Path -Guo

Question 1

What type of biopsy should be done in a suspected melanoma? Why?

Answer 1

punch biopsy–> depth is important for staging

Question 2

What kind of biopsy can be done for a suspected basal cell carcinoma or squamous cell carcinoma?

Answer 2

Shave biopsy

Question 3

What is the most important prognostic criteria for an invasive melanoma? How is this measured?

Answer 3

depth of invasion into the dermis

measured from granular cell layer to the deepest tumor cells

Question 4

What determines if you do a lymph node dissection in a melanoma?

Answer 4

Inject dye into the tumor and watch where the lymph drains –> biopsy that central node

• if + biopsy==> remove ALL lymph nodes
• if - biopsy –> don’t remove

Question 5

How can you make the diagnosis of amelanocytic melanoma?

Answer 5

Biopsy!!!

Question 6

What does Desmoplastic melanoma stain positive for?

Answer 6

S-100 only

Question 7

What is the most important prognostic factor in melanoma?

Answer 7

Angiolymphatic invasion

Question 8

What size margin is needed in a basal cell carcinoma? Why?

Answer 8

1 cm

locally destructive and slow growing

Question 9

What is it called when cylindromas cover the whole head?

Answer 9

Turban tumor

Question 10

What is Leser-Trelat sign? What should be considered?

Answer 10

numerous seborrheic keratosis

consider an underlying malignancy

Question 11

What are some histological features of a Merkel cell carcinoma?

Answer 11

• Trabecular pattern of tumor cells in the dermis/subcutis
• peppered chromatin
• CK 20 +

Question 12

What is Kaposi sarcoma caused by? What is its main histological finding?

Answer 12

• HHV8

- spindle-cell tumor

Question 13

What histological findings are associated with psoriasis?

Answer 13

• hyperkeratosis and parakeratosis
• Munro microabscess
• Capillary look dilation
• hypogranulosis (or absent)
• elongated rete ridges

Question 14

What is the key histological finding in pemphigus vulgaris?

Answer 14

Intraepidermal bullae

“tombstone row” of basal layer keratinocytes

Question 15

What is the staging for a melanoma? How much of a margin should be removed for each stage? What else should be done for a melanoma?

Answer 15

pTis (in situ) =5 mm margin
pT1 (4mm) =2 cm margin

Also do the test with the dye to see if the lymph nodes are affected and also need removed

Question 16

What skin disorder has “saw-tooth” elongation of the tete ridges?

Answer 16

Lichen planus

Question 17

What are the key histological features of psoriasis?

Answer 17

• Thickened epidermis (acanthosis)
• elongated rete ridges
• Neutrophils in the thick layer of parakeratosis
• stratum granulosum is almost absent

Question 18

What are the key histological features of Lichen simplex chronicus?

Answer 18

Acanthosis, hyperkeratosis and hypergranulosis

• elongation of the tete ridges and fibrosis of the papillary dermis with a chronic inflammatory infiltrate
• caused by continuous scratching

Question 19

What does the immunofluorescence of Pemphigus vulgaris look like? What is this due to?

Answer 19

• Pemphigus vulgaris=Chicken wire pattern

- due to IgG autoantibodies to desmoglein

Question 20

What does the immunofluorescence of pemphigus foliateus look like?

Answer 20

• IgG auto antibodies to desmoglein in the superficial layer of the dermis
• superficial acantholysis

Question 21

What does the immunofluorescence of Bullous pemphigoid look like? What is this due to?

Answer 21

linear IgG along the basement membrane

due to anti-basement membrane IgG

Question 22

What does the immunofluorescence of dermatitis herpetiformis look like? What is this due to?

Answer 22

• Granular IgA in the papillary dermal tips

- see neutrophil rich sub epidermal bulla