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Flashcards in Skin Neoplasias - Plaza Deck (16)
1

Seborrheic Keratoses

What is the etiology?

Describe its appearance & distribution.

What is the signifiance of multiple SKs?

Seborrheic Keratoses

FGFR3 mutation. (very common)

A "stuck-on" warty appearance on sun-exposed skin of the elderly. Hyperkeratotic and papillomatous.

This is a Leser-Trelat sign, indicative of an underlying gastric carcinoma.

2

Actinic Keratosis

Describe their appearances grossly and microscopically.

How dangerous are they?

Actinic Keratosis

Erythematous yello/brown scaly lesions, with atypia of the stratum basale. Parakeratosis & Solar elastosis.

0-10% become malignant (watch for full-thickness atypia >> SCC).

3

Squamous Cell Carcinoma

What are the cause & predisposing factors?

How dangerous are they?

Squamous Cell Carcinoma

UVB damage, but also local damage, viral infection, immunosuppression. (Marjolin's Tumor = SCC due to burn or ulcer)

About 5% can metastasize. Normally does not bypass BMZ.

4

Squamous Cell Carcinoma

Describe its gross appearance.

Describe its microscopic appearance.

Squamous Cell Carcinoma

Sharply defined red scaly plaque; sometimes nodular or ulcerative (bad).

Full thickness atypia, contained to epithelium (in situ), unless invasive.

5

Keratoacanthoma

Describe its structure & appearance.

Describe its progression. Is treatment indicated?

How will this affect an immunocompromised patient?

Keratoacanthoma

Crater-shaped nodule filled with keratin. Well differentiated & with good pallor.

Radidly growing, and often rapidly resolving. But, can cause extensive local damage (treatment advocated).

If immunocompromised >> Multiple keratoacanthomae.

6

What is the most common cancer in humans?

Basal Cell Carcinoma

7

Basal Cell Carcinoma

Describe its etiology.

How dangerous are they?

Basal Cell Carcinoma

Dysregulation of Shh/PTCH pathway, secondary to sun exposure.

Not at all; only really metastasizes in the immunocompromised.

8

Basal Cell Carcinoma

Describe its gross appearance.

Describe its microscopic appearance.

Basal Cell Carcinoma

Pearly papule with prominent telangiectasias.

Expansion of epithelial cells from the stratum basale(?)

9

Melanocytic Nevi

Describe the 3 histologically distinct subsets.

Which subset is the most "mature"?

Melanocytic Nevi

Junctional, Compound, Intradermal.

Nevi tend to migrate deep to the epidermis; intradermal tend to be more mature.

10

Distinguish dysplastic nevi from acquired nevi. Focus on appearance, etiology, and outcomes.

Dysplastic nevi are present from birth, either as a familial or sporadic form. They are more numerous & irregular, larger, and provide a higher risk for melanoma than acquired nevi do.

11

Distinguish familial and sporadic dysplastic nevus syndromes.

Sporadic features fewer nevi with a smaller risk of melanoma (10%).

Familial results from AutDom mutation in CDKN2A; more nevi and higher risk (100%).

12

Melanoma

Describe its etiology.

Who is at highest risk?

What factors are important to its description?

Melanoma

Usually a result of sun damage (multifactorial), causing activation of BRAF in melanocytes.

Older, fair-skinned individuals, albinos, and those with dysplastic nevus syndome or excision repair defects (XP).

ABCDE (asym, borders, color, diameter, evolutions)

13

Melanoma

Describe the process by which it can proliferate and metastasize.

What is the Breslow thickness?

Melanoma

Initial radial growth phase occurs within epidermis (non-metastatic). Vertical growth phase extends into dermis (potentially metastatic).

Breslow thickness = depth of invasion. >1.7mm = higher risk for metastasis. >1.00mm = biopsy the sentinel lymphatics.

14

Melanoma

Describe the 4 mentioned subtypes.

Melanoma

Superficial spreading: Most common, in back/extremities. Low-risk.

Nodular: NO radial growth phase. Poor prognosis.

Lentigo Maligna: Involves the head & neck.

Acral Lentiginous: Palm/sole/nailbed of AfAm patients. No UV involvement?

15

Mycosis Fungoides

Describe its etiology.

Describe its progression.

Who is at highest risk?

Mycosis Fungoides

A T-cell lymphoma that invades the dermis & epidermis.

Patch > Plaque > Tumor stages. All may be copresent. Sometimes chronic.

Black men

16

Mycosis Fungoides

Describe its histology.

What is Sezary syndrome?

Mycosis Fungoides

Invasion of neoplastic T-cells with a "cerebriform nucleus". Epidermotropism (prefers epidermis) & Pautrier microabscesses.

A subset of MF which features T-cells in the peripheral blood. Denoted by erythroderma and a worse prognosis.