented Lesions

A

Due to excess melanin
Freckle
Melasma
Solar lentigo

Due to increased number of melanocytes
Melanocyte hyperplasia
       Lentigo simplex
Melanocytic neoplasia
       Nevi
       Melanoma
27
Q

Melasma

A

Pregnancy, oral contraceptives, hydantoin
Mask like facial hyperpigmentation
Cheeks, forehead, temples
Sunlight makes it worse
Melanocytes have enhanced pigment transfer to keratinocytes or macrophages
Resolves after pregnancy over or drug discontinued

28
Q

Solar Lentigo

A

Hyperpigmentation of basal epidermis due to excess melanin production
Sun protective mechanism of melanocytes

29
Q

Lentigo simplex

A 
Localized hyperplasia of melanocytes
All ages
Not sun related (vs. solar lentigo)
Small brown macules
Histopathology: Increased melanocytes, increased pigment in stratum corneum and basal epidermis, rete ridges elongated/thinned
30
Q

key difference between malignant and benign neoplasms

A

malignant CAN (but not necessarily has) metastasize

31
Q

Neoplasia

A

Benign
Definition:
Neoplasm with no capability for metastasis
Can be destructive or symptomatic – this does NOT define malignancy!

Malignant
Definition:
Neoplasm with potential for metastasis and subsequently growth/proliferation at distant site
Often locally destructive but may not be!

32
Q

Nevus (“Mole”)

A

Benign neoplasms of melanocytes
Congenital or acquired
Most have mutations (BRAF most common)
Common: Acquired or congenital
Congenital: Large ones have increased risk of melanoma
Blue: confused with melanoma clinically
Spitz: difficult to distinguish from melanoma under microscope occasionally
Halo: immune reaction to nevus cells
Dysplastic/Atypical: potential precursor of melanoma

33
Q

Spitz nevi

A

All Spitz/spitzoid lesions should be excised
Unpredictable biologic behavior
Many can be reliably classified as benign
Others however difficult to judge malignant potential

34
Q

Blue nevi

A

Dark blue/brown papules
Often clinically concerning for melanoma
Benign
Deep blue color due to deep pigmentation
Tyndall effect – light scatter properties
Entirely dermal proliferation of spindled melanocytes with many melanophages

35
Q

Nevus of Ota/Ito

A

Ota: Peri-ocular, intra-ocular dermal melanocytic nevus
Ito: Mongolian spot, same type of lesion, different site

36
Q

Dysplastic Nevi (DPN)

A

1978: families with many moles and high incidence of melanoma (Dysplastic nevus syndrome)
Later sporadic cases described
Sporadic syndrome is more common (2-17% of population?)
Multiple dysplastic nevi = marker of increased risk of melanoma
Isolated dysplastic nevus = probably no or only minimal risk of melanoma
Usually graded by pathologist
Mild, moderate, severe atypia
Can excise mild depending on clinical circumstances, should excise mod/severe

37
Q

Malignant Melanoma

A

Malignant neoplasm of melanocytes
Used to be uniformly deadly
Most arise in skin
Other sites: oral/anogenital mucosa meninges, esophagus, eye
Risk factors: fair skin, sun exposure, many DPN
Usually asymptomatic, may itch
Change in color or size of pre-existing lesion

CLASSIC teaching is the ABCD’s:
Asymmetry
Border
Color
Diameter   (>6mm or pencil eraser)

Only reliable way to exclude melanoma is to biopsy
Many dermatologists believe that if a patient is concerned about a pigmented lesion that it should be biopsied if requested, even if it looks benign to you
Options for patients with many atypical nevi: photos, frequent follow-up

38
Q

Melanoma test info

A 
Probability to metastasize is best predicted by depth of invasion
This is known as Breslow’s depth
Measured in **millimeters**
Many prognosticators but 
   ***Breslow depth is best***
Sentinel lymph node biopsy
Usually for melanomas > 1 mm thickness
39
Q

Other prognostic indicators

A

Next most important: Ulceration, mitotic rate
For thin melanoma only (< 1mm)
Clark level (essentially a less accurate Breslow)
I – in situ
II – few cells in papillary dermis
III – melanoma fills papillary dermis
IV – reticular dermis
V – subcutis
Others: regression, inflammatory pattern, etc.
Breslow depth is best

40
Q

Seborrheic keratosis

A 
Common epithelial neoplasm
Trunk, head, neck are typical
“stuck on”
Brown and velvety papules/plaques
Leser-Trelat Sign – paraneoplastic, rapid growth of numerous seborrheic keratoses

Sharply demarcated
Variable melanin/histologically overlap with lentigo
Exuberant keratin formation
Horn cysts

41
Q

Skin tag/Fibroepithelial polyp/Acrochordon

A

Very common cutaneous lesion, not neoplastic
Soft flesh colored bag-like tumor with stalk
Inconsequential
May increase in pregnancy
May be increased in diabetes, obesity

42
Q

Epithelial Cyst

A

Down growth of epidermis which becomes cystic
Filled with keratin
Subcutaneous or dermal nodule
Rupture easily and become inflamed
Subtypes: epidermal, pilar, dermoid, steatocystoma multiplex

43
Q

Actinic keratosis

A

Benign neoplasm of epidermis (may precede squamous cell carcinoma)
Induced by sunlight (most common), ionizing radiation, arsenicals, hydrocarbons
Rough spots on skin (less than 1 cm)
Sun exposed skin
Cytologic atypia of basal layer, hyperkeratosis
Some will progress to squamous cell carcinoma (malignant) if untreated (most likely 1%)
Treated by liquid nitrogen, curettage, topical chemotherapy

44
Q

Squamous cell carcinoma

A

Common neoplasm on sun exposed skin in older people
Risk factors sun (#1), carcinogens, chronic ulcer, old burn scar,
Also xeroderma pigmentosum, chemotherapy or organ transplant
In situ: contained above the basement membrane (full thickness atypia)
Invasive: invades basement membrane and dermis
Less than 5% will metastasize

45
Q

Basal cell carcinoma

A 
Most common human malignancy
Slow growing, usually older adults
Rarely metastasize
Risk factors:  sun exposure, light pigment, XP
Pearly papule with telangiectasia

Resemble basal cell layer of epidermis
Arise from base of epidermis, possibly hair follicle derived (controversial)
Clefts are common between base of neoplasm and dermis

46
Q

Adnexal Proliferations/Neoplasms

A

Differentiate toward hair follicle, eccrine, sebaceous, eccrine and apocrine glands
Benign and malignant types
Too many to learn realistically unless a pathologist

47
Q

Cowden’s syndrome

A

Hereditary condition prone to multiple hamartomas and malignancy
Skin: multiple trichilemmomas (Benign proliferation of hair follicle epithelium)
(face), benign keratoses on acral skin
Mucosal papules, cobblestoning tongue
Internal: breast, endometrial and thyroid carcinoma
Cerebellar lesions
Mutation in PTEN (tumor suppressor gene)

48
Q

Sebaceous hyperplasia

A

Acquired, localized increase in sebaceous glands, not neoplastic
Glands larger than normal
Common on the face
Yellow papule

49
Q

Sebaceous adenoma

A

Benign neoplasm

Lobular circumscribed proliferation of sebocytes and the peripheral basaloid epithelial cells

50
Q

Sebaceous carcinoma

A

Malignant neoplasm
Most are periocular (inner/outer lid)
A periocular sebaceous neoplasm is most likely carcinoma, not adenoma or hyperplasia
Extraocular forms less common but more likely to occur in Muir Torre syndrome
Metastasis common, death in 20%

51
Q

Muir-Torre Syndrome

A

Hereditary syndrome
Germline mutations in DNA mismatch repair proteins: MLH1, MSH2, MSH6, PMS2
These repair errors in base pairing during replication, especially in 1-2 bp repeats (microsatellites)
Skin: Sebaceous adenoma and carcinoma, keratoacanthomas
Internal carcinomas: Colon/rectal, endometrial, ovarian
Represents subset of hereditary non-polyposis colorectal carcinoma syndrome (HNPCC)
Young/adult patient with sebaceous adenoma or carcinoma, test for MTS
Immunohistochemistry
Fast, relatively inexpensive
Highly sensitive
If loss of staining (indicating loss of DNA mismatch repair protein), genetic testing for confirmation

52
Q

Dermatofibroma

A

benign

dimple test

53
Q

Hemangioma

A

Well formed vascular spaces in dermis

Clinically must separate from malignant vascular neoplasms (Kaposi’s sarcoma, angiosarcoma)

54
Q

Where to biopsy

A

For rashes – non-ulcerated/intact skin, usually sample center and edge
Discrete lesions
Needs to be representative in horizontal AND vertical axis
Think about depth

55
Q

To shave or punch…

A

Shave: use for superficial lesions (many BCC, AK, SCC in situ, pigmented macules)
Better cosmetics, no sutures, electrocautery

Punch: use for neoplasms involving the dermis (nodular BCC, SCC, melanoma, etc.) and most rashes
Requires sutures
Various sizes 1.5 mm – 8 mm

Skin/Musculoskeletal System (14 decks)

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