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Questions and Answers

Which characteristic is typically associated with seborrheic keratosis?

  • Vascular tumor appearance
  • Explosive and sudden onset
  • Multiple lesions with pigmented variations (correct)
  • Button-like firm nodule

    • What is a common clinical manifestation of dermatofibromas?

  • Dimple sign on compression (correct)
  • Bright red vascular tumors
  • Large cystic formations
  • Hyperpigmented patches

    • In what condition is acanthosis nigricans most frequently observed?

  • During infancy
  • As a result of viral infections
  • Post-surgery healing
  • In association with obesity and diabetes (correct)

    • Which of the following is a notable feature of pyogenic granuloma?

    <p>Originates from capillaries (A)</p> Signup and view all the answers

    What is a potential treatment option for a pyogenic granuloma?

    <p>Electrocautery with curettage (C)</p> Signup and view all the answers

    Which symptom differentiates benign from malignant types of acanthosis nigricans?

    <p>Age of onset (A)</p> Signup and view all the answers

    What is a common appearance of fibroepithelial polyps?

    <p>Flesh-colored bag-like tumors (C)</p> Signup and view all the answers

    What underlying condition can Acanthosis Nigricans occasionally be associated with?

    <p>Diabetes and obesity (D)</p> Signup and view all the answers

    Which of the following describes the epidermal appearance in acanthosis nigricans?

    <p>Marked by numerous peaks and valleys (D)</p> Signup and view all the answers

    What common factor can trigger the formation of pyogenic granulomas?

    <p>Minor trauma (D)</p> Signup and view all the answers

    What is a characteristic feature of seborrheic keratosis?

    <p>Horn cysts (C)</p> Signup and view all the answers

    Which condition is associated with the Leser-Trélat sign?

    <p>Seborrheic keratosis (D)</p> Signup and view all the answers

    What histological feature distinguishes actinic keratosis from other skin lesions?

    <p>Peaks and valley (D)</p> Signup and view all the answers

    Which statement about dermatofibroma is true?

    <p>It exhibits a dimple sign on macro examination. (D)</p> Signup and view all the answers

    What is a potential clinical implication of acanthosis nigricans in adults?

    <p>Cancers, particularly GI adenocarcinomas (C)</p> Signup and view all the answers

    Which of the following conditions involves keratin cysts lined by stratified squamous epithelium?

    <p>Epidermoid cyst (C)</p> Signup and view all the answers

    Which of the following features is characteristic of basal cell carcinoma (BCC)?

    <p>Palisading arrangement of the peripheral cells (D)</p> Signup and view all the answers

    What common factor can lead to multiple basal cell carcinomas seen in Gorlin's syndrome?

    <p>Genetic mutations on chromosome 9 (C)</p> Signup and view all the answers

    Which of these conditions might be related to Acanthosis nigricans and fibroepithelial polyp?

    <p>Obesity and diabetes (C)</p> Signup and view all the answers

    Which histological feature is NOT associated with actinic keratosis?

    <p>Polymorphic retraction of the stroma (A)</p> Signup and view all the answers

    What is a key characteristic of seborrheic keratosis?

    <p>It commonly appears as waxy, flat, coin-like plaques. (C)</p> Signup and view all the answers

    Which growth factor receptor mutation is commonly associated with seborrheic keratosis?

    <p>FGFR3 (B)</p> Signup and view all the answers

    What is a common feature of actinic keratosis?

    <p>It can symbolize a precancerous state. (A)</p> Signup and view all the answers

    What distinguishes dermatofibroma from other skin tumors?

    <p>It typically presents as a firm, dimpled nodule. (D)</p> Signup and view all the answers

    Which lesion is known for its association with insulin resistance and obesity?

    <p>Acanthosis nigricans (B)</p> Signup and view all the answers

    When seborrheic keratosis becomes irritated and inflamed, what histological feature may develop?

    <p>Whirling foci of squamous differentiation (C)</p> Signup and view all the answers

    What is the primary treatment approach for actinic keratosis?

    <p>Cryotherapy or laser therapy (B)</p> Signup and view all the answers

    What is the clinical significance of pyogenic granuloma?

    <p>It frequently occurs following trauma. (B)</p> Signup and view all the answers

    Which histological feature is indicative of seborrheic keratosis?

    <p>Hyperkeratosis and horn cysts (C)</p> Signup and view all the answers

    What distinguishes actinic keratosis from seborrheic keratosis?

    <p>Actinic keratosis has a tendency toward malignant transformation. (C)</p> Signup and view all the answers

    What is the main characteristic of actinic keratosis?

    <p>Rough, sandpaper-like consistency and usually less than 1 cm in diameter (A)</p> Signup and view all the answers

    Which skin types are significantly affected by actinic keratosis?

    <p>Types 1, 2, and 3 skin only (B)</p> Signup and view all the answers

    What is a potential severe outcome of untreated actinic keratosis?

    <p>Development into squamous cell carcinoma (A)</p> Signup and view all the answers

    Which of the following factors is NOT associated with the risk of developing actinic keratosis?

    <p>Family history of eczema (B)</p> Signup and view all the answers

    Actinic cheilitis is associated with which part of the body?

    <p>Lips (C)</p> Signup and view all the answers

    Which characteristics are typically seen in actinic keratosis lesions?

    <p>Rough and may develop into cutaneous horns (B)</p> Signup and view all the answers

    Which environmental exposure is linked to an increased risk of actinic keratosis?

    <p>Repeated sun exposure (B)</p> Signup and view all the answers

    Which of the following describes the color of typical actinic keratosis lesions?

    <p>Tan-brown, red, or skin-colored (D)</p> Signup and view all the answers

    In which demographic is actinic keratosis most prevalent?

    <p>Lightly pigmented Caucasian individuals (D)</p> Signup and view all the answers

    Flashcards

    HPV types linked to anogenital warts

    Certain types of human papillomavirus (HPV), including types 16, 18, 33, and 35, are associated with anogenital warts.

    Risk factors for skin cancer

    Exposure to the sun, certain skin types, immunosuppression, DNA repair defects (like Xeroderma pigmentosum), arsenic exposure, and genetic disorders (like Gorlin's syndrome) can increase the risk of skin cancer.

    Seborrheic keratosis characteristics

    Seborrheic keratosis is a skin growth characterized by basaloid cells, hyperkeratosis (thickened skin), horn cysts, and invagination cysts.

    Dermatofibroma identifying feature

    A dermatofibroma can be identified macroscopically by its dimpled appearance.

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    Epidermoid cyst contents

    An epidermoid cyst contains keratin and its breakdown products, and is lined by stratified squamous epithelium.

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    Actinic keratosis appearance

    Actinic keratosis has a peaked and valley pattern and displays hyperkeratosis (thickened, rough skin) and increased basal cells.

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    Fibroepithelial Polyp structure

    A fibroepithelial polyp has fibrovascular cores covered by benign squamous epithelium.

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    Basal Cell Carcinoma (BCC) feature

    BCC is characterized by a palisading arrangement of peripheral cells, basaloid cells, mitosis, and retraction of the stroma.

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    Leser-Trelat sign association

    A high number of skin seborrheic keratoses at the same time suggests a possible GI (gastrointestinal) cancer link (often seen in adults).

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    Acanthosis Nigricans associations

    Acanthosis nigricans, in children, may be associated with obesity and diabetes. In adults, it can be linked to cancers, particularly GI adenocarcinomas.

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    Verruca Plana

    A type of skin wart.

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    Acquired melanocytic nevi

    Benign moles that develop over time.

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    Pigmented BCC

    A type of skin cancer that can appear dark.

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    Leser-Trélat sign

    Sudden appearance of many seborrheic keratoses, often linked to internal cancer.

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    Dermatofibroma

    Benign tumor of fibrohistiocytes.

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    Pyogenic Granuloma

    Vascular tumor caused by minor trauma.

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    Epidermoid Cyst

    A cyst containing keratin.

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    Acanthos nigricans

    Thickened, darkened skin; can be benign or associated with internal cancer.

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    Fibroepithelial polyp

    A soft, benign skin tumor, often stalk-like.

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    Morphology (of a condition)

    The physical structure that a tissue takes (microscopic view).

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    Seborrheic Keratosis

    A common, benign skin growth appearing as waxy, dark brown plaques.

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    Benign Epithelial Neoplasms

    Common skin growths originating from epidermal or hair follicle stem cells.

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    Dermatosis Papulosa Nigra

    Multiple small seborrheic keratoses common in dark skin.

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    FGFR3 gene mutation

    A genetic change linked to the development of seborrheic keratosis.

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    Hyperkeratosis

    Excessive keratin production in the skin.

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    Basaloid cells

    Cells resembling basal cells of the normal epidermis in seborrheic keratosis.

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    Horn cysts

    Keratin-filled cysts in seborrheic keratoses.

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    Invagination cysts

    Keratin invaginations (folds) within the seborrheic keratosis mass.

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    Paraneoplastic syndrome

    Medical condition triggered by certain tumors, like seborrheic keratoses.

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    What precedes epidermal malignancy?

    Epidermal malignancy is typically preceded by dysplastic changes, which are analogous to the precursor lesions that give rise to Squamous Cell Carcinoma.

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    What is the name of the premalignant skin lesion?

    Premalignant lesions in the skin are called actinic keratoses. They occur in sun-damaged skin and are particularly common in lightly pigmented individuals.

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    Who is most at risk for actinic keratosis?

    Actinic keratosis is more common in Caucasian males with light skin who have prolonged and repeated sun exposure.

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    What factors can contribute to actinic keratosis?

    Besides sun exposure, other factors like exposure to arsenic, industrial hydrocarbons, and ionizing radiation (especially UVB) can contribute to actinic keratosis.

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    What is the size and appearance of actinic keratoses?

    Actinic keratoses are usually less than 1 cm in diameter and have a rough, sandpaper-like texture. They can be tan-brown, red, or skin-colored.

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    What is a cutaneous horn?

    Some actinic keratoses produce so much keratin that a 'cutaneous horn' develops, which can resemble animal horns.

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    Where do actinic keratoses commonly appear?

    Actinic keratoses most frequently occur on sun-exposed areas like the face, arms, and back of the hands.

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    What is actinic cheilitis?

    Actinic cheilitis is a similar type of lesion that occurs on the lips, also caused by sun exposure.

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    What is the significance of actinic keratosis?

    While most actinic keratoses are benign, they can progress to squamous cell carcinoma (SCC) in a small percentage of cases.

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    How common is the progression of actinic keratosis to squamous cell carcinoma?

    Only about 1 out of 1000 cases of actinic keratosis progresses to squamous cell carcinoma.

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    Study Notes

    Benign, Premalignant & Malignant Epithelial Tumors of Skin

    • The presentation covers benign, premalignant, and malignant epithelial skin tumors.
    • Learning objectives include tumor classification and pathogenesis, along with diagnostic features and natural history of relevant tumors.

    Benign Epithelial Lesions

    • Benign epithelial neoplasms are common, arising from epidermal and hair follicle stem cells.
    • Typically, these lesions are biologically insignificant but can cause psychological distress.
    • They generally do not become malignant.
    • Common examples include seborrheic keratosis, fibroepithelial polyps, acanthosis nigricans, and actinic keratosis.

    Seborrheic Keratosis

    • Commonly seen in middle-aged and older individuals.
    • Lesions appear as round, flat, coin-like, waxy plaques ranging in size from millimeters to centimeters.
    • Dark brown in color with a velvety or granular surface.
    • Lesions are very common and generally do not become cancerous.
    • It does not turn malignant.

    Pathogenesis

    • Activating mutations in the fibroblast growth factor receptor-3 (FGFR3) gene can stimulate Ras and PI3K/AKT pathways.
    • Lesions can occur explosively in large numbers as part of a paraneoplastic syndrome (Leser-Trélat sign), possibly due to GI tract adenocarcinoma.

    Morphology

    • Histologically, these neoplasms are exophytic and sharply demarcated, composed of basaloid cells resembling normal epidermis.
    • Variable brown pigmentation within the basaloid cells and exuberant keratin production (hyperkeratosis).
    • Keratin-filled cysts (horn cysts) and invaginations of keratin (invagination cysts) may be present
    • In inflamed lesions, squamous differentiation can be evident
    • Basaloid cells, hyperkeratosis, horn cysts and invaginations cysts

    Dermatosis Papulosa Nigra

    • Commonly seen in individuals with dark skin.
    • Multiple small lesions on the face are termed dermatosis papulosa nigra.

    Leser-Trélat Sign

    • Explosive onset of multiple seborrheic keratoses may be a sign of a paraneoplastic syndrome of GI adenocarcinoma.
    • Caused by the release of epidermal growth factors by tumor cells.

    Dermatofibroma

    • A benign tumor of fibrohistiocytes, more common in females.
    • Presents as a firm, button-like nodule (5-10 mm) in colored skin (tan or brown).
    • Asymptomatic and often diagnosed incidentally.
    • May exhibit a dimple sign

    Pyogenic Granuloma

    • A vascular tumor originating from capillaries.
    • Usually results from minor trauma.
    • Found on the hands, feet, and hips
    • Appears as a round, pedunculated or sessile, smooth, bright red lesion
    • Often bleeds easily.
    • Increased risk in pregnancy and children.
    • Typically treated with electrocautery and curettage.
    • Drug induced

    Epidermoid Cyst

    • An epidermal inclusion cyst, sometimes sebaceous.
    • Contains keratin and breakdown products.
    • Lined by stratified squamous epithelium
    • Located in dermis of face, neck, shoulder, and back.
    • Rupture produces a creamy, malodorous paste.
    • Treated by surgical excision.

    Acanthosis Nigricans

    • Characterized by thickened, hyperpigmented skin with a velvet-like texture
    • Seen in flexural areas (axillae, neck, groin, anogenital regions).
    • Benign type constitutes about 80% of cases, frequently developing in childhood or puberty.
    • Commonly associated with obesity and diabetes.
    • The malignant form appears in middle-aged/older individuals and often associates with underlying cancers (GI adenocarcinomas).

    Fibroepithelial Polyp

    • Commonly discovered in middle-aged/older individuals on the neck, trunk, face.
    • Soft, flesh-colored, bag-like tumor often attached to surrounding skin by a stalk.
    • Composed of fibrovascular cores lined by benign squamous epithelium.
    • Usually insignificant but associated with diabetes and intestinal polyposis.

    Premalignant Epithelial Tumors (Actinic Keratosis)

    • Represents progressively worsening dysplastic changes analogous to squamous cell carcinoma.
    • Characterized by actinic keratoses, occurring in sun-damaged skin and exhibiting hyperkeratosis, common in lightly pigmented individuals (e.g. Caucasian).
    • Exposure to ionizing radiation, industrial hydrocarbons, and arsenicals can produce similar lesions.
    • High incidence in sun-exposed areas—face, arms, and dorsum of hands and lips.
    • Often appear as rough, sandpaper-like, tan-brown, red, or skin-colored lesions less than 1 cm in diameter,
    • Some evolve into cutaneous horns.

    Squamous Cell Carcinoma

    • Second most common skin cancer, usually in older individuals on sun-exposed sites.
    • Less than 5% of cases metastasize to regional lymph nodes.
    • Lesions are usually deeply invasive.
    • Tumors are often associated with defects in DNA repair (xeroderma pigmentosum), and immunosuppression.
    • Originates from stratified squamous epithelium
    • Lesions are frequently observed in sun-exposed skin that show variable keratinization and may ulcerate.

    Morphology (Squamous Cell Carcinoma)

    • In situ (non-invasive) form, lesions are scaling and red plaques.
    • Advanced (invasive) forms are nodular, and show variable keratin production, and may ulcerate.
    • Tumors may exhibit various degrees of differentiation from orderly lobules to highly anaplastic cells with geographic necrosis.

    Morphology (Actinic Keratosis)

    • Presents with varying degrees of cellular atypia in the lower epidermal layers.
    • There might be hyperplasia or atrophy of basal cells, visible intercellular bridges, and an increased thickness of the stratum corneum.

    Basal Cell Carcinoma

    • Most common skin cancer in humans with nearly 1 million cases annually in the US.
    • Typically slow growing and rare metastasizers
    • Arises on sun-exposed sites or areas in lightly pigmented individuals.
    • Can be ulcerating/rodent ulcer form (extensive local invasion of bone or facial tissues)
    • Less frequently superficial spreading or sclerosing forms
    • Often found with xeroderma pigmentosum, immunosuppressive conditions and Gorlin's syndrome
    • Tumors are histologically similar to normal basal cells, appearing as pearly papules with telangiectasias.
    • There are two major growth patterns: multifocal (superficial) or nodular growth.
    • Peripheral cells of the tumor islands show radial alignment/palisading.

    Pathogenesis

    • DNA damage from UV light is sensed by checkpoint kinases (ATM, ATR) triggering p53 activation.
    • Leads to G1 arrest, high-fidelity DNA repair, or apoptosis.

    Nevoid Basal Cell Carcinoma Syndrome

    • Autosomal dominant genetic disorder.
    • Characterized by multiple basal cell carcinomas (BCCs) typically appearing before age 20.
    • Associated with mutations in the PTCH gene on chromosome 9q22.3.
    • Mechanism involves constitutive activation of SMO, triggered by a missing or mutated PTCH protein.

    Keratoacanthoma

    • Considered by some as a variant of well-differentiated SCC.
    • It typically presents as a rapidly growing, cup-shaped tumor with a central keratin-filled depression.
    • Different from conventional SCC as it usually regresses spontaneously.
    • Squamous cells fill the lobules of the tumor and show glassy cytoplasm, without intervening granular layer.

    Risk Factors

    • Exposure to UV light.
    • Skin type (fair-skinned individuals).
    • Immunosuppression.
    • Defects in DNA repair mechanisms.
    • Industrial carcinogens (tars and oils).
    • Chronic ulcers, burns, and scars.
    • Ionizing radiation.
    • Arsenic.
    • Tobacco and betel nut chewing (oral SCC).
    • HPV (anogenital warts)

    Classification (of epithelial tumors)

    • In situ (e.g., Bowen's disease, Bowenoid papulosis, leukoplakia, vulvar intraepithelial neoplasia)
    • Invasive (e.g., highly or poorly differentiated forms)

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