cutaneous neoplasms

Question 1

Seborrheic ketaroses

Answer 1

common cutaneous neoplasms

Develop in middle age or older patients

Brown or tan waxy papules and plaques with stuck on or warty appearance

Most common on face, trunk, and upper extremities

Leser Trelat sign : sudden onset of multiple seborrheic keratoses associated with internal malignancy (Stomach cancer)

Question 2

Actinic keratosis

Answer 2

also known as solar keratosis

common lesions that develop as a result of chronic sun damage

Predilection for sun exposed areas

Middle age to elderly (fair complexion)

Red or tan-brown macules with gritty sand paper like scale

some lesions regress or remain stable
.1-10% become malignant

Question 3

Squamous cell carcinoma

Answer 3

Common neoplasms in old people

20% of all skin cancers

UV radiation most common cause (DNA damage)

other predisposing factors: ulcers, old burns, HPV, radiation, arsenic, immunosuppression

SCC in situ presents as a red scaly plaque

Invasive SCC lesions tend to be nodular and may ulcerate

5% of SCC in situ develop an invasive component

Risk of metastasis-2-4% (likelihood of metastisis location and degree of invasion)

Question 4

Keratoacanthoma

Answer 4

variant of squamous cell carcinoma

pink papule or nodule with a central keratin plug

grows rapidly over a period of 2-10 weeks

Occurs mainly on sun damaged skin

Some lesions will resolve spontaneously

Multiple lesions may be present in immunosuppressed patients

Can cause extensive local destruction and treatment is usually advocated

Dome shaped pink papule or nodule with central crater or keratin plug
crater like lesion, proliferating epithelium is well differentitated

Question 5

Basal Cell carcinoma

Answer 5

Most common human cancer

secondary to chronic sun exposure/UV radiation

Can be locally destructive

Slow growing tumor that rarely metastasize

When it metastasizes the patient is often immunocompromised

Associated with dysregulation of the sonic hedgehog or PTCH pathway (30%-40%)

Pink pearly papules with prominent arborizing with vessels

Question 6

Melanocytic nevi

Answer 6

Melanocytes are normally seen in epidermis
increase with sun exposure (acquired nevi)
Also present at birth (congenital nevi)
Histologically melanocytic nevi may be: Junctional (epidermis only), Compound (epidermis and dermis), Intradermal (in dermis only)

Question 7

Acquired Melanocytic Nevus

Answer 7

Pink tan or brown uniformly pigmented papules and macules

Small (usually

Question 8

Dysplastic nevi

Answer 8

Clinically and histologically distinctive
Dysplastic nevi can occur sporadically or in a familial form

Patients with multiple dysplastic nevi have increased risk of melanoma

Larger than acquired nevi, irregular in shape and uneven in color

increased incidence of melanoma

Familial variant is inherited as Autosomal dominant (mutations in CDKN2A gene 9 p 21 11 in 40% of cases

Patients develop other malignancies (mainly pancreatic cancer)

Question 9

Sporadic vs Familial dysplastic nevus syndrome

Answer 9

Sporadic: lower number of dysplastic nevi (usually 2-10), lifetime risk of melanoma in the sporadic form is approximately 10%

Familial: hundreds of dysplastic nevi, lifetime risk of melanoma approaches 100%

Histology of both looks the same

Question 10

Histology of dysplastic nevi

Answer 10

Lentiginous hyperplasia, irregular nests, bridging or rete ridges, cytologic atypia, lamellar fibroplasia, inflammatory response

Question 11

Melanoma

Answer 11

Represents 3% of all cutaneous malignancies
6th most common cancer in US
More common in whites
affects men and women equally
Typically in adulthood
Most common on back in men and on legs in women

Multifactorial disease, UV exposure at early age, fair complexion and older age, dysplastic nevus syndrome, history of melanoma in family, tanning bed use, xeroderma pigmentosum

ABCDE

Question 12

Melanoma growth phases

Answer 12

Important to recognize melanoma in early phase

Early/superficial melanomas are cured surgically

radial growth phase: melanocytes will proliferate within the epidermis will proliferate within the epidermis (in situ) , no metastatic potential at this stage

Vertical growth phase: dermal invasion and potential for metastasis

the extent of vertical growth phase determines the biologic behavior of melanomas, depth of invasion (Breslow thickness) the most important prognostic indicator

Tumors less than 1 mm in thickness rarely metastasize and greater than 1.7 mm have greater potential to develop metastatic disease

Question 13

Indicators of metastatic potential of melanoma

Answer 13

Ulceration, mitotic rate, angioinvasion

Metastases involve not only regional lymph nodes but also liver, lungs, brain, and virtually any other site

Sentinel lymph node biopsy (1st draining node of a promary melanoma), considered on depth of lesion

Question 14

Types of melanoma

Answer 14

Superficial spreading type: most common type (70%), located on back and extremities

Nodular type: NO radial growth phase, poor prognosis

Lentigo maligna type: most commonly located on head and neck (sun exposed)

Acral lentiginous type: located on the palm, sole or beneath nail, most common type in Af Am

Question 15

Mycosis fungoides

Answer 15

Cutaneous lymphoma
Most common cutaneous lymphoma, occurs in late adulthood with a male predominance

Usually presents as red or pink scaly patches

Stages of patch, plaque and nodules

Usually chronic course although may become aggressive

Question 16

Sezary syndrome

Answer 16

blood involvement of T cell lymphoma
Erythroderma skin is diffusely red and scaly
Poor prognosis
Survival 1-3 years