Neoplasms Of The Skin - HIPON

Question 1

Which cell type is arranged across all five layers of the epidermis?

Answer 1

The keratinocytes.

Question 2

Name the five layers of the epidermis.

Answer 2

1. Stratum basale
2. Stratum spinosum
3. Stratum granulosum
4. Stratum lucidum
5. Stratum corneum

Question 3

Describe briefly the stratum basale of the epidermis.

Answer 3

1. Single layer of cuboidal to columnar cells that stand on the basement membrane.
2. Region of cell division.
3. Also contains melanocytes + Merkel cells.

Question 4

Describe briefly the stratum spinosum of the epidermis.

Answer 4

1. Many layers of polyhedral prickle cells bearing intercellular brigdes (keratinocytes).
2. Mitotic activity is present.
3. Also contains Langerhans cells and processes of melanocytes.

Question 5

Describe briefly the stratum granulosum of the epidermis.

Answer 5

1. Somewhat flattened cells containing keratohyalin granules.
2. Absent as a distinct layer in the thin skin.

Question 6

Describe briefly the stratum lucidum of the epidermis.

Answer 6

1. Thin, translucent layer with cells containing eleidin.

2. Absent from thin skin.

Question 7

Describe briefly the stratum corneum of the epidermis.

Answer 7

1. Squames packed with keratin.

2. Superficial squames are desquamated.

Question 8

Give a brief description of the dermis.

Answer 8

Dense, irregular, collagenous connective tissue subdivided into two layer:

1. Papillary
2. Reticular

Question 9

Give a basic description of the papillary layer of the dermis.

Answer 9

1. Dermal ridges (papillae) and secondary dermal ridges interdigitate with the epidermal ridges (+ interpapillary pegs) of the epidermis.
2. Collagen fibers are slender.
3. Capillary loops + Meissner’s corpuscles are found between the dermal ridges.

Question 10

Give a basic description of the reticular layer of the dermis.1

Answer 10

1. Composed of coarsed bundles of collagen fibers.

2. This layer supports a vascular plexus and interdigitates with the underlying hypodermis.

Question 11

What may be present in the reticular layer of the dermis?

Answer 11

Frequently:

1. Hair follicles
2. Sebaceous glands
3. Sweat glands
4. Krause’s end bulbs
5. Pacinian corpuscles

Question 12

What is the most common neoplasm in terms of sheer numbers?

Answer 12

Tumors of the skin.

Question 13

What is the most common warning sign of skin cancer?

Answer 13

Change in the appearance of the skin, such as a new growth or a sore that will not heal.

Question 14

What is the main cause of skin cancer?

Answer 14

UV light

Question 15

Besides UV light, mention some other factors that play a role in the development of skin cancer.

Answer 15

1. Smoking tobacco
2. HPV
3. Aging
4. Light skin color
5. Artificial UV radiation
6. Immunosuppressive drugs

Question 16

What lesion may occur in areas of skin exposed to sunlight over a long period of time?

Answer 16

Actinic (solar) keratosis - with aberrant differentiation of the epidermal cells.

Question 17

What is the origin of basal cell carcinoma of the skin?

Answer 17

It originates from the lowest layer of the epidermis - most common + least dangerous skin cancer.

Question 18

What is the origin of squamous cell carcinoma of the skin?

Answer 18

It originates from the middle layer - less common, but more likely to spread and to be fatal.

Question 19

What are the 2 forms of skin cancer that are collectively known as non-melanoma skin cancer?

Answer 19

1. Basal cell carcinoma

2. Squamous cell carcinoma

Question 20

What is the origin of melanoma?

Answer 20

It originated in the pigment-producing cells (melanocytes) - least common, but most aggressive, most likely to spread. Fatal if untreated.

Question 21

Where does SCC of the skin commonly arise?

Answer 21

Chronically sun exposed areas:

1. Backs
2. Hands
3. Lips
4. Ears

Question 22

What is the precancerous condition of SCC of the skin?

Answer 22

Actinic (solar) keratosis

Question 23

What is the morphology of SCC of the skin?

Answer 23

Red, scaling, thickened patch on sun-exposed skin.

Question 24

When does SCC of the skin have a low potential for metastasis?

Answer 24

When it arises on sun-damaged skin.

Question 25

What is the most common location of basal cell lesions?

Answer 25

The face

Question 26

Mention some not sun-exposed areas, in which a basal cell carcinoma can occur?

Answer 26

1. Chest 2. Back 3. Arms 4. Legs 5. Scalp

Question 27

What is the gross morphology of a basal cell carcinoma?

Answer 27

1. Begins as a small, dome-shaped bump. 2. Often covered by small, superficial blood vessels --> Telangiectases. 3. Texture is often shiny and translucent - sometimes referred to as "pearly".

Question 28

What types of adnexal neoplasms of the skin may occur?

Answer 28

Neoplasms that involve: 1. Hair follicles 2. Sweat glands/Ducts 3. Sebaceous glands

Question 29

What is a keratoacanthoma?

Answer 29

Neoplastic proliferation of the infundibular portion of the hair follicle.

Question 30

With what can keratoacanthoma be confused both clinically and microscopically?

Answer 30

With SCC.

Question 31

What is the characteristic morphology of keratoacanthoma?

Answer 31

Dome-shaped lesion in which there is a central crater filled with keratin.

Question 32

What is the classic course of keratoacanthoma?

Answer 32

It arises from a previously normal portion of the skin, waxes rapidly over the next 4-6 weeks and then regresses over a further 4-6 weeks, leaving a depressed scar.

Question 33

Mention an aggressive tumor of the skin that derives from neuroendocrine cells.

Answer 33

Merkel cell tumor.

Question 34

What is the microscopic morphology of Merkel cell tumor?

Answer 34

Uniform proliferation of small, round, dark cells, this being responsible for the not infrequent misdiagnosis of cutaneous lymphoma.

Question 35

How do we classify the benign melanocytic tumors (nevi)?

Answer 35

According to the level within the skin where the melanocytic proliferation is predominant.

Question 36

What are the 3 most common variants of benign melanocytic tumors?

Answer 36

1. Junctional 2. Intradermal 3. Compound

Question 37

Mention some rare variants of benign melanocytic tumors.

Answer 37

1. Blue nevus 2. Spitz nevus 3. Pigmented spindle cell nevus of Reed

Question 38

What is estimated about the incidence of melanoma?

Answer 38

Over 1% of children born today will develop malignant melanoma.

Question 39

What is the prognosis of most melanomas and on what does it depend?

Answer 39

Excellent prognosis, if lesions are recognized and excised before entering a vertical growth phase.

Question 40

When is a patient with melanoma at risk of dying from metastatic disease?

Answer 40

If the tumor exceeds a critical depth in the dermis.

Question 41

Where do men most commonly develop melanoma?

Answer 41

On the trunk, particulalry at the back.

Question 42

Where do women most commonly develop melanoma?

Answer 42

Legs or arms.

Question 43

What is the usual color of a melanoma?

Answer 43

Various colors from shades of brown to black.

Question 44

What are the amelanotic melanomas?

Answer 44

A small amount of melanomas are pink, red, or fleshy in color.

Question 45

What is the prognosis of amelanotic melanomas?

Answer 45

They tend to be more aggressive.

Question 46

What are the main warning signs of melanoma?

Answer 46

A change in: 1. Size 2. Shape 3. Color 4. Elevation of the mole

Question 47

What are the main connective tissue tumors of the skin?

Answer 47

1. Fibrous histiocytoma 2. Dermatofibrosarcoma protuberans 3. Tumors/Tumor-like conditions arising from blood vessels

Question 48

What are the 4 cellular components of the epidermis?

Answer 48

1. Keratinocytes 2. Melanocytes 3. Langerhans cells 4. Merkel cells