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Exam 2 Skin block > Dermatopathology part 1 > Flashcards

Dermatopathology part 1 Flashcards

1
Q

What is Vitiligo? What disease is it typically associated with?

A

Chronic depigmenting condition from complete loss of epidermal melanocytes

Associated with pernicious anemia and hasimoto’s thyroiditis.

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2
Q

How does vitaligo cause depigmentation

A

Autoantibody against melanin concentration hormone receptor 1 in serum.

Presents on the 2nd or 3rd decades.

Higher in africans.

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3
Q

Predilection of vitiligo

A

Acral areas and orifices.

Presents as asymptomatic white macules with sharp borders that gradually enlarge.

Hair will also lose pigments.

Can see the lesions better under a wood’s lamp.

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4
Q

TX of vitiligo

A

slowly progressive, but 10-20% experience spontaneous regression.

some benefit with topical steroids, calcineruin inhibitors, and light therapy

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5
Q

Freckle (Ephelis)

A

Basal layer hyperpigmentation

appear after sun exposure in lighhtly pigmented kids

darken with sun expsoure

no risk of malignancy

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6
Q

Lentigo (lentigines)

A

Small (<1.0 cm) circumscribed brown macular lesions.

Hyperpigmentation of cells just above the basement membrane

unlike ephelides, lentigines do not darken with sun exposure.

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7
Q

Lentigo histology

A

The rete ridges are elongated and appear club shaped or tortuous. Melanocytes are increased in the basal layer and melanophages appear in the upper dermis.

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8
Q

Melanocytic nevi Gross features

A

tan to brown.

uniformly pigmented

small (usually <6mm in greatest dimension)

flat to elevated

well defined, rounded borders.

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9
Q

melanocytic nevi histology

A

sharply defined

well nested at the dermal epidermal junction

melanocytes mature as they descend in dermis

no deep mitoses

no deep pigment in melanocytic nests

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10
Q

Melanocytic nevi progression of maturation

A

junctional > compound > intradermal

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11
Q

Junctional melanocytic neves

A

melanocytic nests at the dermal epidermal junction

nests restricted to the tips and sides of rete.

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12
Q

compound melanocytic nevus

A

more raised and dome shaped than junctional nevus

histologic features of junctional nevus (intraepidermal nevus cell nets) + nests and cords of nevus cell in underlying dermis

as cells invade the dermis they mature and become smaller.

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13
Q

Dermal melanocytic nevus histology

A

epidermal nests are lost completly

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14
Q

spitz nevus description of what it presents cellularly

A

composed of spindle and/or epitheliod cells

dyskeratotic melanocytes (kamino bodies): eosinophilic bodies along dermal epidermal junction

sharply defined laterally

line symmetry from left to right

celfts separating nets from keratinocytes

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15
Q

Sptiz nevus. Who get this and describe what it looks like

A

common in children

deep red color may be confused with hemangiomas

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16
Q

Kamino bodies

A

eosinophilic collections of dyskeratotic melanocytes

17
Q

Spitz nevus location of the nests and caveats

A

netsts of melanocytes within the epidermis

nets are seperated from the epidermis by clefts

18
Q

dysplastic (atypical) melanocytic nevus description

A

commonly large, oval, and multiple

irregular pigment common

fading boarder or fried egg appearance (central papule, surrounding macule)

19
Q

dysplastic (atypical) melanocytic nevus Histologically

A

Histologic: usually compound, concentric papillary dermal fibrosis.

20
Q

dysplastic (atypical) melanocytic nevus nets

A

horizontally orieted nests with bridging of adjacent rete

nets are at the tips and sides of rete

cytologic atypia: hyperchromatic, enlarged nuclei

21
Q

Melanoma

A

1 cause of skin cancer deaths worldwide

malignancy of pigment producing cells (melanocytes which are derived from the neural crest)

develops de novo or from pre existing mole

found in the skin, eyes, GI tract, leptomeninges, oral and genital mucosa.\

4% of all skin cancers

22
Q

Verticle phase of melanoma

A

determiens tumor stage and this phase can lead to metastasis to lymph nodes, brain, GI tract, bone, liver and lungs most commonly

23
Q

Risk factors of melanoma

A

Changing mole

other things

24
Q

ABCDE rule of skin lesions

A

assymetry, border irregularity, color variation, diameter > 6mm, evolving

25
Q

radial growth phase

A

horizontal spread of melanoma cells within the epidermis and superficial dermis

tumor cells lack the ability to metastasize

26
Q

verticle growth phase

A

tumor cells invade downward into deeper dermal layers as a mass

cells with metastatic potential emerge

invading cells do not mature as in melanocytic nevi

grossly, a nodule appears

27
Q

superficial spreading

A

most common (50-75% of all melanomas)

25% from preexisting lesion

sun exposed skin, typically on backs of men and lower legs of women but any age

evolved lesions may show ultiple shades: red, tan, brown , blue, black, grey and white

28
Q

superficial spreading: histologic features

A

buckshot scatter of atypical melanocytes within the epdiermis (pagetoid spread)

typically not symmetrical (R to L)

Typically fails to mature from top to bottom

deep mitoses may be present

cytologic atypia

29
Q

Lentigo maligna 1 what gender typically gets it. Describe growth.

A

indolent, slow growing lesion

typically, face of old men

long radial growth phase, 10-50 years

starts as tan brown macule, gradually enlarges, develops darker, asymmetric foci

5% of intraepidermal lesions evolve to become clinically palpable, signaling dermal invasion and transformation into lentigo maligna melanoma.

30
Q

Lentigo maligna 2 caused by, type of growth, and cell descrption

A

broad lesion on sun damaged skin

predominantely junctional growth of atypical melanocytes

cytologic atypia

31
Q

Lentigo maligna 3 distinguishing features

A

distinguishing features: malignant melona in situ. poorly nested and confluent melanocytes at the dermal epidermal junction. adnexal extension. Heavily sun-damaged skin (severe dermis solar elastosis)

32
Q

lentigo maligna melanoma

A

lentigo maligna with a vertical growth phase

33
Q

acral lentiginous melanoma

A

least common, < 5% of all melanomas

most common melanoma in african americans adn asians

palms, soles, beneath the nail plate

hutchinson’s sign

34
Q

nodular melanoma where on the body

A

15-30% of melanomas

anywhere on the body

can be amelanotic

35
Q

Nodular melanoma histo

A

vertical growth phase melanoma

no apparent radial growth phase

dermal growth occurs in isolation or occasionally, in association with an epidermal component

mitoses are frequent and often atypical

36
Q

Breslow measurement

A

actual measurement of tumor

most closely correlates with survival statistics

37
Q

clark level

A

not based on measurement, but on the number of layers of skin that the tumor has penetrated

  1. epidermis
  2. papillary dermis, not yet to papillary reticular junction
  3. fills papillary dermis
  4. reticular dermis
  5. subcutaneous tissues
38
Q

Sentinel node biopsy

A

lymphoscintigraphy radioactive tracer and a gamma probe is used

recommended for intermediate tumors (1 to 4 mm thickness) or high risk thin tumors

minimally invasive technique that has been shown to help accurately stage the regional nodal basin with a lower associated rate of complications and costs compared to ELND

subsequently full lymph dissection is performed if metastatic disease is present and adjuvant therapy like interferon alpha is administered

39
Q

prognostic factors

A

tumor thickness

mitotic rate

ulceration

lymph node involvement

satellite lesions

distant metastases

age: older the wrose
gender: female have better prognosis

anatomic location: upper extremities better than head, neck, trunk, +/- lower extremities

Exam 2 Skin block (22 decks)

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