1. Things To Know
   1. pg1168
      1. macroscopic
      2. microscopic
   2. keep a list of skin signs of internal malignancy
   3. Vocab Review
      1. wheal
      2. vesicle
         1. bula
      3. scale
      4. macula
      5. erythema
      6. nodule
         1. solid raised lesion >5 mm
      7. xanthoma
         1. papule or nodule that is yellow
      8. erosion
         1. shallow denuding of the epidermis
      9. atypia
         1. early change moving twd dysplasia
      10. Actinic means sunlight induced
      11. keratosis means you have extra keratin
   4. Sunlight and the Skin
      1. Ozone layer
         1. depletion
      2. UVA
         1. long wave
         2. black light
         3. tanning beds
         4. carcinogenic
      3. UVB
         1. Medium wave
         2. sunburns
         3. vit d activation
         4. stronger carcinogenic effect
         5. photoaging
            1. dermis
            2. solar elastosis
            3. deep furrows
            4. decreased type I collagen synthesis
            5. retinoic acid
            6. helps
      4. Melanin
         1. melanosomes
            1. melanocytes
         2. absorbs
            1. UVA
            2. UVB
      5. Sunburn
         1. edema
         2. ???
   5. Skin Types
      1. Type I
         1. always burns
            1. never tans
         2. albinism
         3. xeroderma pigmentosa
            1. rare
            2. genetic disorder
            3. UV is extra carcinogenic
      2. Type II
         1. usually burn
            1. tans with difficulty
      3. Type III
         1. mild burns
            1. average tan
      4. Type IV
         1. rarely burn
            1. tan easily
      5. Type V
         1. brown skin
            1. black skin
      6. Type VI
         1. 6% lower selenium levels
            1. 200 mcg per day
            2. 50% reduction in prostate cancer
2. Actinic keratosis
   1. pre-cancerous
      1. in situ
         1. percursor to
            1. Squamous Cell Carcinoma
   2. Gross Morphology
      1. < 1 cm
      2. hyperkeratosis
         1. skin horns
            1. tan-brown, red or skin colored
            2. rough like sand paper
      3. face, arms, dorsal hands, lips, head
         1. esp. in balding men
   3. Risk Factors
      1. Skin I, II, III
         1. sun exposure
      2. Arsenic
         1. exposure
   4. Co-morbidity
      1. Bowen's dz
         1. marker
            1. second
            2. internal
            3. malignancy
         2. mouth or genitals
      2. SCC
         1. if ignored
   5. Histopathology
      1. Early
         1. Atypia
            1. lower 1/3 of epidermis (basal cell layer)
         2. mb hyperplasia of basal cells
         3. mb atrophy of epidermis
         4. intercellular bridges are intact
      2. Later
         1. Stratum corneum
            1. thickens
         2. parakeratosis
            1. keeps nuclei
         3. dermis
            1. elastosis
            2. dt sun damage
         4. full thickness atypia
            1. precedes SCC in situ
   6. Trt
      1. Cryotherapy
      2. No Biopsy
3. Nevocellular nevi (nevus)
   1. aka
      1. moles
      2. melanocytic nevi
      3. pigmented nevi
   2. get smaller w. age
   3. Etio
      1. males
      2. Skin Type I, II, III
      3. people who vacation in hot climates
         1. sun burnt
      4. > in kids after chemotherapy for leukemia
   4. Gross Morphology
      1. pigmented
         1. red
      2. papule
         1. round, clean borders
   5. Histopathology of Benign Nevi
      1. junctional
         1. on border btw dermis and epidermis
      2. compound
         1. in both dermis and epidermis
      3. intradermal
         1. only in dermis
4. Dysplastic nevi
   1. pre-malignant lesion
      1. likely to become melanoma
   2. Gross Morphology
      1. >6 mm
      2. flat or raised
      3. multi-colored
         1. variegated
      4. irregular borders
      5. distorted skin lines
      6. sun exposed or NON-sun exposed areas
         1. anus
   3. Histopathology
      1. Compound nevi nests
      2. Atypia of cells
         1. moving twds dysplasia
      3. Nuclei
         1. hyperchromatic
         2. angulated
      4. Loss of melanin in epidermis
   4. Etiology
      1. mutation
         1. Chromosome 1
            1. melanin generates free radicals
      2. Only Skin Type I, II, III
         1. 6% lifetime risk of melanoma
   5. Prevention
      1. monitor nevi
      2. trt or remove
         1. antioxidants
         2. Hp
      3. skincheck.org
5. Malignant melanoma
   1. Cancer of melanocytes/nevus cells
   2. Risk Factors
      1. Type I Skin, xeroderma, etc
         1. sun exposure
         2. Hx of severe blistering sunburn
      2. Dysplastic nevus syndrome
      3. total # of benign pigmented nevi >2 mm\
   3. Gross Morphology
      1. A
         1. asymmetry
      2. B
         1. border
            1. irregular or scalloped
      3. C
         1. color
            1. mottled
            2. chromatin clumping
      4. D
         1. diameter
            1. >6mm
      5. E
         1. elevation
      6. Other
         1. bleeding
         2. itching
         3. sloughing
      7. Area
         1. Oral
            1. Anogenital
            2. Muscosa
            3. Back
            4. Legs
            5. Meninges
            6. Uvea/Retina
   4. Histopathology
      1. Radial growth phase
         1. moves out laterally
            1. ballon like
      2. Vert. growth phase
         1. grow down
            1. into dermis
      3. LARGER than nevi
   5. 4 Types of Melanoma
      1. Lentigo maligna
         1. in situ
            1. years
      2. Superficial spreading melanoma
         1. in situ
            1. months
         2. most common (70%)
      3. Acral-lentigenous melanoma
         1. acral
            1. means
            2. on the extremety
         2. lentigenous
            1. melanocytes lining up
         3. rapid growth
         4. Type V or VI Skin
            1. Bob Marley
            2. palms, soles, nail bed
      4. Nodular Medanoma
         1. 2nd most common melanoma
         2. starts in the vertical growth phase
         3. never in situ
   6. Tx
      1. IL-2
      2. Astragalus
      3. Quercitin
      4. Curcumin
      5. Green Tea
   7. Prognosis
      1. 5 yr survival is 80%
      2. depth decreases the prognosis
      3. > lymphocytes improves the prognosis
6. Squamous cell carcinoma
   1. Incidence
      1. elderly
      2. sun exposure
      3. 2nd most common cancer
   2. Risk factors
      1. Type I skin
         1. xeroderma pigmentosum
      2. sun exposure
      3. Arsenic
      4. Coal tar
         1. miners
         2. tar shampoo
      5. Chronic draining osteomyelitis sinuses
         1. bone
         2. infection
         3. comes out thru the skin
            1. tursn into SCC
      6. Old burn scars
      7. immunosuppression
   3. Gross Morphology
      1. Exophytic lesion
         1. sticks out from skin surface
         2. grows slowly
         3. on sun exposed skin
      2. Scaling plaques
         1. red
            1. nodular
            2. may ulcerate
      3. may ulcerate
   4. Histopathology
      1. Epidermis
         1. ALL LEVELS
      2. nuclei
         1. enlarged
         2. hyperchromatic
      3. cells
         1. polygonal sq. w. keratinization
         2. necrotic middles
         3. dyskeratosis
            1. 1168
            2. when single cells become keratin forming?
            3. rest of ells are not
   5. Course
      1. well differentiated
      2. tends to metastasize late if neglected
      3. 5% nodal involvement at dx
   6. Keratoacanthoma
      1. variant of SCC
         1. self-limiting
         2. looks terrible
            1. then goes away
      2. rapid growth
         1. follwed by
            1. spontaneous regression
      3. symmetrical cup shaped tumor with a central depression filled with keratin debris
7. Basal cell carcinoma
   1. 1st most common
   2. elderly
      1. exposed to sun
   3. where does it grow?
      1. hair follicles
   4. resemble normal basal cells
   5. Risk Factors
      1. Type I skin/xeroderma pigmentosum
      2. sun exposure
      3. basal cell nevus syndrome
         1. Grolin syndrome
         2. anti-oncogene deletetion syndrome
         3. autosomal dominant inheritance
   6. Gross Morphology
      1. Telangiectatic papule or nodule
         1. especially
            1. face
         2. cotton ball w. alcohol for 2 min.
      2. pigmented or skin-colored
      3. rodent ulcer
         1. excavated lesion w. a rolled pearly boder
   7. Histopathology
      1. Nests of basal-like cells
         1. arising from follicular epithelium or epidermis
      2. Two Types
         1. Multifocal, superficial
         2. Nodular
            1. grow vertical
   8. Course
      1. Metastasizes
         1. Almost NEVER
      2. Rodent ulcer
         1. mb disfiguring
         2. locally invade bone and facial sinuses - if neg.