Ch 19 Pathoma - Skin Pathology Flashcards
Skin functions as a barrier against ___ and ___. Epidermis is comprised of ___ primarily. Dermis consists of these 4 things.
environmental insult; fluid loss; keratinocytes; CT, nerve endings, blood/lymphatic vessels, adnexal structures (hair shafts, sweat glands, sebaceous glands)
Name the 3 layers of skin
epidermis, dermis, and subcutaneous fat (hypodermic, subcutis)
Name the 5 layers of epidermis from surface to base and any defining characteristic.
Stratum: corneum (keratin/anucleate); lucidum (only seen in thick skin - palms and soles); granulosum (granules in keratinocytes); spinosum (desmosomes btwn keratinocytes); basalis (regenerative stem cell layer) (Come Lets Get Sun Burnt)
Which inflammatory dermatoses can be defined as an pruritic, erythematous, oozing rash with vesicles and edema?
Atopic (eczematous) dermatitis AND contact dermatitis
Atopic (____) dermatitis is a pruritic, erythematous, oozing rash with ___ and ___. It often involves the ___ and ___ surfaces. It is a type __ hypersensitivity reaction associated with ___ and ___.
eczematous; vesicles; edema; face; flexor; 1; asthma; allergic rhinitis
Contact dermatitis is a ___, ___, and ___ rash with vesicles and edema. It arises upon exposure to ___. Name 3 types. Tx involves ___ and ___ if needed.
pruritic, erythematous, oozing; allergens; poison ivy/nickel jewelry (type IV hypersens); irritant chemicals (detergents); drugs (penicillin); removal of offending agent; topical glucocorticoids (steroids can also be used for eczema)
Acne vulgaris are ___ (whiteheads/blackheads), ____ (pimples), and ____, extremely common, especially in ____.
comedones; pustules; nodules; adolescents
Acne vulgaris is due to chronic inflammation of ___ and associated ___. There is a hormone associated increase in ___ production and excess ___ production block follicles, forming comedones. ___ infection produces ___ that break down ___, releasing pro inflammatory ___. Result is pustule or nodule formation
hair follicles; sebaceous glands; sebum (sebaceous glands have androgen receptors); keratin; Propionibacterium acnes; lipases; sebum; fatty acids
Treatment for acne vulgaris include ___ (antimicrobial) and ___ (e.g. isotretinoin), which reduce ___ production.
benzoyl peroxide; vitamin A derivatives; keratin
____ is well-circumscribed, salmon colored plaques with silvery scale, usually on ___ surfaces and the ___. ___ of nails may also be present. It is due to ____.
Psoriasis; extensor; scalp; pitting; excessive keratinocyte proliferation
Psoriasis has a possible ___ etiology and is often associated with HLA-__. Lesions often arise in areas of ___ (environmental trigger). Treatment involves these 3 things.
autoimmune; C; trauma; corticosteroids; UV light with psoralen (P UVA); immune-modulating therapy
Name the 4 histological markers of psoriasis.
1) acanthosis (epidermal hyperplasia); 2) parakeratosis (hyperkeratosis with retention of keratinocyte nuclei in the stratum corneum); 3) Munro microabcesses (collections of neutrophils in the stratum corneum); 4) thinning of the epidermis above elongated dermal papillae (results in bleeding when scale is picked off - Auspitz sign)
___ is pruritic, planar, polygonal, purple papules, often with reticular white lines on their surface (____), which commonly involves ___, ___, and ___.
Lichen planus; Wickham striae; wrists, elbows, oral mucosa (oral involvement manifests as Wickham striae)
In lichen planus, histology shows ___ of the ____ with a ___ appearance. Etiology is ___, and it is often associated with chronic ___ infection.
inflammation; dermal-epidermal junction; sawtooth; unknown; hep C virus
Name the 5 P’s of lichen planus
pruritic, planar, polygonal, purple papules
____ is the autoimmune destruction of desmosomes between keratinocytes. It is due to Ig__ antibody against ___ (type __ hypersensitivity reaction). It presents as __ and __ bullae.
Pemphigus vulgaris; IgG; desmoglein; 2; skin; oral mucosa
In pemphigus vulgaris, there is ___ (separation) of stratum ___ keratinocytes (normally connected by ___) resulting in supra/sub-basal blisters. Basal layer cells remain attached to BM via ___, and have a ___ appearance. The bullae are thick/thin walled and do/do not rupture easily (__ sign).
acantholysis; spinosum; desmosomes; supra; hemidesmosomes; tombstone; thin; do; Nikolsky (the thin walled bullae rupture easily leading to shallow erosions with dry crust)
How does the immunofluorescence that highlight IgG differ in pemphigus vulgaris vs bullous pemphigoid?
PV: highlights IgG surrounding keratinocytes in a fish net pattern BP: highlights IgG along basement membrane in a linear pattern
Bullous pemphigoid is the autoimmune destruction of ___ between basal cells and underlying basement membrane. It is due to Ig__ antibody against ___ components (___) of the BM.
hemidesmosomes; IgG; hemidesmosomes; BP180;
Bullous pemphigoid presents as supra/sub-epidermal blisters of the skin, usually in ___. ___ is spared, which helps tell the difference between BP and pemphigus vulgaris. Basal cell layer is attached/detached from the BM. Tense bullae do/do not rupture easily.
sub; elderly; oral mucosa; detached; do (clinically milder than pemphigus vulgaris)
___ is the autoimmune deposition of IgA at the tips of dermal papillae. It presents as pruritic ___ and __ that are grouped (___). Strong association with __ disease, so it resolves with ___ diet.
Dermatitis herpetiformis; vesicles; bullae; herpetiform; celiac; gluten-free (IgA against gluten cross reacts with reticulin fibers that attach the BM to the dermis)
____ is a hypersensitivity reaction characterized by targetoid rash and bullae. Targetoid appearance is due to ___ surrounded by ___.
Erythema multiforme; central epidermal necrosis; erythema
Erythema multiforme is most commonly associated with ___. Name 4 other associations.
HSV infection; mycoplasma infxn, drugs (penicillin and sulfonamides), autoimmune disease (SLE), and malignancy
Erythema multiforme with oral mucosa/lip involvement and fever is called ____. ____ is a severe form of it characterized by diffuse sloughing of skin, resembling a large ___. Most often due to ____.
Stevens-Johnson Syndrome (SJS); toxic epidermal necrolysis; burn; adverse drug reaction
___ is a benign squamous proliferation. It is a common epithelial tumor in ____. It presents as raised, bicolored plaques on extremities or face, and often has a coin-like waxy ‘___’ appearance. It is characterized by ___ on histology
Seborrheic keratosis; elderly; stuck-on; keratin pseudocysts
Leser-Trélat sign is the sudden onset of multiple ___ and suggests underlying ___.
seborrheic keratoses; carcinoma of the GI tract (likely a paraneoplastic syndrome)
Acanthosis Nigricans is ___ with ___ of the skin (‘__‘-like skin), which often involves the ___ or ___. It is associated with ___ or ___
epidermal hyperplasia; darkening; velvet; axilla; groin; insulin resistance (type 2 DM); malignancy (gastric carcinoma)
____ is a malignant proliferation of basal cells of the epidermis. Risk factors stem from UV_-induced DNA damage and include these 3 things. Treatment is ___. Metastasis is common/rare.
basal cell carcinoma; B; prolonged sun exposure; albinism; xeroderma pigmentosum (AR defect in nucleotide excision repair); surgical excision; rare
What is the most common cutaneous malignancy?
basal cell carcinoma
Basal cell carcinoma presents as an elevated ___ with a central, ulcerated crater surrounded by ___. Describe the 3 P’s. Histology shows ___ of basal cells with ___.
nodule; dilated vessels (telangiectatic); pink, pearl-like papule; nodules; peripheral palisading
Classically which lip are basal cell carcinoma and squamous cell carcinoma found on respectively?
top, bottom (it’s a bunch of BS)
Squamous cell carcinoma is the malignant proliferation of squamous cells characterized by formation of ___. Risk factors stem from ___ damage and include these 3 things. Name 3 additional risk factors.
keratin pearls; UVB-induced DNA; prolonged sun exposure; albinism; xeroderma pigmentosum; immunosuppressive therapy; arsenic exposure; chronic inflammation (e.g. scar from burn or draining sinus tract)
Squamous cell carcinoma presents as ___, ___ mass, usually on the ___. Treatment is ___. Metastasis is common/rare.
ulcerated; nodular; face; excision; uncommon
____ is a precursor lesion of SCC and presents as a hyperkeratotic, scaly plaque, often on the face, back or neck.
actinic keratosis
___ is a well differentiated SCC that develops rapidly and regresses spontaneously. It presents as a __-shaped tumor filled with ___.
keratoacanthoma; cup; keratin debris
Melanocytes are responsible for skin ____ and are found at the ___ layer of epidermis. They are derived from ___. They synthesize ___ in ___ using ___ as a precursor. They then pass the ___ to keratinocytes.
skin pigmentation; basal; neural crest; melanin; melanosomes (specialized organelles); tyrosine; melanosomes
___ is localized loss of skin pigmentation due to autoimmune destruction of melanocytes.
vitiligo
____ is a congenital lack of pigmentation. It is due to an enzyme defect (usually ___) that impairs __ production. Can involve the eyes (___ form) or both eyes and skin (___ form). There is an increased risk of these 3 cancers due to reduced protection against UVB.
Albinism; tyrosinase; melanin; ocular; oculocutaneous; SCC, basal cell carcinoma, melanoma
A freckle (___) is a small, tan to brown ____, that darkens when exposed to ___. It is due to an increased number of ___ not increased ___.
ephelis; macule; sunlight; melanosomes; melanocytes
___ is a mask-like hyper pigmentation of the cheeks, associated with __ and ___.
Melasma; pregnancy; oral contraceptives
___ is a benign neoplasm of melanocytes. A congenital one is often associated with ___. Acquired ones arise later in life.
Nevus (mole)
An acquired nevus begins as nests of melanocytes at the ____. It is the most common mole in ___. It then grows by extension into the ____ (___ nevus). The ___ component is eventually lost resulting in an ___ nevus, which is the most common mole in ___.
dermal-epidermal junction; children; dermis; compound; intradermal nevus; adults
A nevus is characterized by a flat ___ or raised ___ with symmetry/asymmetry, sharp/irregular border, evenly distributed color, and small diameter (less than__ mm). ___ nevus is a precursor to melanoma
macule; papule; symmetry; sharp; 6; dysplastic
Melanoma is a malignant neoplasm of ___. Risk factors are based on UVB-induced DNA damage from these 3 factors. An additional risk factor is ___ (autosomal dominant disorder characterized by formation of ___ that may progress to melanoma)
melanocytes; prolonged exposure to sunlight; albinism; xeroderma pigmentosum; dysplasti nevus syndrome; dysplastic nevi
Melanoma presents as a mole-like growth with ABCDE.
Asymmetry; Borders are irregular; Color is not uniform; Diameter greater than 6mm; Evolution over time
Melanoma is characterized by two growth phases. ___ growth horizontally along the ___ and ___ (increased/low risk of mets); ___ growth into the ___ (increased/low risk of mets). Depth of extension (____) is the most impt prognostic factor in predicting mets.
Radial; epidermis; superficial dermis; low; Vertical; deep dermis; Breslow thickness
Name 4 variants of melanoma and anything characteristic
1) Superficial spreading (most common; dominant early radial growth - good prognosis); 2) lentigo maligna melanoma (lentiginous proliferation [radial growth], good prognosis); 3) Nodular (early vertical growth, poor prognosis); 4) Acral lentiginous (arises on palms or soles, often in dark skinned; not related to UV)
Which variant of melanoma is not related to UV?
Acral lentiginous
Impetigo is a superficial/deep bacterial/viral skin infection most often due to ___ or ___. It commonly presents in adults/children. It presents as erythematous ___ that progress to ___, that can rupture resulting in erosions and dry, crusted, ___-colored serum. Usually located on the ___.
superficial; bacterial; S aureus; S pyogenes; children; macule; pustule; honey; face
Cellulitis is a superficial/deep infection, usually due to ___ or ___. It presents as a red, tender, swollen rash with ___. Name 3 risk factors of cellulitis.
deep (dermal and subq); S aureus; S pyogenes; fever; recent surgery, trauma, or insect bite
Cellulitis can progress to ___ where you see ___ of subcutaneous tissues due to infection with ___ ‘flesh eating’ bacteria. Production of ___ leads to crepitus and it’s a surgical emergency
necrotizing fasciitis; necrosis; anaerobic; CO2
Staphylococcal scalded skin syndrome causes sloughing of skin with ___ and ___. Leads to significant skin loss. It is due to ___ infection. ___ toxins result in epidermolysis of the ____.
erythematous rash; fever; S aureus; Exofliative A and B; stratum granulosum
How do you histologically distinguish between toxic epidermal necrolysis (SJS) and staphylococcal scalded skin syndrome?
By the level of skin separation TEN: dermal-epidermal junction (deeper) SSSS: at stratum granulosum
___ are flesh colored papules with a rough surface. Due to ___ infection of keratinocytes. Characterized by ___. __ and __ are common locations.
Verucca (wart); HPV; koilocytic change; hands and feet
____ is firm, pink, umbilicate papules due to ___. Affected keratinocytes show cytoplasmic inclusions (aka ___). Most often arises in adults/children. Also seen in ___ and ___ individuals
Molluscum contagiosum; poxvirus; molluscum bodies; children; sexually active; immunocompromised
What skin disorder is seen here and what is the identifying characterisitc?
Pemphigus vulgaris (separation of the stratum spinosum keratinocytes due to autoimmune disorder that attacks desomosomes); tombstone appearance
What skin disorder is this? And what is it due to?
Bullous pemphigoid; autoimmune destruction of hemidesmosomes
(bascal cell layer detaches from basement membrane)
What is seen here? What is the defining feature?
Basal cell carcinoma; basal cells with peripheral palisading
