The Skin & Its Lesions Flashcards by Iseoluwa Ojo

Parts of the skin
• Keratinocytes secrete (soluble or insoluble?) molecules such as _______ and _______ that regulate _______ immune responses

soluble ; cytokines

defensins ; cutaneous

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Parts of the skin

Melanocytes within the ________ are responsible for the production of ________, a ________ pigment that absorbs and protects against potentially ________ ____________ radiation in ________.

epidermis; melanin

brown; injurious

ultraviolet (UV) radiation

sunlight.

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Parts of the skin

Dendritic cells:
– one of the first lines of defense against micro-organisms
– Secrete factors that _______ innate immune system
– function as _________________cell

augment

an antigen presenting cell

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Parts of the skin

• ________cytes
• _______ cells
• Skin __________

• Lymphocytes
• Merkel cells
• Skin adnexae

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Categories of skin lesions
• Inflammatory
– Acute
– Chronic
• __________
• _________
• __________
• ______________

Infectious
Non-infectious
Blistering
Non-blistering

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Categories of skin lesions

• Neoplastic
– ___________
– ________
– ___________

– Benign
– Premalignant
– Malignant

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Categories of skin lesions

Disordersof pigmentation
– ________ ________
– ________ ________
– ________/________ noma

– Benign nevus
– Dysplastic nevus
– Melanoma/Melanocarci noma

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Categories of skin lesions

List 3

Inflammatory
Neoplastic
Disordersof pigmentation

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______ is the Largest organ in the body

Skin

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First line of defense against infections and physical agents is???

Skin

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Skin

Endocrine functions of synthesizing ________ under sun exposure

vitamin D

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Classification of malignant skin tumours
• Tumors of ___________

• Tumors of ___________

• Tumors of keratinocytes

• Tumors of melanocytes

• Tumors of Merkel cells

• Tumors of Langerhans cells

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Classification of malignant skin tumors

• Tumors of keratinocytes –___________,_________

• Tumors of melanocytes –_______________

• Tumors of Merkel cells –____________

• Tumors of Langerhans cells –________________

Squamous cell carcinoma – Basal cell carcinoma

Malignant melanoma

Merkel cell carcinoma

Langerhans cell histiocytosis

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Epidemiology of skin cancers
• Melanoma and nonmelanoma skin cancer (NMSC)
– most common types of cancer in (white or black?) populations.
– _____easing incidence rate worldwide
– ______/_________ mortality rate

white

increasing

Stable/decreasing

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Most rapidly increasing cancer in white
populations is??

Melanoma

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Most common skin cancer in Nigeria is ???

Melanoma

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Melanoma

•___-fold increase in incidence rates over last ____ decades

• More in (males or females?) than (males or females?)

More in males than females

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Melanoma

• ________ if detected and treated at it’s earliest stage
• Mainly arises from the _____ and are found in the ____ exposed areas

Curable

skin

sun

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Most deadly of all skin cancers is??

Melanoma

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Melanoma: Other Sites of Origin

• ______ and ________ mucosal surfaces
• __________
• ________
• _____ of the eye

Oral and anogenital

Oesophagus

Meninges

Uvea

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Melanoma: Risk factor
• Mostly ________
• Related to ________ predisposing environmental factor- ________________________________________

sporadic

a single ; Ultraviolet Radiation (UVR) damage from sun exposure.

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UVR is strongly linked with DNA damage

T/F

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Only ______ to ______ % of melanomas are inherited

Study These Flashcards

10- 15

Pathogenesis of melanoma

Mutations Disrupting Cell Cycle Control Genes

• A ______________________ gene CDKN2A encodes ____/____, _____/—— and _____/____

• Loss of ______ - clearly implicated in human melanoma.

Study These Flashcards

cyclin dependent kinase inhibitor gene

p15/INK4b ; p16/INK4 ; p14/ARF.

p16

Pathogenesis of melanoma • p16 - inhibits _______ and ——— • p14 - enhances _____ by inhibiting _______

CDK4 and CDK6 p53 MDM2

MDM2 an oncoprotein that ________ the __________ of ______

stimulates degradation p53

Mutations Disrupting Cell Cycle Control Genes • Any of these ____,____,_____ ,_____,______ genes can be mutated in melanoma • The net effect is the same: – increased ___________________ – due to loss of ____________ and escape from oncogenic induced cellular __________

p16, p14, CDK4, CDK6, p53 melanocytic proliferation cell cycle control senescence

Pathogenesis of melanoma Mutations Activating Pro-growth Signaling Pathways • Mutations in _______ and _______ – Aberrant increases in ________ and _________ signaling which promote cell growth and survival. – Additionally, there can be mutation in the _____stream arm of ____ which include _________

NRAS and BRAF RAS and PI3K/AKT down; RAS BRAF

Pathogenesis of melanoma Mutations That Activate Telomerase • The ______ gene is commonly mutated • Associated with increased ______ mRNA expression • this gene encodes the ______ unit of ______ • Reactivation of ______ enzyme activity ______ ______ and protects cells from ______

TERT ;TERT catalytic; telomerase telomerase preserves telomeres; senescence

Clinical features: ABCDE of melanoma • ————— • Irregular ________ • Variegated _______ • Increasing ________ • __________ or change over time especially if rapid

• Asymmetry • Irregular borders • Variegated colour • Increasing diameter • Evolution

Assumetry of melanoma One half ______________

does not match the other

Irregular borders of melanoma • The edges are ________,________, or _________

ragged, notched, or blurred

Colour of melanoma • The pigmentation is ___________ • Shades of tan, brown, or black are present.

not uniform.

Diameter of a melanoma • Diameter greater than _______ should raise concern • Any sudden or continuing ___________ should also be of special concern

6mm increase in size

Melanoma: Prognostic factors • Tumour _______ • Number of _______ • Evidence of _______ _______ • _______ of the overlying skin • Presence of tumour infiltrating _______ • Gender (_______ >———-) • Microscopic involvement of the _______ lymph node • High stage (TNM)

depth ; mitoses tumour regression Ulceration; infiltrating (M >F) sentinel

Squamous cell carcinoma (SCC) • Commonly affects (men or women?) > _____ years • Less than ____% of these tumors metastasize to regional nodes; • These lesions are generally deeply _______ and involve the _________.

men > 60 years 5% invasive ;subcutis.

Most common skin malignancy seen in LUTH is ??

Squamous cell carcinoma (SCC)

Squamous cell carcinoma: Risk factors • _______ damage induced by __________ • Immunosupression, increasing susceptibility to oncogenic virus HPV 5 and 8 • Industrial carcinogen (__________) • Chronic __________ • __________ __________

DNA ; UV light tars; ulcers xeroderma pigmentosum

Squamous cell carcinoma: Risk factors • Draining ____________ • _________________ • Ingestion of ____________ • Ionizing radiation • ____________ and ____________ chewing • ____________ ____________ • ____________

osteomyelitis Old burn scars arsenicals; Tobacco ; betel nut Actinic keratosis; Albinism

Squamous cell carcinoma: Pathogenesis • Most studies on the genetics of squamous cell carcinoma have focused on acquired defects in ______ tumors and their precursors (________ ______), and the relationships between these defects and ___________

sporadic tumors actinic keratoses sun-exposure

Squamous cell carcinoma: Pathogenesis • The incidence of _____ mutations in _______ ________ found in Caucasians is high, suggesting that _____ dysfunction is an (early or late?) event in the development of tumors induced by __________.

TP53 ; actinic keratoses p53 ;early sunlight.

Squamous cell carcinoma: Pathogenesis DNA damage by UV light is sensed by __________ such as ______ and ______ which send out signals that upregulate the expression and stability of ______

check point kinases ATM and ATR p53

Squamous cell carcinoma: Pathogenesis • P53 in turn arrests cells at the ____ phase and either the DNA is ______ at this point or there is ________ of the cells that are beyond repair • When these protective function, DNA damage leads to rapid _______ of mutations and eventual _________

G1 phase ; repaired apoptosis; accumulation carcinogenesis

Common sites of squamous cell carcinoma List 4

• Face • Ears • Scalp • Dorsal hands

Squamous cell carcinoma: Clinical features • May present as ______ or _________ • Thin SCC ((superficially or deep?) _______) may clinically simulate in situ _________ or _______ • Thicker tumors typically present as __________,_________,________

thin plaque ; erythematous scaly papule superficially invasive carcinoma ; actinic keratosis erythematous plaque, nodule, ulcer

Grading of SCC • _______ differentiated • ______ differentiated • ______ differentiated • ___ differentiated

• Well differentiated • Moderately differentiated • Poorly differentiated • Undifferentiated

Treatment of SCC •___________ with adequate margins • ______,________,______ therapy

Surgical excision curettage, electrodessication, cryotherapy, radiation

Basal cell carcinoma • Patients with ________ _________, who have a diminished capability for _____________________________ , develop a large number of _________________________ early in life

xeroderma pigmentosum, repairing sun induced mutations basal cell and squamous cell carcinomas (SCCs)

____________ is the most common nonmelanoma malignancy of skin in Caucasians , constitutes about _______% of NMSC

Basal cell carcinoma 75-90

Basal cell carcinoma: Epidemiology • Occurs in ______ races, but much more often in _____ skinned people • Usually in patients >___ years of age • Male: Female ___:____

all ;fair 40 1.6:1

Basal cell carcinoma: risk factors • Associated with ________ exposure (particularly ____________ exposure) • History of _______ treatment • Associated with various syndromes: ___________ syndrome;________ syndrome; __________ __________

UV light ; intermittent intense radiation basal cell nevus syndrome Bazex syndrome; xeroderma pigmentosum

Basal cell carcinoma: clinical features • ____________ , ________ , nodule or plaque, which is often _________, ______ or _________ • ________ BCC may mimic a _________ neoplasm • Metastases are exceedingly (common or rare?) (preferred sites: ____________, _______, ______)

erythematous patch; papule, eroded ; ulcerated ; indurated Pigmented ;melanocytic rare ; lymph nodes lung ; bones

Sites of basal cell carcinoma • Mainly __________ skin, in any ________ area (e.g head and neck) • Also at sites with ________ or _______ exposure

sun exposed ; hair bearing limited ; no sun exposure

Treatment of basal cell carcinoma • Surgical: __________ , standard __________, __________ surgery, __________ with or without __________, __________ • Medical: topical __________, __________ • __________

saucerization full thickness excision Mohs micrographic surgery curettage with or without electrodesiccation cryosurgery 5-fluorouracil; imiquimod Radiation

Examples of malignant skin adnexal tumours Sweat glands -____________ carcionoma -___________ carcinoma -__________ carcinoma -_______________________ carcinoma Sebaceous glands -_________ carcinoma

-adenoid cystic carcionoma -myoepithelial carcinoma -mucinous carcinoma -microcystic adnexal carcinoma -sebaceous carcinoma

The Skin & Its Lesions Flashcards

(55 cards)