Path: Skin: One

Question 1

what is the Benign epithelial tumor?

Answer 1

seborrheic keratosis

Question 2

What is chc histo of seborrheic keratosis

Answer 2

“Horn Cysts” = epidermal invaginations filled with keratin

Question 3

What is gross appearance of seborrheic keratosis

Answer 3

waxy, “stuck on” appearance

Question 4

What sign is assc with seborrheic keratosis and what is it?

Answer 4

Leser-Trelat sign: Large explosion of multiple seborrheic keratosis

Question 5

What causes leser trelat?

Answer 5

transforming GFα (produced by tumor cells)

Question 6

What does appearance of Sign of Leser-Trelat signify

Answer 6

underlying carcinoma of GI tract

Question 7

define acanthosis nigricans

Answer 7

reactive hyperplasia in response to growth factors

Question 8

how does acanthosis nigricans present

Answer 8

Velvety thickened, dark skin most commonly in flexural areas

Question 9

What 2 conditions is acanthosis nigricans assc with

Answer 9

□ Obesity and endocrine abnormalities (DM)

Gastric carcinoma

Question 10

what causes Actinic keratosis

Answer 10

sun exposure

Question 11

What does actinic keratosis progres to

Answer 11

SqCC

Question 12

3 findings on histo of actinic keratosis

Answer 12

parakeratosis
□ Dysplasia of lower epidermis
Solar elastosis

Question 13

what is 1st and 2nd MC skin cancers

Answer 13

1. Basal cell CA

2. SqCC

Question 14

WHat 3 things cause SqCC and what is MC

Answer 14

MC = sun exposure
arsenic
immunosuppression

Question 15

what genetic condition predisposes to SqCC

Answer 15

xeroderma pigmentosum

Question 16

gross SqCC

Answer 16

red/flesh colored

ulcerative

Question 17

Histo of SqCC (4)

Answer 17

dysplasia of entire dermis
extension of tumor into dermis
squamous “pearls”
solar elastosis

Question 18

Metastasis difference between SqCC and BCC

Answer 18

Sq - may mets

BCCrarely mets

Question 19

risk for BCC (2)

Answer 19

chronic sunlight exposure

Nevoid Basal Cell CA Syndrome (NBCCS)

Question 20

Gross BCC (3)

Answer 20

pink, pearly nodules
telangiectasia
central ulceration (rodent chewed)

Question 21

Histo BCC

Answer 21

Retraction artifact - pulls away from dermis

Peripheral pallisading- cells line up like a fence

Question 22

What is Nevoid Basal Cell CA Syndrome (NBCCS), and age it occurs

Answer 22

mutiple BCCs < 20yo

Question 23

What gene and what gene product are invloved in NCCBS

Answer 23

PTCH gene

SHH gene product = increase in “smoothened”

Question 24

Keratocacanthoma: variant of what CA,

Answer 24

SqCC

Question 25

Keratocacanthoma: gross

Answer 25

gross: cup shaped, keratin-filled plug

Question 26

Vitiligo may respond to what?

Answer 26

May respond to light therapy (PUVA)

Question 27

Define Lentigo, contrast with ephelis

Answer 27

Benign localized hyperplasia of melanocytes | vs. ephelis = freckle (increased melanin but not increased melanocytes)

Question 28

lentigo micro

Answer 28

melanocytic hyperplasia with Elongation of rete pegs

Question 29

define nevi (size too)

Answer 29

3 or more melanocytes in a nest < 5mm

Question 30

define Junctional nevus intradermal nevus compund nevus

Answer 30

Junctional nevus = growth within epidermis Intradermal nevus = melanoctyes only in dermis Compund nevus = melanocytes in epidermis and dermis

Question 31

histo features of nevi

Answer 31

no dermal mitotic figures | "maturation" nuclei get smaller with descent into dermis

Question 32

other than size, what is unique about congenital nevi

Answer 32

Slightly increased risk for melanoma

Question 33

with dysplastic nevi, what signifies increased risk of melanoma

Answer 33

increasing number of lesions

Question 34

MC and other risk factors for melanoma (5)

Answer 34

MC = sunlight | others: Dysplastic moles; genetic factors; congenital nevi; blistering sunburns; xeroderma pigmentosa

Question 35

clinical warning signs of melanoma (3)

Answer 35

enlarging or new mole as adult itching or painful mole ABCDE

Question 36

what does ABCDE stand for

Answer 36

``` ® Assymmetry ® Border ® Color ® Diameter Evolution ```

Question 37

Contrast radial growth phase with vertical growth phase in melanoma

Answer 37

radial = in-situ; horizontal growth in epidermis and superficial dermis vertical = significant invasion into dermis, mets potential

Question 38

what is best prognostic indicator of metastasis risk in melanoma

Answer 38

Breslow thickness = depth of dermal invasion ()

Question 39

how is breslow measured

Answer 39

Measured from granulosa cell layer to deepest melanoma cell

Question 40

what Breslow depth warrants sentinel node procedure

Answer 40

> 1mm

Question 41

histo of melanoma (3)

Answer 41

abscence of maturation (nuclei same size as depth increases) | single cell breakaways

Question 42

4 types of melanoma (MC?)

Answer 42

MC = superficial spreading, good px lentigo maligna = radial (horizontal growth) = good px nodular = vertical = bad px acral lentiginous = palms/soles/dark skinned/ not uV related

Question 43

favorable px indicators Breslow depth less than?

Answer 43

Breslow depth less than 1.7 mm

Question 44

favorable px indicator: M or F

Answer 44

female

Question 45

favorable px indicator: extremity or ttruncal lesion

Answer 45

extremity is better

Question 46

What 2 mutations is assc with melanoma (activating/deletion?)

Answer 46

activation of BRAF (a typrisne kinase) | deletion of p16INK4A

Question 47

BRAF is part of what kinase pathway (3)

Answer 47

RAS/RAF/MAP

Question 48

what 3 things are in patho report for melanoma

Answer 48

1) Breslow depth 2) Presence/absence of ulceration Mitotic index

Question 49

What cell and type of tumor is mycoses fungioides

Answer 49

cutaneous T cell lymphoma

Question 50

What does early mycoses fungioides mimic and what is it's progression

Answer 50

mimcs eczema --> patch (flat, bigger than macule) --> plaque (elevated, solid > 1cm) --> nodule

Question 51

Histo of mycosis fungioides (cutaneous T cell lymphoma) (2)

Answer 51

1. Epidermotropism: lymphocytes in dermis and epidermis (without spongiosis) 2. Sezary cell- cerebriform contours to nuclei

Question 52

WHat is Sezary Syndrome (aka)

Answer 52

Seeding of blood by malignant lymphocytes in mycosis fungiooides aka: erythrodermic stage

Question 53

CP of Sezary Syndrome

Answer 53

all skin is itchy and red

Question 54

what is mycoses fungiodes essentially a disease of?

Answer 54

CD4+ clonal subset of T cells