Neoplastic, benign, and malignant

condition morphology histology etiology treatment Systemic associations

Infantile Hemangioma - Rubbery, bright red -benign proliferation of -topical beta blocker Complications:
nodule of extra blood endothelial cells -corticosteroids -ulceration
vessels -pulsed dye laser -disfigurement
-Grows RAPIDLY -impaired vital
between Weeks 5-7 functions (vision,
plateaus goes away feeding)

-90% gone by 9 yo

Additional information:
> 5 cutaneous hemangiomas risk factor for extracutaneous hemangiomas

condition morphology histology etiology treatment Systemic associations

Nevus Simplex -pinkish -benign dilation -None!--> most fade within

irregularly shaped of capillaries in 1-2 years
macules and the skin
patches
-often on
forehead, scalp,
upper eyelids,
posterior neck
and back

-salmon patch
“stork bite”

Additional information:
Redness can reappear during crying
*Most common pediatric vascular lesion!
condition morphology histology etiology treatment Systemic associations

Port Wine Stain -dark red patch -benign capillary malformation -make-up *Sturge-Weber Syndrome
on face present at birth -pulse dye laser
-facial port wine stain of V1
-darken and thicken over time -ipsilateral eye abnormality
-leptomeningeal and brain
abnormality
-Manage: MRI of brain, OPTHO

Additional information:

condition morphology histology etiology treatment Systemic associations

Congenital Nevi -well-circumscribed -benign proliferation -None *Neurocutaneous melanosis

black/dark brown of melanocytes often -surgical excision
plaque present at around head and -seizures
birth neck -malignant melanoma of CNS
-Neuro symptoms from
increased ICP/spinal cord
compression
-POOR PROG (70% die by 10
yo)

Additional information:
larger size of nevus= increased risk of melanoma (2-5%)
condition morphology histology etiology treatment Systemic associations

Intradermal Nevus -moles *Dysplastic nevus syndrome

-many funny looking moles all
-smooth, skin color over

Additional information:

condition morphology histology etiology treatment Systemic associations

Cherry Angioma -Cherry red papule -benign proliferation of blood vessels -None

-Frequency of angiomas increase with age

Additional information:
condition morphology histology etiology treatment Systemic associations

Spider Telangiectasia -telangiectasia: spider- -dilated blood vessels

like close to surface

Additional information:

condition morphology histology etiology treatment Systemic associations

Pyogenic granuloma -polyploid lobulated -benign proliferation of tissue -associated with trauma and
erythematous plaque pregnancy
-can ulcerate and BLEED
very easily!

Additional information:
condition morphology histology etiology treatment Systemic associations

Venous Lake -solitary, soft -benign dilated vessel

compressible dark blue
papule found on sun- -usually in sun-exposed
exposed surface areas: especially lower lip!

-more common in elderly

Additional information:

condition morphology histology etiology treatment Systemic associations

Hereditary Hemorrhagic -scattered -benign abnormal *arteriovenous malformations

Telangiectasia (HHT) erythematous blood vessel
macules on lips formation

Additional information:
condition morphology histology etiology treatment Systemic associations

Seborrheic Keratosis -greasy looking, dark -benign skin None!

brown sharply tumor of the
demarcated papules keratinocytes

-increases as
people age

Additional information:

condition morphology histology etiology treatment Systemic associations

Solar Lentigo -light brown -sun-induced melanosis *Neurofibromatosis 1

macules/patches in -Café-au-lait
sun-exposed areas -increased pigment not -Crow’s sign: freckling in axilla or
melanocytes groin
-> 6 lesions
-“ink spots”

Additional information:
condition morphology histology etiology treatment Systemic associations

Neurofibroma -multiple sessile or -benign nerve

pedunculated sheath tumor in
papules, PNS
nontender

Additional information:

condition morphology histology etiology treatment Systemic associations

Dermatofibroma -light brown papule -benign fibrous

usually on legs histiocytoma
and arms
-stable size

-hard dimple size

when press down

Additional information:
condition morphology histology etiology treatment Systemic associations

Skin Tags -skin colored papules -usually occurs in flexural -Snip excision -associated with obesity
surfaces (friction): -CV risk factors
underarms, groin, base of
neck, eyelids

Additional information:

condition morphology histology etiology treatment Systemic associations

Epidermal Inclusion Cyst -cyst -benign -abx if infected

-inject kenalog if
-originate from acutely inflamed
follicular
infundibulum

-most common
“body” cyst
-occur in area of
severe acne
Additional information:
condition morphology histology etiology treatment Systemic associations

Sebaceous Cyst -cyst -originate in sebaceous duct -only if symptomatic *palmoplantar keratoderma=
keratin 17 mutations

Additional information:

condition morphology histology etiology treatment Systemic associations

Trichilemmal (pilar) cyst -benign

-originates in outer
root sheath

Additional information:
condition morphology histology etiology treatment Systemic associations

Milia -white papules on -benign

bilateral eyelids

Additional information:

condition morphology histology etiology treatment Systemic associations

Dermoid Cyst -contains hair, glandular -collection of cystic -surgical excision *MIDLINE CYSTS
structures, smooth material around -do imaging studies before
muscle fusion planes excision!!!

-common around
eyes

Additional information:
condition morphology histology etiology treatment Systemic associations

Pseudocysts -ganglion (synovial cysts -surgical excision

on wrists and fingers -often recur after
draining
-Mucocele: collection of
saliva on surface of skin

Additional information:

condition morphology histology etiology treatment Systemic associations

Actinic Keratosis -rough papules -PRE-CANCEROUS -Liquid Nitrogen! CAN DEVELOP INTO
on sun-exposed lesions -5-FU, CO2 laser for SQUAMOUS CELL
skin multiple AK CARCINOMA***

Additional information:
condition morphology histology etiology treatment Systemic associations

Basal Cell Carcinoma -MOST COMMON HUMAN -Excision Risk factors:

CANCER -Mohs surgery -Fair Skin
-Radiation -living near the equator
-Most common skin cancer -5-FU -UV exposure
-electrodessication -Organ transplant
-METS is very rare: unless and curettage -ionizing radiation
untreated for many years -arsenic exposure
-Smoothened inh -topical nitrogen
-cancer of the stem cells in (Vismodegib) mustard
Nodular
hair follicle -scar sites

Patho: Basal cell nevus***

-PTCH (patched) gene mut. syndrome (GORLIN)
-p53 point mutation -Aut Dom
-PTCH gene mut
Subtypes: -Multiple BCC: on jaw,
-Nodular: pearly, rolled palms and soles
Superficial border and telangiectasia,
*Palisading “rodent ulcer”, often on nose Defects:
*Retration artifact -bifid ribs
-Superficial: erythematous, -scoliosis
scaly, eroded macule, often -frontal bossing
on trunk and extremities -hypertelorism
-short 4th metatarsal
-Morpheaform: waxy, -CNS disorder
whitish, sclerotic plaques -cysts/fibromas
Morpheaphorm

Additional information:
Incidence: BCC>> SCC>> melanoma
Gorlin Syndrome
Mortality: melanoma>> SCC>> BCC
condition morphology histology etiology treatment Systemic associations

Squamous Cell Carcinoma -2nd most common skin cancer -ED and C Risk factors:
-excision -UV light
-Preceded by AK (10% risk) -Mohs -organ transplant
-radiation recipients (20 years=
Variants 70%)
-In situ: -immunosuppresion:
Bowen’s disease: scaly plaques HIV, CLL
like psoriasis -HPV
-Thermal injury
Erythroplasia of Queyrat: velvety -chemical carcinogens
Bowen’s disease lesions on glans penis/oral mucsa (arsenic)
-radiation
Bowenoid papulosis: SCC
associated with condylomata
In-situ: proliferation of acuminate (HPV 16 and 18)
atypical keratinocytes
-Keratoacanthoma: low grade SCC.
RAPID GROWTH*** 4-6 weeks
Erythroplasia of Queyrat
-Invasive SCC: Higher risk of mets.
Locations: lip, ear, scrotal, penile,
anal
Squamous “keratin” pearls

Bowenoid papulosis

Invasive SCC: keratin

pearls, invasive growth

Keratoacanthoma Additional information:

Incidence: BCC>> SCC>> melanoma
Mortality: melanoma>> SCC>> BCC
Condition histology etiology treatment Systemic associations

Melanoma Subtypes Sentinal Lymph bx: -3rd most common skin

1. Superficial spreading 1. inject radioactive tracer cancer, most common
-most common 2. identify “hotspot” cause of skin cancer deaths
-upper back, chest, abd 3.excise lymph node (> 80%)
“spring break” Results:
-radial growth pattern (-)= downstream nodes are -Cancer of melanocytes
-BRAF mut probably neg. Stage 1 or 2 -often presents as a nevus
Superficial spreading (+)= Stage 3 (mole)
2. Nodular
-same locations (upper back, Targeted therapy ABCDE’s:
chest, abd) -BRAF and MEK inh. A= asymmetry (1 side diff )
-vertical growth -20-30% patients B= border irregularity
-BRAF mut (notched)
Immunomodulatory C= color variation (mixed)
Nodular 3. Lentigo maligna -immune checkpoint inh. D= diameter (> 6 mm)
-chronic sun exposure: head, Monoclonal antibodies bind E= evolution
neck, UE “OFF” switch on T-cells
-radial growth keeps T-cells active Look for “ugly duckling”
-slowest growing destroy melanoma cells
Ulceration -large surgical defects -autoimmune effects Utah:
-many mutations -1/3 response in pts -highest incidence
Worse prog: -lots of whites decreased
Lentigo maligna -many mitotic figures 4. Acral lentiginous -adoptive immunotherapy melanin less absorption
-Ulceration -palms, soles, fingers, toes, Harvest TIL reinject into of UV light
nails patient (must give chemo at -closer to equator
Breslow Depth: -not related to sun exposure the same time to prevent -high altitudes
< 1 mm: 95% 5-yr survival -likely subtype for darker deactivation by pt’s
> 4 mm: 50% 5-yr survival skinned ppl suppressor T-cells) Staging:
T= tumor depth, ulceration,
Acral Lentiginous Staging: 5. Mucosal Viralytic therapy mitotic figures
Stage 0= in situ -mucosal surface: nasal, oral, -melanoma: ICAM-1 N= lymph nodes
Stage 1= thin tumor anus, vulvar -Inject virus into tumor M= mets
Stage 2= thicker -not related to sun exposure binds ICAM-1produce
Stage 3= lymph node -activating c-kit mut virions burst cell. Breslow depth: >.75 mm
Stage 4= organs mets -high recurrence rates - “abscopal” effect (inject in sentinel lymph node biopsy
one site, has effect in
-No marker for melanoma to distant site)
Mucosal help detection -GM-CSF
condition morphology histology etiology treatment Systemic associations

Ephiles (freckle) -melanocytes overproduce melanin -None

granules change coloration of
keratinocytes

-triggered by sunlight

Additional information: