Benign and Malignant Skin Conditions Flashcards Preview

OS 212 DERMATOLOGY > Benign and Malignant Skin Conditions > Flashcards

Flashcards in Benign and Malignant Skin Conditions Deck (89):
1

Other names of Epidermal cyst

Epidermal inclusion cyst, infundibular cyst

2

Origin of Epidermal cyst

Infundibulum of hair follicle (nonacral skin)
Implantation of epidermis into dermis thru trauma

3

Clinical Features of Epidermalcyst

Solitary or multiple 1-5cm cyst
Slowly growing, round, firm, movable
(+) surface punctum
Often found in face, neck torso; Occasionally palms and soles

4

When you squeeze Epidermal cyst

foul smelling cheesy, whitish material coming out

5

Histopathology of epidermal cyst

Cyst wall is made up of stratified squamous epithelium with several layers including a GRANULAR CELLULAR LAYER.

Cavity contains laminated, horny, or keratinous material

6

Any cavity lined by epithelium

Cyst

7

Miniature epithelial cysts, small versions of epidermoid cysts

Milium

8

Origin of Milium

Infundibulum of hair follicle (Primary milium)
Epithelial structures e.g eccrine ducts (secondary milium)

9

Clinical features of Milium

Small, multiple, white, globoid, firm 1 to 2 mm papules
Found in face; eyelids, cheeks and forehead
Occurs at any age
Can be secondary to trauma, sunburn

10

Histopathology of Milium

Lining is composed of normal epidermis just like epidermoid cyst including a GRANULAR CELL LAYER

Cavity conntains laminated, horny, or keratinous material

Cysts are small and located way up, close to the epidermis unlike epidermoid cysts

11

Other names of Pilar cyst

Trichilemmal cyst, isthmus-catagen cyst

12

Origin of Pilar cyst

Isthmus of anagen hairs or sac surrounding catagen and telogen hairs

13

Clinical Features of Pilar cyst

Solitary or multiple
Middle age, female
Predilection for scalp
Smooth, firm, dome-shaped 0.5-5 cm nodules/tumor
No surface punctum, easily nucleated (easy to excise)

14

Histopathology of Pilar cyst

Content is homogenous, compact. eosinophilc keratin
No granular cell layer
Keratinocytes abrupty keratinize

15

Origin of Steatocystoma

Sebaceous duct (only true sebaceous cyst)

16

Clinical Features of Steatocystoma

Simplex (solitary, noninherited)
Multiplex (Multiple, autosomal)
Yellowish to skin colored, papules or cysts < 3mm to 3cm
Predilection for chest but also axillae, groin, trunk, extemities

17

histopathology of steatocystoma

Convouted cystic structure
Cyst wall = stratified squamous epithelium without an intervening granular cell layer

Cavity may contain hair, sebum, keratin

18

Diagnostic for steatocystoma

presence of an sebaceous lobule that is found adjacent to or within the cyst wall.

19

Other name for Seborrheic keratosis

Senile warts

20

Clinical features of Seborrheic keratosis

Mostly multiple
flesh-colored, gray brown to black papules with stuck on appearance

Older patients

21

5 histologic types of Seborrheic keratosis

Hyperkeratotic type
Acanthotic type
Reticulated type
Clonal type
Irritated type

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Hyperkeratotic SK

Increased thickening of stratum corneum
Papillomatosis (Upward projection of dermal papillae)
Acanthosis (Thickened spinous cell layer)

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Acanthotic type SK

Thickening of the spinous cell layer
interwoven tracts of epithelial cells surrounding islands of dermal stroma
Presence of Pseudohorn cysts

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Reticulated type SK

lace like or net like pattern (thin, interlacing strands of basaloid cells)

25

Clonal type SK

Hyperkeratsis, papillomatosis, acanthosis
Nests or clones of basaloid cells

26

Irritated type SK

Hyperkeratosis, papillomatosis, acanthosis
numerous squamous eddies (Flattened squamous cells in an onion peel-like fashion)

27

Numerous small, well-circumscribed whorls of flattened eosinophilic squamous cells that gradually keratinize towards the center

Squamous Eddies

28

Three common features of seborrheic keratosis

Hyperkeratosis
Papillomatosis
Acanthosis

29

Clinical features of Epidermal Nevus

Younger age group
mostly single
Brown > grey, black, flesh colore warty, papule plaque

30

2 forms of Epidermal Nevus

Localized (nevus verrucosus) - plaque or linear
Systematized

31

Systematized EN with long linear usually unilateral lesions on extremities

Nevus unius lateris

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Systematized EN with bilateral and more extensive distribution on trunk

Ichthyosis hystrix

33

Histopathology of Epidermal nevus

Hyperkeratosis, papillomatosis, and acanthosis

34

Other names for Bowen's Disease

SCC in situ

35

Clinical Features of Bowen's Disease

Solitary, slow growing, well-defined, erythematous, scaly patch or plaque

Occurs in sun-exposed skin

Also in unexposed (arsenic)

36

two variants of SCC

Glabrous skin (naturally hairless)
Anogenital areas (eythroplasia of Queyrat - glans penis, inner prepuce)

37

2nd most common skin malignancy

SCC

-more frequent in males

38

Risk Factors for SCC

Increased age
Light skin pigmentation
Genetic disorders (xeroderma pigmentoum, albinism)
Immunosuppresion
Smoking and tobacco chewing

39

Etiology of SCC

Cummulative UVR exposure (UVB >UVA)
Oncogenic HPV (16, 18, 31)

40

Clinical Features of SCC

Mostly isolated and single
Head, neck, dorsum of hands
Scalp, ears, vermillion part of lower lip
Shallow ulcer with crust and raised indurated border

Highly differentiated: Firm, hard (keratinization)
Pootly Differentiated: Fleshy/granulomatous, soft, asymptomatic unless with perineural invasion

41

Histopathology of SCC

atypical keratinocytes, proliferating downwards, discontinued and detached from overlying epidermis

Keratin pearls or horn pearls which look like squamous eddies

42

Basal Cell Carcinoma

rarely metastasize

43

Most common skin malignancy

Basal cell carcinoma

More fequent in males
Age of onset:>40

44

Etiology of BCC

cummulative UV exposure (UVB>UVA)
PTCH gene mutation

45

Nodo-ulcerative type of BCC

ToL : Papule ,nodule

Color: Pearly, tranlucent

Smooth surface, telangiectasia, ulcer with pearly rolled border

46

Pigmented type of BCC

ToL: Papule, nodule

Color: Brown, blue, black

Smooth glistening surface, hard, firm, may be indistinguishable from nodular melanoma or SSM

47

Superficial type of BCC

ToL: Patch, plaque

Color: Pink, red

Scaling, telangiectasia, fine threadlike border

48

Morpheaform/fibrosing/sclerosing type of BCC

ToL: Macule, Patch, plaque

Color: Whitish, yellowish, skin colored

Smooth shiny surface, indurated, superficial scar. INVERTED FORM OF INVASION

49

Fibroepithelioma type of BCC

ToL: Nodule

Color: Pink to flesh colored

Soft resembling fibroma or papilloma

50

Histopathology of BCC

note where the nests are on junctional nevi present with nests at tips of rete ridges

Compound nevi: some nexts in epidermis and dermis

Dermal nevi: nests in the dermis and none in the epidermis

51

CF of Common Acquired Melanocytic Nevi

Benign Tumors -> moles
White people have more moles
Darker people -> palms, soles, and nailbeds

52

Junctional nevus

Nests of nevus cells on the epidermis

53

Dermal (Intradermal) nevus

nests of nevus cells in the dermis

54

Compound nevus

nests of nevus cells in the epidermis and dermis

55

Evolution of Nevus

Junctional -> compound -> dermal

56

Histology of Common acquired Melanocytic Nevi

Only note where nests is

57

CF of malignant Melanoma

Generally after puberty
Most frequent: 30-70
Most common sites: Lower extremities and trunk of women, trunk(back) of men

58

Fitzpatrick (MMRISK)

Moles (atypical or dysplastic >5)
Moles (numerous, >50, size >5 mm)
Red hair or freckling
Inability to tan
SUnburn
indred

59

Six signs of Malignant Melanoma (ABCDEE)

Asymmetry
Border
Color
Diameter (>6mm)
Elevation
Enlargement

60

4 major types of Malignant Melanoma

Superficial Spreading Melanoma (SSM) - Most common
Nodular Melanoma (NM)
Lentigo Malignant Melanoma (LMM)
Acral lentiginous Melanoma (ALM)

61

Cells of melanoma are either epitheloid or spindle
large, round cells, single or in clusters seeding the dermis from the epidermis

PAGETOID spread - Invasion of all levels of epidermis as single or group of cells upwards

Positive for S100

Superficial Spreading Melanoma

62

Exophytic, uniform, blackish; looks like pigmented BCC

Dome-shaped, cells from epidermis have invaded the dermis

No radial or horizonal growth phase: only vertical

Nodular melanoma

63

Atrophic epidermis, proliferation along basal layers of hair structures and ducts (Eccrine)

Infiltrates hair follicle and downward invasion

May present as patch or nodule

Proliferation of plump spindle cells along basal layer, thin and atrophic epidermis

Solar elastosis (disturbance in dermal connective tissue)

Lentigo Maligna Melanoma

64

Hyperpigmentation around the nail plate

HUTCHINSON's SIGN (peri-ungual pigmentation)

May look like a stain, enlarging

Hyperplastic epidermis

Acral Lentiginous Melanoma

65

Most important prognostic factor for localized melanomas

Tumor thickness

66

Tumor infiltrating lymphocytes

Better with TIL (immune system wards off tumor)

67

Clark's anatomic Level of Invasion

Level 1 - in situ melanoma

level 2 - melanoma within the epidermis and a few within the papillary dermis

Level 3- Tumor cells that has invaded the papilalry dermisl propensity for vertical growth phase for metastasis

Level 4; Melanoma in the reticular dermis

Level 5: melanoma cells had gone down to SQ fat

68

Most common benign proliferative abnormality of the sebaceous glands in older individuals

Sebaceous Tumors

69

Yellowish to tan papules, umbilicated 2-3 cm, with side telangiectasia

Sebaceous Tumors

70

Histopathology of Sebaceous glands

Markedly enlarged sebaceous gands

Numerous lobules grouped around a central dilated sebaceous duct

71

Poorly differentiated hartoma of hair germs

Trichoepithelioma

72

More common in nasolabial folds versus nose, forehead, upper lip

Pilar tumor

73

Histopathology of Pilar Tumor

Tumor lobules/islands of basaloid cells

either be solid or lace-like/net-like (reticulated)

Several horn cysts (Attempts to form hair shaft)

Embedded in upper dermis (fibrous stroma)

74

Adenomas of the intraepidermal Eccrine ducts

Syringoma (Eccrine Tumors)

M>F

Usually multiple

75

Small, whitish, or yellowish soft papules in the lower eyelids, upper chin, genitalia or thighs

Eccrine Tumor

76

Histopathology of Eccrine Tumor

Presence of ductal structures lined by 2 layers of cuboidal cells, with COMMA like tails, tail-like structures that look like a tadpole -Dx factor

Small nests, strands of epithelial cells

77

Tends to flatten, regress with time. It doesn't extend beyond site of injury

Hypertrophic Scar

78

Extends beyond site of injury and grows progressively with claw-like extensions

KELOID

79

Histopathology of hypertrophic Scar

Fibrobastic proliferation of increased collagen oriented PARALLEL to the skin surface

Vascularization with blood bessels oriented PERPENDICULAR to the skin surface

80

Histopathology of Keloids

Presence of markedly thickened hypereosinophilic bands of thickened collagen

Zebra pattern

81

also known as Vascular tumor

Juvenile capillary hemangioma/strawbery nevus

Most common vascular tumor in infancy

More common in females

82

Natural History of Vascular tumors

Proliferating stage (8-12 months)

Involuting stage (1-5 years)

>50% regress after 5 years
70-90% usually regress by age 7

83

Hemorrhage from entrapment of platelets in hemangioma, causing coagulopathy

Kasabach-Meritt phenomenon

84

Histopathology of vascular tumors

Proliferation of capillaries in lobular configuration

Exopytic, dome-shaped

85

Manifests multiple variably sized and rounded nodules with a pushing contour in apposition to a stroma that shows no significat fibroplasias. The nodule of tumor show a peripheral palisade of basaloid cells and, at their interface with the stoma, slit-like retraction. With Eosinophilic condensation of basement membrane aterial adherent to the cytoplasms of the palisading basaloid cells

NODULAR BCC

86

Histologic feature similar to those of nodular BCC but with the addition of melanin. The melanocytes are interspersed between tumor cells and contain numerous melanin granules in their cytoplasm and dendrites

Pigmented BCC

87

A proliferation of basaloid cells parallel to the long axis of the epidermis. Slit like stromal retraction with mucin deposition in the papillary dermis

Superficial BCC

88

densely proplastic and heavily collagenized stroma, small, irregular tongues of neoplastic basaloid cells, often 1-4 cells thick, are embedded in the collagen table

Morpheaform BCC

89

Manfests atypical basaloid cells that grow in thin lacy strands radiating down from points of continuity with the overlying epidermis

Fribroepithelioma of Pinkus