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(J2) Skin > Tumors > Flashcards

Tumors Flashcards

(53 cards)

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1
Q

What is the most common pigmented lesion in lighter skinned individuals?

A

Ephils/freckles

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2
Q

What is the most deadly skin cancer?

A

melanoma

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3
Q

What is the most common malignant skin tumor?

A

basal cell carcinoma

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4
Q

What are ephils?

(appearance and histologic features)

A

Ephils = freckles

hyperpigmented macule, darkens with sun exposure

increased melanosomes** (normal melanocytes)

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5
Q

Where and in what populations are ephils most commonly seen?

A

lighter skin

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6
Q

What is lentigo?

(appearance and histologic features)

A

benign melanocyte hyperplasia

darkened macule/papules (do not change w/ sun exposure)

linear (lentiginous) spread of melanocytes above the basal layer

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7
Q

Where and in what populations is lentigo most commonly seen?

A

No preference for race, gender, or age

frequently begins in childhood and progresses throughout lifetime

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8
Q

What are nevi?

(appearance)

A

nevus = mole

benign melanocyte neoplasm

uniformly darkend macule/papule, well defined borders , typically <6mm (opposite of ABCDE of melanoma)

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9
Q

What are the histologic features/types of nevi?

A

Junctional nevi:

  • nest of cells along dermoepidermal junction in the epidermis
  • macule (flat) > papule
  • most common in children

Compound nevi:

  • growth of nests through junction into dermis
  • papule (raised) > macule

Intradermal nevi:

  • loss of epidermal component, only dermal now; nests -> cords
  • papule (raised) > macule
  • most common in adults

General progression:

junctional -> compound -> intradermal

Blue nevi:

  • black/blue; non-nested; dendritic; fibrosis
  • commonly mistaken as melanoma
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10
Q

What are dysplastic nevi?

(appearance and histologic features)

(significance of frequency)

A

potential precursor of melanoma

  • darkend macules; “pebbly” surface; darker, raised center with lighter irregular periphery
  • more in line with ABCDE of melanoma
  • coalesced nests
  • fibrosis of Rete ridges
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11
Q

How do nevi relate to melanoma?

What non-skin cancer are they also associated with?

A

Dysplastic nevi are less likely to develop into melanoma themselves (although they can) than they are indicative of an increased risk for development of melanoma

Dysplastic nevus syndrome

-autosomal dominant disorder

  • 2 or more atypical nevi -or- >100 typical nevi
  • associated with 50% incidence of melanoma by age 60
  • increased risk of pancreatic cancer
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12
Q

What is melanoma?

(appearance)

A

malignant melanocyte neoplasm

ABCDE:

  • Asymmetry
  • irregular Border
  • non-uniform Color
  • Diameter >6mm
  • Evolution

flat or nodular depending on subtype

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13
Q

What are the histologic features/types of melanoma?

(associated prognosis)

A

Lentigo maligna:

  • lentigious growth (radial growth limited to basal layer)
  • most common on face of older men
  • good prognosis, indolent

Superficial spreading:

-dominant early radial growth

-good prognosis

Acral lentiginous growth:

  • lentiginous growth (unrelated to sun exposure)
  • can affect mucous membranes, nail beds, palms, and soles
  • most common in dark skinned individuals

Nodular:

  • dominant early vertical growth
  • poor prognosis
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14
Q

Where are the different subtypes of melanoma most commonly seen?

A

Superficial spreading/nodular:

  • sun exposed areas
  • backs of men

-extremities of women

Lentigo maligna:

  • sun exposed areas
  • face of older men

Acral lentiginous:

  • independent of sun exposure
  • dark skinned populations
  • palms, soles, nailbeds, mucous membranes
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15
Q

What are the risk factors for developing melanoma?

A
  • UVB exposure (particulalry severe exposures in childhood rather than cumulative exposure)
  • fair skin
  • light colored eyes (green/blue)
  • dysplastic nevus syndrome (>100 typical or at least 2 atypical)
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16
Q

What is the most important prognostic factor of melanoma?

A

Breslow thickness:

  • depth from granular layer to deepest portion of tumor
  • thicker = worse
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17
Q

What is seborrheic keratosis?

(appearance and histologic features)

A

benign squamous proliferation

  • discolored, coin-like, waxy plaques
  • uniform color
  • spontaneously arise
  • keratin pseudocysts
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18
Q

Where and in what populations is seborrheic keratosis most commonly seen?

A

elderly

-trunk, extremities, head, neck

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19
Q

What is Leser-Trélat sign?

A

sudden eruption of multiple seborrheic ketaroses indicating possible GI carcinoma

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20
Q

What is acanthosis nigricans?

(appearance and histologic features)

A

Epidermal hyperplasia

  • thick, hyperpigmented
  • acanthosis (epidermal hyperplasia)
  • papilmatosis (hyperplasia of dermal papilae)
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21
Q

Where and in what populations is acanthosis nigricans most commonly seen?

A
  • interignious/flexor surfaces​ (axila, groin, neck)
  • benign versions typically present in childhood and progress into adulthood; diabetics and obese
  • paraneoplastic typically in middle aged men
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22
Q

What are the causes of acanthosis nigricans?

Study These Flashcards
A

Benign:

  • obsesity/endocrine (diabetes, Cushing syndrome)
  • autosomal dominant inheritance
  • drug related (corticosteroids)

Paraneoplastic:

-GI adenocarcinoma

23
Q

What are fibroepithelial polyps?

Study These Flashcards
A

Acrochordon/skin tags

24
Q

What are epithelial inclusion cysts?

Study These Flashcards
A

Sebaceous cyst/wen

25
What is **actinic keratosis**? | (appearance and histologic features)
premalignant epidermal tumor -**hyperkeratosis**, possibly resulting in **keratin horn** **-rough texture** - **elastosis** (abnormal elastic fibers in dermis) - **parakeratosis** (**retained nuclei** in stratum corneum)
26
**Where** and in **what populations** is **actinic keratosis** most commonly seen?
- **sun exposed areas** - **light skinned** individuals - **adults** (\>50)
27
What are **risk factors f**or deveoloping **actinic keratosis**?
**-sun/UV exposure** -arsenic
28
What is the **prognosis/treatment** for **actinic keratosis**?
- **can spontaneously regress** - can persist or **progress to squamous cell carcinoma** - **cryotherapy** or **imiquimod** to treat (mostly for prevention of progression or aesthetic reasons)
29
What cancer is actinic keratosis most likely to progress to?
squamous cell carcinoma
30
What is **cutaneous squamous cell carcinoma**? (appearance and histologic features)
**Malignant squamous cell proliferation** in the skin - **ulcerated nodule**, bleeds easily - pink **keratin pearls**
31
**Where** and in **what populations** is **cutaneous squamous cell carcinoma** most commonly seen?
- typically on face (on or below **lower lip**) - sun exposed areas - more common in **men** - leg lesions more common in women - **older adults** **-work involves prolonged sun exposure**
32
What are **risk factors** for developing **cutaneous squamous cell carcinoma**?
- **sun/UVB exposure** (cumulative) - **albinism** - **xerderma pigmentosum** - arsenic - immunosupression
33
What is the **prognosis/treatment** for **cutaneous squamous cell carcinoma**?
**Good prognosis** -**slow growing, rarely metastasizes** Excision to treat
34
What is **Bowden's disease**? | (appearance and histologic features)
**Cutaneous squamous cell carcinoma _in situ_** premalignant squamous cell carcinoma - **erythematous, scaly plaque** - **full thickness of epidermis**, but **basement membrane intact**
35
What is **basal cell carcinoma**? | (appearance and histologic features)
**Malignant basal cell proliferation** -"**pink** **pearly papule"** with **umbilication** **-telangectasias** - **palisading** (outer cells nuceli are aligned) - **separation artifact** (mass seperates from surrounding tissue when sectioned)
36
**Where** and in **what populations** is **basal cell carcinoma** most commonly seen?
- sun exposed areas (on or above **upper lip**) - most common tumor of eyelid and nose - older adults - work involves prolonged sun exposure
37
What are risk factors for **basal cell carcinoma**?
- **sun/UVB exposure** (cumulative) - **albinism** - **xerderma pigmentosum** - immunosupression
38
What is the **prognosis/treatment** for **basal cell carcinoma**?
**Excellent prognosis** **-slow growing, rarely metastasizes** **excision** to treat
39
**Mutations** in what pathway are associated with **basal cell carcinoma**?
**SHH pathway**: - **PTCH** (**receptor for SHH**), complexed with SMO (inactivating SMO) when not bound by SHH - **SMO**, activates transcription enhancing growth and division Most common mutation is in PTCH preventing it from forming complex with SMO, leading to unregulated cell proliferation
40
What is dermatofibroma? | (appearance and histologic features)
Benign fibrous histiocytoma - **firm, tan/brown papule** - possibly **tender** - **well-defined, non-encapsulated mass** in the dermis
41
What is a **characterisitc and diagnostic feature** of **dermatofibroma**?
**Dimple sign**: -**central dimple** appears when lesions is **pinched**
42
What is a common feature in the history of those with dermatofibroma?
past trauma at the location of the lesion
43
**Where** and in **what populations** is **dermatofibroma** most commonly seen?
legs of women
44
What is the **prognosis/treatment** for **dermatofibroma**?
asymptomatic, slow growing, benign no treatment requred
45
What is **dermatofibrosarcoma protuberans**? (appearance and histologic features)
primary fibrosarcoma of the dermis (**malignant**) - **firm nodule** with possible ulceration - **"pinwheel" or storiform** fibroblasts - extends into subcutaneous fat -\> **"honeycomb" pattern**
46
What is the **prognosis/treatment** for **dermatofibrosarcoma protuberans**?
- malignant, **rarely metastasize** - extension into subcutaneous fat allows for **recurrence** - wide excision to treat (wide to prevent recurrence)
47
What is **mycosis fungoides**? | (appearance and histologic features)
**Cutaneous T-cell lymphoma** - **early** pruritic red-brown scaling patches/plaques (**resemble psoriasis**) - progress to **fungating nodules** - small clusters of **CD4+ T cells** with **cerebriform nuclei** in the epidermis-\> **Pautrier microabsesses**
48
**Where** and in **what populations** is **mycosis fungoides** most commonly seen?
- **initialy located on trunk**, can later spread elsewhere - **adults**, over the age of 40
49
What is the **prognosis/treatment** for **mycosis fungoides**?
Prognosis varies depending on progression - more lesions/systemic spread (Sezary syndrome) = bad - nodular lesions = bad - topical cortiocosteriods, UV therapy (early treatment) - chemotheraputics (late treatment)
50
What is **mastocytosis**? | (appearance and histologic features)
proliferation of **mast cells** in the dermis (**urticaria pigmentosa**) -red-brown papule/plaque
51
**Where** and in **what populations** is **mastocytosis** most commonly seen?
extremities, trunk, or face (less common in sun exposed places) **cutaneous lesions (90%): children** systemic (infiltration of orans as well) (10%): adults
52
What are common **features/signs** of **mastocytosis**?
**Darier sign**: -formation of wheals (dermal edema and erythema) from rubbing of skin **Dermatographia**: - wheals from stroking skin with pointed object - able to "write" on skin with resulting swelling
53
What is the **prognosis/treatment** for **mastocytosis**?
Cutaneous (children): -frequently resolves before puberty; **good prognosis** Systemic (adults): -possible **poor prognosis** **no cure, only supportive treatment**

(J2) Skin (7 decks)

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