Dermatologic neoplasms

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This article deals with dermatologic neoplasms, also known as skin tumours. It includes dermatologic cancer, which can be deadly. Collectively, dermatologic cancers are the most common form of cancer.

An introduction to dermatopathy is found in the dermatopathology article. Non-malignant disease is covered in the non-malignant skin disease article.

The Big Three malignant

Basal cell carcinoma

Squamous cell carcinoma of the skin

  • Abbreviated skin SCC, SCC of the skin, and SCC of skin.

Melanoma

  • Known as the great mimicker in pathology; it may look like many things.

Less common malignant

Dermatofibrosarcoma protuberans

  • Abbreviated DFSP.

Cutaneous B-cell lymphoma

  • Abbreviated CBCL.

General

  • CBCL is less common than cutaneous T-cell lymphoma (CTCL).[1]

Microscopic

Features:

  • Dermal lymphoid infiltrate.
  • "Grenz zone" - space between the epidermis and the dermal infiltrate - key feature.

IHC

  • B cell and T cell markers.

Cutaneous T-cell lymphoma

  • Abbreviated CTCL.

General

  • Mycosis fungoides - is a subtype (???).
  • CTCL is more common than cutaneous B-cell lymphoma (CBCL).[2][3]

Stages - like Kaposi sarcoma:

  • Patch.
  • Plaque.
  • Nodular.

Microscopic

  • Atypical lymphocytes:
    • Have folded "cerebriform" nuclei; Sezary-Lutzner cells.[4]
  • Grouping:
    • Nests in the epidermis - known as "Pautrier microabscesses".
    • Single lymphocytes in epidermis - without accompanying edema.
    • Short linear arrays of lymphocytes along the basal layer of the epidermis; "epidermotropism".[4]

DDx:

Images

www:

IHC

Key stain:

Other stains:

  • CD3 +ve.
  • CD8 -ve.
  • CD20 -ve (to r/o significant B cell population).
  • CD30 -ve.
  • CD5 +ve.
  • CD7 -ve (often lost first in T cell lymphomas).
  • Ki-67 high.
  • CD56 -ve.

Merkel cell carcinoma

Eccrine carcinoma

General

  • Arises from the proximal sweat duct.

Microscopic

Features:

  • Pleomorphic nuclei with nucleoli.
  • Duct-like structures - key feature.
  • Extends from dermis into epidermis (follows path of a benign sweat duct).

Notes:

Kaposi sarcoma

See Kaposi sarcoma.

Sebaceous carcinoma

Microcystic adnexal carcinoma

Trichilemmal carcinoma

General

  • Super rare.
  • Not well-described.

Microscopic

Features:[6]

  • Clear (glycogen-rich) cytoplasm in center of lesion.
  • Peripheral palisading at edge of lesion - root sheath differentiation (hair follicle).
  • Contiguous with hair follicle or assoc. with trichilemmoma.

DDx:

Lymphomatoid papulosis

General

  • Rare.
  • Benign behaviour.

Microscopic

Features:

  • Dermal lymphocytosis.
    • No epidermal lymphocytes.
  • Focal nuclear atypia.

DDx:

IHC

Rare malignant

Basosquamous carcinoma

Should not be confused with basaloid squamous cell carcinoma (AKA squamous cell carcinoma, basaloid variant).

General

  • Very rare.
    • Largest case series, as of 2000, 35 cases.[8]
  • May be considered an aggressive variant of basal cell carcinoma.[8]
  • Aggressive behaviour.[9]

Microscopic

Features:

Note:

  • Busam notes that there is disagreement about what defines this tumour;[11] however, he goes on the describe it as a collision tumour.[10]

DDx:

Intermediate

Atypical fibroxanthoma

  • Abbreviated AFX.

Benign

Syringoma

General

  • Benign sweat duct tumour.
  • Eccrine differentiation.
  • Usually close to lower eyelid.[12]

Microscopic

Features:[13]

  • Proliferation of benign ducts with lined by a bilayer (as in normal sweat ducts) with abnormal architecture:
    • Tadpole like appearing ducts.

DDx:

Images:

Chondroid syringoma

  • Used to be called mixed tumour of skin.[16]

General

  • Mixed apocrine & eccrine tumour of skin, usually in the head & neck[16], especially nose and cheek.[17]
  • May be in major and minor salivary glands.[17]

Microscopic

Features:

  • Mix tumour with:[16]
    1. Epithelial component:
      • Nests of cells with:
        • Moderate dull eosinophilic cytoplasm.
        • Round/ovoid nuclei with nucleoli.
    2. Mesenchymal component - key feature:

Images:

Dermal cylindroma

Keratoacanthoma

Sebaceous adenoma

General

Notes:

Microscopic

Features:

  • Abnormal sebaceous glands (pale fluffy cytoplasm):
    • Increased basal epithelium.
    • Multiple dilated glands - opening to the surface.

Images

www:

Trichilemmoma

  • May be spelled tricholemmoma.

General

  • Benign neoplasm with features of the pilosebaceous follicular epithelium.[19]
  • Associated with nevus sebaceous.[20]
  • Muliple trichilemmomas associated with Cowden syndrome.[21]

Microscopic

Features:[21]

  • Superficial dermal lesion contiguous with the epidermis:
    • Core of lesion:
      • Cuboidal cells with round nuclei, eosinophilic-clear cytoplasm.
    • Periphery of lesion:
      • Surrounded by hyaline band.
      • Peripheral palisading.

DDx:

Images:

Eccrine poroma

General

  • Benign tumour arising from the distal sweat duct.
  • Erythematous - gross.

Microscopic

Features:[24]

  • Broad sheets of basaloid cells - attached to the epidermis - containing ductal structures - key feature.
  • Biphasic stroma:
    1. Edematous stroma.
    2. Sclerotic stroma.
  • Moderate nuclear pleomorphism.
  • +/-Occasional mitoses.

Notes:

  • Area above gland appears crusted.

DDx:

Images

www:

Nodular hidradenoma

Trichoblastoma

Trichofolliculoma

General

  • Benign.

Microscopic

Features:[26]

  • Irregular hair follicle (basilar nest of cells with an acellular hair shaft) with:
    • Smaller satellites (follicles) consisting of well-circumscribed basilar cells.

Note:

  • Lack artificial clefting between the (basilar) nests and stroma (seen in BCC).
  • Surrounding stroma does not have a basophilic tingle (seen in BCC).

DDx:

Images

www:

Apocrine carcinoma of the skin

General

  • Rare.[27]
  • Usually very good prognosis.[27]

Microscopic

Features:[27]

  • Nests.
  • Apocrine snouts - "decapitation secretion"

DDx:

Images

Stains

Features:[27]

  • PAS +ve.
  • PASD +ve.

IHC

Dermatomyofibroma

Should not be confused with dermatofibroma.
  • Abbreviated DMF.

General

  • Uncommon.

Microscopic

Features:[28]

  • Poorly formed fasicles parallel to the skin surface, usu. restricted to the superficial dermis.
  • Moderate cellular density - less cellular than DFSP.
  • Eosinophilic cytoplasm.

DDx:

Images:

IHC

Features:[28]

  • CD10 +ve.
  • Vimentin +ve.

Others:[28]

  • CD34 -ve.
  • Factor XIIIa -ve.
  • S-100 -ve.

Papillary eccrine adenoma

  • Abbreviated PEA.

General

  • Uncommon.
  • Benign.[29]

Treatment:

Gross

  • Central location.

Note:

  • The digital papillary adenoma is considered malignant; the AFIP says these are best classified as adenocarcinomas, i.e. digital papillary adenocarcinoma.[31]

Microscopic

Features:[32][33]

  • Well-circumscribed lesions consisting of multiple cystic spaces lined by a bilayered epithelium with:
    • Papillary projections into the lumen.
    • Amorphous eosinophilic material in the cystic spaces.
    • Surrounded by a fibrous stroma.[34]

Note:

  • May appear to have more than two cell layers.

DDx:

Image:

IHC

Outer layer of epithelium:[34]

  • SMA-alpha +ve.
  • Keratin 14 +ve.

Inner layer of epithelium:[34]

  • Keratin 8 +ve.

Other stains:[33]

  • Vimentin +ve.
  • CEA +ve.
  • EMA +ve.
  • S-100 +ve.

Sign out

SKIN LESION, LEFT PARIETAL SCALP, BIOPSY:
- PAPILLARY ECCRINE ADENOMA.

Micro

The sections show a well-circumscribed multi-locular superficial dermal lesion with a bilayered epithelium and intracystic papillary projections. The cystic spaces contain amorphous eosinophilic material. The cystic component is surrounded by a dense fibrous stroma with a mixed inflammatory infiltrate, consisting primary of plasma cells and lymphocytes.

There is no significant nuclear atypia and no mitotic activity is appreciated. The overlying epidermis matures appropriately. A granular layer is present.

See also

References

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  2. URL: http://emedicine.medscape.com/article/1099540-overview. Accessed on: 24 August 2010.
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  4. 4.0 4.1 Klatt, Edward C. (2006). Robbins and Cotran Atlas of Pathology (1st ed.). Saunders. pp. 385. ISBN 978-1416002741.
  5. Kumar, Vinay; Abbas, Abul K.; Fausto, Nelson; Aster, Jon (2009). Robbins and Cotran pathologic basis of disease (8th ed.). Elsevier Saunders. pp. 1185. ISBN 978-1416031215.
  6. Busam, Klaus J. (2009). Dermatopathology: A Volume in the Foundations in Diagnostic Pathology Series (1st ed.). Saunders. pp. 399-400. ISBN 978-0443066542.
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