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Skin Neoplasms

Skin and Soft Tissue Neoplasms

Disorders of Pigmentation and Melanocytes = ? * Freckles -- Lentigo -- Melanocytic Nevus -- Dysplastic Nevi -- Melanoma
Most common pigmented lesions of childhood = ? * Freckle (Ephelis) - from increased melanin in basal keratinocytes..... * Due to HYPERTROPHY
Lentigo basics = ? * Linear HYPERPLASIA of melanocytes.... * Does NOT darken when exposed to sunlight (is dark to begin with though)
Melanocytic Nevus (Mole) basics and what it is commonly confused with = ? * Benign, and can come out during pregnancy... * Confused with Melanoma a good bit
Melanocytic Nevus Patho = ? * Mutations in BRAF or NRAS
How the Melanocytic Nevus tumor stops growing ? * Oncogene-induced senescence = get cellular arrest by p16 when BRAF/NRAS are out of whack
Maturation Sequence of Nondysplastic Melanocytic Nevi = ? * Flat = when it forms at the EPI/DERMis Junction --> Junctional Nevus.... * Compound Nevus = at Junction AND in the DERMIS... * DERML NEVUS = all of it grows in the DERMIS
Histo of Junctional Type = ? * small, flat, uniform, nests at the dermal-epidermal junction
Compound Type = ? * raised, and more domed shape... * see intraepidermal and dermal nevus cells
Melanocytic Nevus Variants = ? * Congenital nevus -- Blue nevus -- Spitz nevus -- Halo nevus -- Dysplastic nevus
Congenital Nevus = ? * nevus cells are surrounded such structures such as hair follicles, dense nevus cells in the dermis,
Blue Nevus = ? * Is a Dermal Lesion = is benign, but can reoccur
Spitz Nevus = ? * DDx = Hemangioma... * Common in children.... * Histologically mimics MELANOMA... * See streaming down nests and hypergranulosis
Halo Nevus = ? * Looks like a white patch, with a red dot in the middle of it... * Is from Lymphocytic infiltrate around nevus cells
Dysplastic Nevus = ? * usu numerous and found on the back... * found at the epi/dermal junction... * See architectural changes and bridging... * PRECURSOR to MELANOMA
Dyplastic Nevus genes usu involved = ? * CDK = cyclin dependent kinase
Melanoma basics = ? * DEADLY if not caught early.... * Can arise not only from skin, but from mucosal surfaces
Melanoma Cx Features = ? * Usu asymptomatic or may start with pain/itching.... * Most are >10mm at Dx.... * ABC's = Asymmetric, Irreg Borders, and Color Changes
Melanoma Histo = ? * Has either a Radial Phase = Flat, wide growth OR Vertical Phase = Raised, that is due to increased mitosis (VERTICAL = Worst Prog.)... *
Signaling Pathways important in Melanoma = ? * Cell Survival = mTOR Pathway (usu in non-sun exposed ppl)... * Cell Prolif = RAS/RAF Pathways (BRAF/NRAS) (sun exposed ppl)
Some Melanoma Prognostic Factors = ? * Depth, Number of Mitoses, Growth Patterns, Tumor Regression/Progression
Merkel Cell Carcinoma = ? * Neuroendocrine CA of the skin.... * rare, aggressive, common mets... * BIGGEST ISSUE = it may be rarer than Melanoma, but is TWICE as deadly
Morphology of Merkel cell Carcinoma = ? * Raised/Indurated Ulcer looking lesion, with rolled edges.... * Histo: See lots of large blue cells
AEIOU of Merkel Call CA = ? * Asymmetry, E ?, immunocomp?, older than 55, and UV exposure
Benign Epithelial Tumors = ? * Seborrheic keratosis -- Acanthosis nigricans -- Fibroepithelial polyp (skin tag)
Seborrheic Keratosis mutations and is from ? * Due to mutations in FGFR3 and is from tumor growth factor alpha.... *
Leser-Trelat sign = ? * Large numbers of seborrheic keratosis appear as part of paraneoplastic syndrome (lots of them)
Seborrheic keratosis histo = ? * well demarcated, coin like lesion, filled with dark keratin, and is composed of benign BASALOID cells thar produce the keratin layer and can get keratin horns
Actinic Keratosis = ? * PRE-Malig epi lesion, from sun expose and exhibits hyperkeratosis and parakeratosis... * HIGH incidence in light skinned people... * Can get a CUTANEOUS HORN
Malignant Epidermal Tumors = ? * Basal Cell Carcinoma -- Squamous Cell Carcinoma
Basal cell Carcinoma basics = ? * Most common, slow growing, tends to be in sun exposed ppl and light skinned ppl... * Incidence rises in immunocomp ppl
BCC Morphology and Histo = ? * Raised, Shiny, telangiectatic nodules .... * Histo = see nests of Basaloid cells and Artifactual retraction (BCC separates from the rest of the layers)
Gorlin syndrome = ? * A nevoid BCC syndrome when we have basal cell nevi arising before the age of 20... * We see medulloblastoma, ovarian fibroma, palmar pits, and other things in these pts.
Patho of Gorlin Syn = ? * Mutation in PTCH, and doesn't have SMO joined to it to keep it inhibited
Squamous cell carcinoma = ? * 2nd most common skin CA.... * Higher in MEN.. * Usu detected when small and usu resectable
SqCC Morpho/Histo = ? * can look like a scab... * see the typical squamous keratin pearls and intracellular bridges
Patho of SqCC = ? * From UV Exposure (280-320nm) = formation of pyrimidine dimers (C-T bind instead of the normal A-T and C-G)
Tumors of the Dermis = ? * Dermatofibroma (benign fibrous histiocytoma) -- DFSP (dermatofibrosarcoma protruberans)
Dermatofibroma = ? * BENIGHN... * usu a Hx of Trauma, and arises on the legs of middle aged women... * looks like BCC without the vasc... * Histo = see well circumscribed prolif of collagen bundles and see the overlying hyperplasia of the epidermis
Soft Tissue Tumors = ? * Fatty Tumors -- Fibrous tumors and Tumor like lesions -- Fibrohistiocytic Tumors -- Synovial sarcoma
Lipomas and Liposarcomas = ? * Liposarcomas = see in DEEP tissues and in the retroperitoneum (pleomorphic is worst kind)
Fibrous Tumors and Tumor Like-Lesions = ? * Reactive pseudosarcomatous proliferations -- Fibromatosis -- Fibrosarcoma
Reactive Pseudosarcomatous Proliferations types and basics = ? * Nodular Fasciitis = painless, solid, benign, fast growing mass that has spindle fibers and RBCs in it..... * Myositis Ossificans = see bone growing the muscle after a trauma (young athletic ppl usu)
Fibromatoses = ? * Superficial Fibromatosis = nodular or poorly defined broad fascicles of fibroblasts & myofibroblasts surrounded by abundant dense collagen (ex. Peyronies - penis curve).... * Deep-Seated Fibromatosis (Desmoid Tumors) = lg, reoccur if incomplete excision
Deep-Seated Fibromatosis genes = ? * Mutations in APC or B, in those with or without underlying Gardner syndrome
Fibrosarcoma = ? * Histology = Buzzword is Herringbone Pattern (spindle cells and TONS of mitosis)
Fibrohistiocytic Tumors = ? * contain both fibroblast elements and macrophages.... * Benign Fibrous Histiocytoma and Malignant Fibrous Histiocytoma
Synovial Sarcoma = ? * Cell of origin is unclear and ppl usu 20-40... * usu in soft DEEP tissue,slow grower, and around the hip/knee (can be in neck too).... * Can be Monophasic = epi OR spindle cells only, OR Biphasic = BOTH epi and spindle cell
Synovial Sarcoma genes and important trait = ? * from translocation in T(X,18) (p11;q11)... * Has a high chance to Mets to LUNG, LNs, and BONE
Created by: thamrick800