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Flashcards in Dermatopathology 1 Deck (110):
1

Name a hypopigmentation disorder

Vitiligo

2

define: Vitiligo

complete loss of epidermal melanocytes

3

what autoimmune diseases is Vitiligo associated with

pernicious anemia
Hashimoto's thyroiditis

4

Vitiligo has an antibody against what

melanin-concentrating hormone receptor 1 in serum

5

during what decades does Vitiligo occur

2nd
3rd

6

what race has has higher incidence of Vitiligo

African American

7

where does Vitiligo usually occur

acral areas
orifaces

8

Along with skin, what can also loose pigmentation

hair

9

if repigmentation occurs with Vitiligo where does it usually occur

around hair follicle
looks like freckle

10

what is Ephelis

freckle

11

in what layers skin does Ephelis occur and what happens there

basal layer hyperpigmentation

12

Is there risk of malignancy with Ephelis

no

13

What does Lentigo look like

small circumscribed brown macular lesions

14

Where in the skin does Lentigo have a problem

hyperpigmentation of cells just above the basement membrane

15

what is the difference between Ephelides and Lentigo

lentigines does not darken with sun exposure

16

what is a more common name for Lentigo

"liver or age spots"

17

what does the histology pic for Lentigo

Rete ridges

18

name 5 features for Melanocytic nevi
-color?
- size?

- tan to brown
-uniformly pigmented
-small
-flat to elevated
-well-defined, rounded borders

19

what are some histological features for Melanocytic nevi

- dermal-epidermal junction
- no deep mitosis
-melanocytes mature as they descend in dermis
- no deep pigment in melanocytic nests

20

what are the 3 steps in melanocytic nevi progression of maturation

junctional
compound
intradermal

21

what is happening in Junctional for Melanocytic Nevus

Melanocytic nests @ dermal-epidermal junction
- nests at tips and sides of rete

22

what is happening in compound for Melanocytic Nevus?
- clinical?
-histological?

- more Raised and Domed shaped than Junctional
- dermal-epidermal nevus cell nests and nests and cords of nevus cell in underlying dermis
- invasion of dermis--> mature and get smaller

23

what is happening in Intradermal ( dermal) for Melanocytic Nevus?

epidermal nests are lost completely

24

name two kinds of Melanocytic Nevi

Spitz nevus
Dysplastic melanocytic nevus

25

Spitz nevus have what type of cells and contain what else

spindle and/or epithelioid cells
Kamino bodies

26

what are Kamino bodies

dyskeratotic melanocytes : eosinophilic bodies along dermal-epidermal junction

27

who usually gets Spitz Nevus

children

28

what does Spitz Nevus look like

deep red color
symmetrical

29

in Spitz Nevus what separates nests of melanocytes within the epidermis

epidermis by clefts

30

Clinically what does Dysplastic (atypical) melanocytic nevus look like?
-pigment?
- shape?

large, oval, many
irregular pigment
fried-egg appearance
central papule, surrounding macule

31

histology what does Dysplastic ( atypical) melanocytic nevus look like

- nest horizontally orientated
-bridge retes
-hyperchormatic
- enlarged nuclei

32

Define melanoma

malignancy of pigment-producing cells

33

melanocytes are derived from what

nerual crests

34

what is the number one cause of skin cancer deaths worldwide

Melanoma

35

what are 5 subtypes of Meloma

1. superficial spreading
2. lentigo maligna
3. nodular
4. acral
5. amelanotic

36

what are the growth phases of meloma

radial and vertical

37

what determines tumor stage of meloma

vertical phase

38

Melanoma is third most common metastatic tumor where

brain after lung and breast cancer

39

what is the number risk factor for Meloma

changing mole

40

what familial disease is a risk factor for Melanoma

- Xeroderma pigmentosum
-familial dysplastic nevus syndrome

41

what pneumoic do you use for melanoma

ABCDE
asymmetry
border irregularity
color variation
diameter > 6mm
evolving

42

If a patient has Melanoma what should you not do them on their body

avoid shaving, scissors excision or curettage

43

For melanoma where is radial growth phase and characterize the tumor cells

- horizontal spread of melanoma cells within epidermis and superficial dermis
- tumor cells lack ability to metastatsize

44

Superficial spreading Melanoma:
why does it occur
talk about growth phases
clinical presentation

sun-exposed skin
- radial growth phase of uncertain length before vertical growth phase develops
- multiple colors

45

histologic features of Superficial spreading malignant melanoma

- fails to mature top to bottom
- deep mitosis may be present
-not symmetrical

46

Lentigo Maligna: who usually gets its

face of old men

47

Lentigo Maligna:
describe radial growth phase
color

- long 10-50 years
- starts brown gets darker

48

intraepidermal lesions evolve to become clinically palpable and turn into

lentigo maligna melanoma

49

what is the difference between lentigo maligna and lentigo maligna melanoma

lentigo maligna has a vertical growth phase

50

where in the skin does lentigo maligna occur

poorly nested melanocytes at dermal-epidermal jucntion

51

Acral lentiginous melanoma
- occurs in who
- where on the body

African Americans
Asians
- palms, soles, beneath nail plate (hutchinsons sign)

52

What is the most common and least common type of Melanoma

most: superficial spread
least: acral

53

Nodular melanoma
- color
- location
- growth phases

-amelanotic
- anywhere on body
- vertical yes, no radial growth phase
-mitosis

54

what are two ways to report tumor thickness

Breslow
Clark level

55

Breslow

measurement from skin surface

56

Clark level

not based on measurement, but on number of layers of skin that tumor has penetrated

57

which method of tumor thickness most closely correlates with survival statistics

Breslow's

58

If a tumor is
in situ
4 mm

.5 cm
1cm
1-2cm
2cm
at least 2cm

59

Sentinel node biopsy

surgical procedure used to determine if cancer has spread beyond a primary tumor into your lymphatic system.

60

what instruments are used for sentinel node biopsy

lymphoscintigraphy
radioactive tracer
gamma probe

61

what is the number one prognostic factor for Melanoma

tumor thickness

62

what gender has a better prognosis for Melanoma

females

63

there are 5 stages of melanoma: what happens to the 5 year survival rate as you progress through the stages

decreases

64

In sentinel node biopsy, if metastatic disease is present what procedures are done

Full lymph node dissection
And interferon alpha

65

what is the most common benign tumor in older individuals

Seborrheic keratosis

66

clinically what does Seborrheic keratosis look like

light brown, flat macules
- velvety/waxy to rough ( verrucous) surface
- crumble with scraping

67

what is Leser-Trelat sign

multiple eruptive seborrheic keratoses with internal malignancy

68

name a subtype of seborrheic keratosis

dermatosis papulosa nigra

69

what does dermatosis papulosa nigra look like and who gets it

brown to black, smooth, dome-shaped papules
African Americans

70

key histological features for seborrheic keratosis

- keratin production at surface
- horn cysts ( keratin-filled)
-"shreaded-wheat" or " onion skin"

71

where is Acanthosis nigricans found

folds of neck, axilla, and groin

72

the Benign acanthosis nigricans occurs in who and is associated with what

- childhood/puberty
- endocrine abnormalities

73

Malignant Acanthosis Nigricans occurs in who and associated with what

middle-aged and older
visceral malignancy

74

what happens in the skin for Acanthosis Nigricans

-hyperpigmentation at first sign
-hyperplasia of stratum spinosum
- makes skin think and velvety

75

histologically what does Epidermal (inclusion) cyst look like

cyst wall resembles normal epidermis, filled with strands of keratin

76

what is the earliest identifiable lesion that can develop into squamous cell carcinoma

Actinic keratosis

77

what are risk factors for actinic keratosis

years of sun exposure
fair skin
immunosuppression

78

what key for early diagnosis for actinic keratosis? what can you find

palpitation
" gritty skine"
"broken glass"
- poorly demarcated, slightly erythematous papule or plaque

79

histologically for actinic keratosis what is found in each of the layers

stratum corneum: parakeratosis (retained nucleus)
basal cell layer: hyperplasia
Superficial dermis: solar elastosis

80

how does one distinguish between actinic keratosis and melanoma

biopsy

81

what is the most common cancer in the US

nonmelanoma skin cancer (NMSC)

82

what are two types of nonmelanoma skin cancers

basal cell carcinoma
squamous cell carcinoma

83

Squamous cell carcinoma arises in what layer of the skin

epithelium

84

who is more likely to get squamous cell carcinoma

middle-aged
elderly population

85

what is the most important risk factor for squamous cell carcinoma

DNA damaged induced by UVB (1) and UVA (2)

86

clinically what does squamous cell carcinoma look like

scaly pink patch or thin keratotic papule

87

what is a subtype of SCC
what does it look like
- where can it arise of skin

Bowen disease
- sharply demarcated pink plaque
-can arise from non-sun-exposed skin

88

Bowen's disease of glans penis, which manifests as one or more velvety red plaques

Erythroplasia or Queyrat

89

Bowen vs. squamous cell carcinoma: basement memebrane

Bowen: no invasion
SCC: invades

90

Bowen nucleus

atypical
-involve ALL levels of epidermis

91

what does invasive SCC look like

raised, firm, pink-to-flesh colored keratotic papule or plaque arising on sun-exposed skin

92

what must be done if you want a definitive diagnosis of NMSC

biopsy,
- must reach mid dermis

93

if regional lymphadenopathy is present, how does diagnose SCC

lymph node biopsy and FNA ( fine needle aspiration)

94

how does one treat SCC

- mohs micrographic surgery

95

what is keratocanthoma

benign epithelial tumor might progress into SCC

96

clinically describe Keratocanthoma

red to flesh colored dome-shaped papule with a central crater filled with keratinous plug

97

what is the most common malignancy

basal cell carcinoma

98

where in the skin does BCC occur

pluripotential cells in basal layer of epidermis or follicular structures

99

what is the most important risk factor for BCC

UV radiation

100

how does BCC present clinically

non-healing lesions that bleeds

101

Nodular BCC presentation
common site?

Telangiectasias
face most common location
translucency

102

most common site for superficial BCC

trunk
-light red color
-atrophic center with fine translucent micropapules

103

talk about the nests of BCC for histology

basaloids cells and palisade at border of nest
- nests in fibromyxoid stroma

104

what does Keratoacanthoma look like in histology

large, red, glassy, squamoid cells
- neutrophil microabscesses
- eosinophils and lymphocytes

105

histo: what separates the tumor nodules for basal cell carcinoma

stroma

106

how often does metastases occur in basel cell carcinoma

rare

107

Mohs surgery is the removal of what

tumor and a thin rim of normal-appearing skin around defect

108

for Mohs surgery what is the frozen-section technique allows for what?

examination of tissue while patient is in office

109

Which nonmelanoma skin cancer metastasizes to the lymph nodes

squamous cell carcinoma

110

what nonmelanoma skin cancer is the most common

basal cell carcinoma