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

Main article: Basal cell carcinoma

Squamous cell carcinoma of the skin

  • Abbreviated skin SCC, SCC of the skin, and SCC of skin.
Main article: Squamous cell carcinoma of the skin

Melanoma

Main article: Malignant melanoma
  • Known as the great mimicker in pathology; it may look like many things.

Less common malignant

Dermatofibrosarcoma protuberans

  • Abbreviated DFSP.
Main article: Dermatofibrosarcoma protuberans

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

  • CTCL - very high mag. (WC/Nephron)

  • CTCL - intermed. mag. (WC/Nephron)

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

Main article: 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

Main article: Sebaceous carcinoma

Microcystic adnexal carcinoma

Main article: 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.
Main article: Atypical fibroxanthoma

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

Main article: Dermal cylindroma

Keratoacanthoma

Main article: Keratoacanthoma

Sebaceous adenoma

General

Notes:

Microscopic

Features:

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

Images

  • Sebaceous adenoma - low mag. (WC/Nephron)

  • Sebaceous adenoma - high mag. (WC/Nephron)

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

  • EP. (WC)

www:

Nodular hidradenoma

Main article: Nodular hidradenoma

Trichoblastoma

Main article: 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:

  • Trichofolliculoma. (WC)

Apocrine carcinoma of the skin

General

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

Microscopic

Features:[27]

  • Nests.
  • Apocrine snouts - "decapitation secretion"

DDx:

Images

  • Apocrine carcinoma - intermed. mag. (WC/Nephron)

  • Apocrine carcinoma - high mag. (WC/Nephron)

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

  1. ↑ URL: http://emedicine.medscape.com/article/1099540-overview. Accessed on: 24 August 2010.
  2. ↑ URL: http://emedicine.medscape.com/article/1099540-overview. Accessed on: 24 August 2010.
  3. ↑ URL: http://emedicine.medscape.com/article/1098342-overview. Accessed on: 24 August 2010.
  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.
  7. ↑ URL: http://path.upmc.edu/cases/case513/dx.html. Accessed on: 25 January 2012.
  8. ↑ 8.0 8.1 Martin, RC.; Edwards, MJ.; Cawte, TG.; Sewell, CL.; McMasters, KM. (Mar 2000). "Basosquamous carcinoma: analysis of prognostic factors influencing recurrence.". Cancer 88 (6): 1365-9. PMID 10717618.
  9. ↑ 9.0 9.1 Bowman, PH.; Ratz, JL.; Knoepp, TG.; Barnes, CJ.; Finley, EM. (Aug 2003). "Basosquamous carcinoma.". Dermatol Surg 29 (8): 830-2; discussion 833. PMID 12859383..
  10. ↑ 10.0 10.1 Busam, Klaus J. (2009). Dermatopathology: A Volume in the Foundations in Diagnostic Pathology Series (1st ed.). Saunders. pp. 397. ISBN 978-0443066542.
  11. ↑ Busam, Klaus J. (2009). Dermatopathology: A Volume in the Foundations in Diagnostic Pathology Series (1st ed.). Saunders. pp. 372. ISBN 978-0443066542.
  12. ↑ Kumar, Vinay; Abbas, Abul K.; Fausto, Nelson; Aster, Jon (2009). Robbins and Cotran pathologic basis of disease (8th ed.). Elsevier Saunders. pp. 1177. ISBN 978-1416031215.
  13. ↑ URL: http://emedicine.medscape.com/article/1059871-diagnosis. Accessed on: 12 May 2010.
  14. ↑ Boecker, W.; Junkers, T.; Reusch, M.; Buerger, H.; Korsching, E.; Metze, D.; Decker, T.; Loening, T. et al. (2012). "Origin and differentiation of breast nipple syringoma.". Sci Rep 2: 226. doi:10.1038/srep00226. PMID 22355740.
  15. ↑ Nosrati, N.; Coleman, NM.; Hsu, S. (2008). "Axillary syringomas.". Dermatol Online J 14 (4): 13. PMID 18627735.
  16. ↑ 16.0 16.1 16.2 Kumar, B. (Jan 2010). "Chondroid syringoma diagnosed by fine needle aspiration cytology.". Diagn Cytopathol 38 (1): 38-40. doi:10.1002/dc.21159. PMID 19693940.
  17. ↑ 17.0 17.1 Rauso, R.; Santagata, M.; Tartaro, G.; Filipi, M.; Colella, G.. "Chondroid syringoma: a rare tumor of orofacial region.". Minerva Stomatol 58 (7-8): 383-8. PMID 19633639.
  18. ↑ 18.0 18.1 URL: http://www.ispub.com/journal/the_internet_journal_of_dermatology/volume_7_number_2_23/article/cutaneous_mixed_tumor.html. Access on: 21 September 2011.
  19. ↑ URL: http://emedicine.medscape.com/article/1059940-overview. Accessed on: 2 September 2011.
  20. ↑ Baykal, C.; Buyukbabani, N.; Yazganoglu, KD.; Saglik, E. (Jan 2006). "[Tumors associated with nevus sebaceous].". J Dtsch Dermatol Ges 4 (1): 28-31. doi:10.1111/j.1610-0387.2006.05855.x. PMID 16503928.
  21. ↑ 21.0 21.1 Busam, Klaus J. (2009). Dermatopathology: A Volume in the Foundations in Diagnostic Pathology Series (1st ed.). Saunders. pp. 386. ISBN 978-0443066542.
  22. ↑ 22.0 22.1 URL: http://ccr.cancer.gov/staff/gallery.asp?profileid=12822. Accessed on: 2 September 2011.
  23. ↑ URL: http://dermatlas.med.jhmi.edu/derm/indexDisplay.cfm?ImageID=667496720. Accessed on: 2 September 2011.
  24. ↑ URL: http://www.pathconsultddx.com/pathCon/diagnosis?pii=S1559-8675(06)70190-5. Accessed on: 2 July 2010.
  25. ↑ Punia, RP.; Garg, S.; Bal, A.; Mohan, H. (2008). "Pigmented nodular hidradenoma masquerading as nodular malignant melanoma.". Dermatol Online J 14 (1): 15. PMID 18319032.
  26. ↑ Busam, Klaus J. (2009). Dermatopathology: A Volume in the Foundations in Diagnostic Pathology Series (1st ed.). Saunders. pp. 382. ISBN 978-0443066542.
  27. ↑ 27.0 27.1 27.2 27.3 27.4 Paties, C.; Taccagni, GL.; Papotti, M.; Valente, G.; Zangrandi, A.; Aloi, F. (Jan 1993). "Apocrine carcinoma of the skin. A clinicopathologic, immunocytochemical, and ultrastructural study.". Cancer 71 (2): 375-81. PMID 7678545.
  28. ↑ 28.0 28.1 28.2 Busam, Klaus J. (2009). Dermatopathology: A Volume in the Foundations in Diagnostic Pathology Series (1st ed.). Saunders. pp. 504. ISBN 978-0443066542.
  29. ↑ Rulon, DB.; Helwig, EB. (May 1977). "Papillary eccrine adenoma.". Arch Dermatol 113 (5): 596-8. PMID 857729.
  30. ↑ URL: http://archderm.jamanetwork.com/article.aspx?articleid=541159. Accessed on: 10 December 2012.
  31. ↑ Duke, WH.; Sherrod, TT.; Lupton, GP. (Jun 2000). "Aggressive digital papillary adenocarcinoma (aggressive digital papillary adenoma and adenocarcinoma revisited).". Am J Surg Pathol 24 (6): 775-84. PMID 10843279.
  32. ↑ 32.0 32.1 Laxmisha, C.; Thappa, DM.; Jayanthi, S.. "Papillary eccrine adenoma.". Indian J Dermatol Venereol Leprol 70 (6): 370-2. PMID 17642667.
  33. ↑ 33.0 33.1 Guccion, JG.; Patterson, RH.; Nayar, R.; Saini, NB.. "Papillary eccrine adenoma: an ultrastructural and immunohistochemical study.". Ultrastruct Pathol 22 (3): 263-9. PMID 9793207.
  34. ↑ 34.0 34.1 34.2 Mizuoka, H.; Senzaki, H.; Shikata, N.; Uemura, Y.; Tsubura, A. (Jan 1998). "Papillary eccrine adenoma: immunohistochemical study and literature review.". J Cutan Pathol 25 (1): 59-64. PMID 9508346.
  35. ↑ Fox, SB.; Cotton, DW. (Apr 1992). "Tubular apocrine adenoma and papillary eccrine adenoma. Entities or unity?". Am J Dermatopathol 14 (2): 149-54. PMID 1566975.
  36. ↑ Ishiko, A.; Shimizu, H.; Inamoto, N.; Nakmura, K. (Oct 1993). "Is tubular apocrine adenoma a distinct clinical entity?". Am J Dermatopathol 15 (5): 482-7. PMID 8238787.
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