Ch 24: Neoplasms Continued

Question 1

An African-American middle aged woman comes into your office with an irregular brownish/blackish patch on part of her palm. You notice there is also some pigment changes under her thumb as well. You are pretty sure it’s cancerous…

What do you think she has?

Answer 1

Acral Lentiginous Melanoma

*most common form of melanoma in dark-skinned people; generally limited to palms, soles, subungual regions

Question 2

______ is unusually widespread compared to other neoplasms (virtually any organ involved) and may remain undetectable after successful excision for years, only to reappear years later…

Answer 2

Metastatic melanoma

Question 3

Staging and prognosis of melanoma is based on what attributes?

Answer 3

tumor thickness, ulceration, dermal mitotic rate, lymphocyte response, location, sex, regression, levels of invasion, lymphatic invasion, and stage

Question 4

Describe the measurement taken to determine the “Breslow Thickness” of a melanoma

Answer 4

The most superficial aspect of the stratum granulosum to the point of deepest penetration of the tumor into the dermis

*note: this is the STRONGEST prognostic indicator for melanomas confined to stage 1/2

Question 5

Determine if these properties about melanomas have better or worse survival rates:

1) Ulceration
2) Increased dermal mitotic rate
3) Presence of tumor-infiltrating lymphocytes (TILs)
4) Melanomas on extremities
5) Melanomas on sole of foot/subungual regions
6) Men with melanomas (compared to women)

Answer 5

1) worse survival rate
2) worse survival rate
3) better survival rate
4) better survival rate
5) worse survival rate
6) worse survival rate

Question 6

Considered the most important factor influencing patient survival; determined by biopsy of lymph nodes lying in the regional drainage pattern

Answer 6

Staging

Question 7

What does TNM stand for

Answer 7

T = primary tumor (thickness, mitogenicity, etc)
N = node (numbers of lymph nodes involved)
M = metastasis (distant; at various sites)

Question 8

What is a micrometastasis? Macrometastasis?

Answer 8

Micrometastases are nodal metastases diagnosed after sentinel/ ELECTIVE lymphandenectomy.

Macrometastases are detectable by THERAPEUTIC lymphadenectomy

Question 9

A 10 year old boy comes in to see you because his mother is concerned about a nodule on his neck. It appears elevated, spheroid, pink and smooth. You mention there is an uncertain prognosis, and exclaim “It’s just a MELTUMP.”

What are we dealing with here?

Answer 9

Spitz tumor (benign)

*common in adolescents; progression to melanoma rare (but more posible in adults).

MELTUMP = MElanocytic Tumor of Uncertain Malignant Potential

Question 10

A benign, dark blue/gray/or black firm, well demarcated papule or nodule

Answer 10

Blue Nevus

Question 11

What is an ephelides?

Answer 11

A freckle! (brown macule often on people w/fair, sun-exposed skin; pigment deepens w/light exposure)

Question 12

Discrete brown macule w/out dependence on sun exposure; sometimes called “liver spots”

Answer 12

Lentigo (“liver spots” = solar lentigo)

Question 13

Underlying cause of verrucae

Answer 13

HPV

Question 14

Elevated papules with papillomatous surface; common on dorsum of hands or face, with presence of kilobytes in upper epidermis

Answer 14

Verruca vulgaris (common wart) – cause: HPV types 2 and 4

Question 15

Benign but painful hyperkeratotic nodules on soles of feet

Answer 15

Plantar warts – cause: HPV type 1

Question 16

Name two types of warts associated with HPV that appear around the genitalia

Answer 16

1) Condyloma acuminatum (HPV types 6 and 11)

2) Bowenoid papulosis (HPV types 16 and 18)

Question 17

Most common type of keratoses, have a “pasted on” appearance composed of “horn cysts” (small cysts of keratin)…

And, why should you worry if a bunch of these appear suddenly?

Answer 17

Seborrheic keratosis.

Sudden appearance associated with internal malignancies like gastric adenocarcinoma

Question 18

Most common malignant tumor in persons with pale skin and freckles; usually due to sun-damage but can also occur on areas of skin not exposed to the sun

Answer 18

Basal Cell Carcinoma

Question 19

A 65 year old former surfing aficionado comes to you with several small pearly papules on his face that are laced with tiny little veins. Biopsy reveals deeply basophilic epithelial cells protruding into the papillary dermis. What’s the diagnosis?

Answer 19

Basal cell carcinoma

Question 20

A 45 year old caucasian woman who loves the outdoors presents to you with a scaly, ulcerated papule on the back of her hand that is very red. She says it’s also really itchy. Biopsy reveals atypical basal keratinocytes with a thickened epidermis. What’s the diagnosis?

Answer 20

Squamous cell carcinoma

Question 21

An aggressive, rare tumor composed of solid nests of undifferentiated cells resembling small cell carcinoma of the lung; may be due to a relatively common polyomavirus

Answer 21

Merkel Cell Carcinoma

due to Merkel cell polyoma virus in 80% of cases

Question 22

Describe Adnexal Tumors and list a few types

Answer 22

Adnexal tumors are small elevated skin nodules that often occur in people w/a familial history of similar tumors; commonly appear at puberty, typically benign.

Types: Cylindroma, Syringoma, Poroma, Trichoepithelioma

Question 23

How can you differentiate between a dermatofibroma and dermatofibrosarcoma protuberans (both fibrohistiocytic tumors with varied spectrum of differentiation)?

Answer 23

Positivity for CD34 is present in dermatofibrosarcoma protuberant and absent in dermatofibroma.

Question 24

A 68 year old male comes in presenting with a long history of erythematous, scaly patches around the buttocks. Biopsy reveals atypical lymphocytes expanding into the epidermis (epidermotropism) with large numbers of atypical lymphocytes displaying cerebriform nuclei. What is the diagnosis? And, what would you call this diagnosis if you knew it had spread systemically?

Answer 24

Mycosis Fungoides

Systemic spread of lymphocytes is called Sezary syndrome

Question 25

What are some skin diseases associated with HIV?

Answer 25

1) Kaposi Sarcoma (etiologic agent - HHV 8)
2) Bacillary Angiomatsosis (from infection w/Bartonella species)
3) Eosinophilic Folliculitis