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36 Cards in this Set

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Ephelids (Melanocytic Lesions)
Freckles

Lighten in winter and darken in summer

Increased pigment at basal layer
Melasma (Melanocytic Lesions)
Mask of pregnancy 

Diffuse patchy pigment on face

Pigment in epidermis and/or dermis
Mask of pregnancy

Diffuse patchy pigment on face

Pigment in epidermis and/or dermis

Hormonal.
Vitiligo (Melanocytic Lesions)
White patches

Complete loss of pigment 

Loss of melanocytes and pigment
White patches

Complete loss of pigment

Loss of melanocytes and pigment
Albinism (Melanocytic Lesions)
Absence of pigment in skin, hair, and nails

Autosomal recessive

Loss of pigment with normal appearing melanocytes
Mongolian Spot (Melanocytic Lesions)
Bluish-gray lumbosacral patch in newborns 

More common in pigmented races 

Resolves in early childhood

Sparse deep dendritic melanocytes
Bluish-gray lumbosacral patch in newborns

More common in pigmented races

Resolves in early childhood (Present in neonates and then fades clinically).

Sparse deep dendritic melanocytes (in dermis)
Cafe au Lait (Melanocytic Lesions)
Light brown patches 

6 or more 0.5 cm in child --> neurofibromatosis 

6 or more 1.5 cm in adolescence --> neurofibromatosis 

Increased pigment in basal layer
Light brown patches

6 or more 0.5 cm in child --> neurofibromatosis

6 or more 1.5 cm in adolescence --> neurofibromatosis

Increased pigment in basal layer
Lentigo
Lentigo (Melanocytic Nevus)
Macular pigmented lesions on sun exposed skin 

Indication of photodamage

Microscopic:  

Increased melanocytes at Dermal-Epidermal (DE) junction without nest formation.
Macular pigmented lesions on sun exposed skin

Indication of photodamage

Microscopic:

Increased melanocytes at Dermal-Epidermal (DE) junction without nest formation.
Junctional Nevus
Junctional Nevus (Melanocytic Nevus)
Macular pigmented lesion 

Microscopic:

Nests of melanocytes along the DE junction
Macular pigmented lesion

Microscopic:

Nests of melanocytes along the DE junction
Compound Nevus
Compound Nevus (Melanocytic Nevus)
Slightly raised pigmented plaque 

Microscopic: 

Nests of melanocytes at DE junction and within the dermis
Slightly raised pigmented plaque

(Macular and Papular lesions clinically)

Microscopic:

Nests of melanocytes at DE junction and within the dermis
Intradermal Nevus
Intradermal Nevus (Melanocytic Nevus)
Papular lesions 

Microscopic:

Nests of melanocytes within the dermis
Papular lesions

Microscopic:

Nests of melanocytes within the dermis
Spitz's Nevus
Spitz's Nevus (Melanocytic Nevus)
Papular regions of children 

Histologically "benign juvenile melanoma" -- NOT!

Microscopic:  

Epitheliod and spindle cell melanocytes can look atypical 

Nests often vertically oriented
Papular regions of children

Histologically "benign juvenile melanoma" -- NOT!

Microscopic:

Epitheliod and spindle cell melanocytes can look atypical

Nests often vertically oriented

(Often confused with melanoma)
Blue Nevus
Blue Nevus (Melanocytic Nevus)
Bluish papule or macule 

Deeper melanin appears blue due to Rayleigh scattering 

Microscopic: 

Heavily melanized dendritic melanocytes within the mid to deep dermis
Bluish papule or macule

Deeper melanin appears blue due to Rayleigh scattering

Microscopic:

Heavily melanized dendritic melanocytes within the mid to deep dermis
Halo Nevus
Halo Nevus (Melanocytic Nevus)
Depigmented zone around a nevus 

Common (okay) in children 
Bad in elderly 

Microscopic: 

Lymphocytes surround benign nests of melanocytes
Depigmented zone around a nevus

Common (okay) in children
Bad in elderly

Microscopic:

Lymphocytes surround benign nests of melanocytes
Congenital Nevus
Congenital Nevus
Large "bathing trunk nevus" has increased risk of melanoma 

Small form not strongly associated with melanoma 

Microscopic: 

Benign melanocytes extend more deeply into dermis and even subcutaneous tissues.
Large "bathing trunk nevus" has increased risk of melanoma

Small form not strongly associated with melanoma

Microscopic:

Benign melanocytes extend more deeply into dermis and even subcutaneous tissues.
Dysplastic Nevus
Dysplastic Nevus (Melanocytic Nevus)
Larger irregular morphology 

Heritable Melanoma Syndrome 

Controversial Diagnosis 

Microscopic: 

Atypical melanocytes 

Nests steam horizontally 

Severely atypical treated as melanoma in situ
Larger irregular morphology (often larder than most moles -- can be confused with melanoma)

Heritable Melanoma Syndrome (sparse and low risk)

Controversial Diagnosis (could be atypical nevus or Clark's nevus)

Microscopic:

Atypical melanocytes (in junctional nests with disordered organization)

Nests steam horizontally

Severely atypical treated as melanoma in situ
Nevus
Slightly irregularity of border and color 

Dermoscopy reveals a fine reticular pigment network without atypical features.
Slightly irregularity of border and color

Dermoscopy reveals a fine reticular pigment network without atypical features.
Actinic Keratosis
Actinic Keratosis
Scaly/hyperkeratotic lesions on sun exposed skin

Considered pre-cancerous, but only about 1% evolve to SCC.  

Microscopic: 

Atypical keratinocytes in lower epidermis 

Underlying solar elastosis (bluish dermis)

Overlying parakeratosi...
Scaly/hyperkeratotic lesions on sun exposed skin--(hard and spiny feel it)

Considered pre-cancerous, but only about 1% evolve to SCC.

Microscopic:

Atypical keratinocytes in lower epidermis

Underlying solar elastosis (bluish dermis)

Overlying parakeratosis (retained nuclei)

Treatment:

cryogenic surgery (liquid nitrogen)

fluorouracil cream
Seborrheic Keratosis (treatment is unnecessary, they just look gross)
Appear as one gets older -- most commonly in elderly

Stuck on lesions -- keratotic with varying shades of brown, but can be skin colored or even erythematous

Can be rough or smooth surface and be large or small

May have keratotic pores or...
Appear as one gets older -- most commonly in elderly

Can show in younger if there is a strong genetic tendency in family

Stuck on lesions -- keratotic with varying shades of brown, but can be skin colored or even erythematous

Can be rough or smooth surface and be large or small

May have keratotic pores or pseudocysts

Sometimes inflamed or bleeding from picking

Not limited to sun exposed surfaces

(Feel "velvety" when compared to actinic keratosis)

Microscopic:

Epidermal hyperplasia
Orthokeratosis (no retained nuclei)
Horn pseudocysts -- cysts connect to the surface like this
Acanthosis Nigricans (need to treat the internal disease or obesity)
Most common in obesity but rarely associated with internal rumors.  

Clinically velvety brown plaques -- usually in the axillae.
Most common in obesity but rarely associated with internal tumors (or diabetes, auto-immune diseases, familial, and medication reactions)

Clinically velvety brown plaques -- usually in the axillae.

(Sometimes associated with skin tags-acrochordons)

Microscopic:

papillomatosis and orthokeratosis
Fibroepithelial Polyps
Also known as acrochordons

Skin tags 

More common in obesity involving neck, axillae, and groin areas.  

Can be associated with Acanthosis Nigricans.
Also known as acrochordons

Skin tags

More common in obesity involving neck, axillae, and groin areas.

Can be associated with Acanthosis Nigricans.

Microscopic:

epidermis covering an polypoid fibrovascular core


Can be treated with cyrogenics
Epidermoid Cysts
Epidermoid Cysts
Sometimes referred to as "sebaceous cysts"--NOT!

Expansion of hair follicle forms epithelial lining.  Also forms EICs from trauma

Pilar cysts has trichilemmal keratinization 

Acne cyst results from follicular rupture
Sometimes referred to as "sebaceous cysts"--NOT!

Expansion of hair follicle forms epithelial lining. Also forms EICs from trauma

Pilar cysts has trichilemmal keratinization arises from the lower region of the hair follicle

Acne cyst results from follicular rupture
Sebaceous Hyperplasia
Common in middle and elderly men.  

Umbilicated pale yellowish papules

Benign tumor of sebaceous glands
Common in middle and elderly men.

Umbilicated pale yellowish papules

Benign tumor of sebaceous glands
Syringoma
Seen under the eyes of women 

Small skin colored papules

Benign tumor of eccrine sweat glands
Seen under the eyes of women

Small skin colored papules

Benign tumor of eccrine sweat glands
Nevus Sebaceous
Birthmark lacking hair when on scalp 

Prepubertal may appear smooth yellow/orange 

Adolescent has cobblestone surface

Adult form in prone to basal cell carcinoma.
Birthmark lacking hair when on scalp

Prepubertal may appear smooth yellow/orange

Adolescent has cobblestone surface

Adult form in prone to basal cell carcinoma.
Adenoma Sebaceum
Central facial papules 

One manifestation of Tuberous Sclerosis 

Angiofibromas, histologically.
Central facial papules

One manifestation of Tuberous Sclerosis

Angiofibromas, histologically.
Neurofibroma
Von Recklinghausen's 

Solitary lesion more commonly 

Spindle cell tumor of Schwann cells and fibroblasts
Von Recklinghausen's

Solitary lesion more commonly

Spindle cell tumor of Schwann cells and fibroblasts
Xanthelasma
Yellowish plaques on eyelids

Not strongly associated with increased lipids -- other xanthomas associated with increased lipids (associated with lipid disorders)

Foamy histiocytes contain the lipid.
Yellowish plaques on eyelids

Not strongly associated with increased lipids -- other xanthomas associated with increased lipids (associated with lipid disorders)

Foamy histiocytes contain the lipid.
Trichilemmona
Indicative of Cowden Syndrome/ Breast Carcinoma
Sebaceous Adenoma
Multi-Torre Syndrome/mult CA
Dermatofibroma
Common in the legs of woemn 

Brownish papule with "dimple sign" 

Benign fibrohistiocytic tumor
Common in the legs of women, most common growth in the knee in young adults, may arise from former arthropod bite

Brownish papule with "dimple sign"

Benign fibrohistiocytic tumor

Microscopic:

bland fibrohistiocystic dermal proliferation; histiocytes may contain hemosiderin pigment from ingestion of hemoglobin
Keratoacanthoma (GET RID OF THIS)
Rapidly growing "volcanoe-like" lesion with keratin center

Sometimes resolve spontaneously

Rare metastasis -- take it out immediately?

Resembles squamous cell carcinoma histologically

Microscopic:

Glassy well differenciated keratinocytes form a cup-like depression
Angiomas (Mesenchymal Tumors)
Cherry angiomas most common 

Strawberry angiomas in children often resolve spontaneously 

Pyogenic granuloma is a traumatic variant 

Port wine stains are very common in the form of a "stork bite"  on posterior neck 

Venous lakes occur ...
Capillary blood vessels in the dermis

Cherry angiomas most common

Strawberry angiomas in children often resolve spontaneously

Pyogenic granuloma is a traumatic variant

Port wine stains are very common in the form of a "stork bite" on posterior neck

Venous lakes occur on lips and ears

Telangiectasia of face is more commonly due to sun damage than rosacea
Keloid (Tumor-Like Lesions)
Hypertrophic scars that extend beyond initial injury 

More common in African-American
Hypertrophic scars that extend beyond initial injury

More common in African-American

Microscopic:

broad bands of collagen

Can be treated with corticosteroids
Lipoma (Mesenchymal Tumors)
Soft mobile subcutaneous mass 

Solitary or multiple 

Stable size 

When tender = angiolipoma
Expanded fat lobules below the dermis encapsulated within a thin fibrous capsule

Soft mobile subcutaneous mass

Solitary or multiple

Stable size

When tender = angiolipoma
Verruca (Warts)
Verruca -- common warts; seeds = microhemorrhage

Plantar warts -- common warts "pounded inward" 

Verruca plana -- flat warts 

Condyloma accuminatum -- gential, STD, HPV 6, 11 most common 

Molluscum Contagiosum -- pox virus, not HPV -- ...
Verruca -- common warts; seeds = microhemorrhage

Plantar warts -- common warts "pounded inward"

Verruca plana -- flat warts

Condyloma accuminatum -- gential, STD, HPV 6, 11 most common

Molluscum Contagiosum -- pox virus, not HPV -- children and STD in adults

Mosaic warts -- extensive plantar involvement
Heritable Melanoma Syndrome (Melanocytic Nevus)
Associated with Dysplastic Nevus

But actually:

100 nevi, large and irregular

Associated of family history