30. Epithelial Tumors

Question 1

This is one of the most common skin neoplasms that devo in middle age or older people.

Answer 1

Seborrheic Keratoses

Question 2

Descibe this seborrheic keratoses and where we expect to see it

Answer 2

Papules and plaques with ‘stuck on’ warty apperance

Most common on face, trunk, upper extremeties

Question 3

What is the cause of Seborrheic keratoses?

Answer 3

Mutation in FGF 3

Question 4

What is this?!?

Answer 4

Leser-Trelat Sign: multiple SKs are associated with internal maligancies.. espeically stomach cancer

Question 5

This is indicitative of what? Describe it

Answer 5

Seborrheic Keratoses

Acanthotic, HORNCYSTS, see variable hyperkeratosis and you someimes see a monotonous basaloid band

Question 6

Woman comes in with erythematous yellow/brown lesions on the tops of her hands. She states she spends most days outisde gardening. Dx

Answer 6

Actinitc Keratosis

its solar or senile keratosis– usually from chronic sun damage

Question 7

Does Actinic Keratosis often become maligant?

Answer 7

No.. only .1-10% become malignant, most regress or remain stable

Question 8

Describe what goes on histologically with Actinitc Keratosis

Answer 8

See atypia in basal layer of epidermis

(in dif stains, we see blud-gray elastic fibers in dermis d/t so sun exposure)

Question 9

Common neoplasm in older people d/t UVB radiation that causes DNA damage: also associated with old burn scars, HPV, radiation, arsenic, immunsuppresed people

Answer 9

Squamous Cell car.

Question 10

PRognosis for SCC

Answer 10

5% develop invasive component

–30% of them have metestatic potiential

Question 11

This is SCC—what do we worry about

Answer 11

Invasive SCC tend to be nodular and may ulcerate… likelyhood of metastasis is related to thickness of lesion and degree of invasion into subcutis

Othe image is example of common sharply defined red scaly plaque SCC

Question 12

Describe features of SCC histology

Answer 12

We can see full thickness dysplasia

becomes invasive once it breaks through basement membrane

Question 13

How can we tell this is invasive SCC

Answer 13

Break through the BM

Question 14

Whats this little tumor?

Answer 14

Keratoacanthoma

Question 15

Solitary flesh colored nodule with central keratin plug

Rapid growth over 2-10 weeks and mostly on sun damaged skin

Answer 15

Keratoacanthoma

Question 16

When do we expect to see multilple keratoacanthomas?

Answer 16

Immunosuppresed pts

Question 17

Why do we do tx for keratoacanthomas?

Answer 17

can cause extensive local destrucion.

Question 18

Describe this lesion and it’s histology

Answer 18

Keratoancanthoma

Crate like lesion, proliferating epi is well differentiationed with epithelial palor

Question 19

Helpful chart on BSC vs SCC

Question 20

What is our MOST common human cancer

Answer 20

BSC: secondary to chronic sun exposure

** can be locally destructive

Question 21

Do we worry about metestasis with BSC… and why does it happen

Answer 21

SLOW growing, rarely mets–if does, bc pt is immunocompromised

Associated with dysregulation of sonic hedgehog or PTCH pathway

Question 22

Whats this little beauty?

Answer 22

BSC with telangectasia…can als be crater like

Question 23

HE of BSC… describe

Answer 23

see large nodules blue or purple in color

you can sometimes see clefting between stroma and tumor

Question 24

This guy was present at birth and increases in growth with sun exposure

Answer 24

melanocytic nevi

Question 25

What type of Melanocytic nevi is this?

Answer 25

Its junctional... epidermis only

Question 26

Melonocytic nevi are:

Answer 26

Compound nevi; epidermis and dermis

Question 27

Melanocytic nevi that are intradermal are:

Answer 27

in the dermis only

Question 28

What is this?

Answer 28

Congenital Melanocytic Nevi

Question 29

These are larger then aquired nevi \>0.5cm, irregular in shape and uneven discoloration; can occur sporadicaly or in familial form.

Answer 29

Dysplastic Nevi

Question 30

Why do we worry about mulplie dysplastic nevi?

Answer 30

Increased risk of melenoma

Question 31

Describe dysplastic nevi sydrome

Answer 31

familial or sporadic, large in number (more then 80) see increased chance melanoma as well as other maligancies (pancreateic carcinoma)

Question 32

Genetic abnormality in Dysplastic nevus syndrome

Answer 32

Autosomal dominant, mutation in CDKN2a gene 9p21-11 in 40% cases

Question 33

Sporadic vs familial nevi have different or same histology

Answer 33

same

Question 34

represents 3% of all skin cancers 6th most common cancer in US MOre common in white M=F

Answer 34

Melanoma

Question 35

Risk factors for melanoma

Answer 35

multifactoral: sun exposure at EARLY AGE (most important risk factor), fair complexion, old age, dysplasic nevi syndrome, hitstory of melanoma and XP

Question 36

What clinical features do we look for in melanoma

Answer 36

A: asymmetry B: Borders; notched, uneven, blurred C: color, uneven shades D: diameter; \>6 mm

Question 37

How do we determine how bad melanoma is?

Answer 37

Verticle growth or dermal invasion: this is when we see potential for metastasis

Question 38

Importance of radial growth of melanoma

Answer 38

melanocytes will proliferate within epidermis but NO NO NO metestatic ptoential at this stage: its early to find early on bc easily cured (surgically)

Question 39

Depth of invasion is most important predictor of metastatic disease:

Answer 39

called Breslow thickness Tumors \<1mm rarely metastasize \>1.7mm more potential

Question 40

Where does melanoma like to metestasize?

Question 41

Most common type of melanoma and located on the back and extremeties

Answer 41

Superficial spreading type

Question 42

Melenoma with NO raidal growth phase ... directly invades the dermis-- poor prognosis

Answer 42

Nodular type

Question 43

Melenoma mostly commonly located on head and neck area: sun exposed

Answer 43

Lentigo maligna type

Question 44

located on palm, sole, or beneath nail; most common melanoma in AA

Answer 44

Acral Lentiginous type

Question 45

HE of melanoma

Answer 45

early on... only in dermis, then we then progress and have keritinocytes all over and in nests.

Question 46

Older man presents with erythrodermic rash--\> over time progresses to patch--\>plaque--\> nodules

Answer 46

Mycosis fungiodes most common CTCL \*\*becomes aggressive if chronic

Question 47

What is this???

Answer 47

Sezary Syndrome Blood involvement of T cell lymphoma, erythroderma, poor prognosis, survial of 1-3 yrs

Question 48

What is this?

Answer 48

Mycosis Fungoides: infiltration of epidermis and dermis by neoplastic T cells, often have cerebriform nucleus characterized by infolding of nuclear memebrane