Derm in Review Kodas / Path Flashcards by A Blake

Acne

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Rosacea

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Rhinophyma

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psoriasis

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Reactive arthritis

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Erythema annulare centrifugum

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lichen planus

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lichen planus

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atrophic lichen planus

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lichen planus

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pityriasis rubra pilaris

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pityriasis rubra pilaris

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PLEVA

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PLC

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atopic derm

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atopic derm

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seborrheic dermatitis

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vitiligo

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vitiligo (wood’s lamp)

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lupus - malar rash

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DLE

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dermatomyositis - heliotrope

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dermatomyositis - Gottron papules

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dermatomyositis - poikiloderma

morphea

linear morphea

Parry-Romberg progressive hemifacial atrophy, dyspigmentation

sclerodactyly scleroderma, MCTD

Raynaud's CREST, scleroderma

vulvar lichen sclerosus

livedo reticularis

LCV

HSP

cryoglobulinemia

calciphylaxis

purpura of primary systemic amyloidosis

macular amyloid

lichen amyloid

pyoderma gangrenosum

relapsing polychondritis a/w: tracheal, nasal collapse; aortic insufficiency, dissecting aortic aneurysm

Behcet's

acute febrile neutrophilic dermatosis

erythema nodosum

granuloma annulare

generalized granuloma annulare

lupus pernio

necrobiosis lipoidica

tuberous xanthomas

xanthelasma

CTCL

urticaria pigmentosa

elastosis perforans serpiginosa

urticaria

dermatographism

angioedema

erythema marginatum

erythema migrans

actinomycetoma

actinomycosis

anthrax

lyme (erythema migrans)

cellulitis

erysipelas

folliculitis

impetigo

necrotizing fasciitis

paronychia

pitted keratolysis Kytococcus sedentarius, Dermatophilus congolensis, Corynebacterium, Actinomyces

rhinoscleroma Klebsiella rhinoscleromatis

scarlet fever

staph scalded skin

trichomycosis axillaris ## Footnote *Corynebacterium (C tenuis, C propinguum, C flavescens) or Serratia marcescens*

tularemia

leprosy

HSV

VZV

exanthem subitum / roseola HHV-6

Kaposi's HHV-8

hand-foot-mouth ## Footnote *coxsackievirus*

herpangina ## Footnote *enteroviruses (coxsackie, adeno, echo)*

measles / rubeola ## Footnote *paramyxovirus*

molluscum

Erythema infectiosum / Fifth's disease ## Footnote *Parvovirus B19*

rubella

syphilis

chancroid ## Footnote *haemophilus ducreyi*

yaws ## Footnote *Treponema pallidum pertenue*

leishmaniasis

larva migrans ## Footnote *hookworms: ancylostoma*

onchocerciasis ## Footnote *Onchocerca volvulus*

onchocerciasis Onchocerca volvulus

rocky mountain spotted fever

tinea versicolor

white piedra ## Footnote *trichosporon*

tinea nigra ## Footnote *Exophiala phaeoannellomyces*

tinea capitis

tinea corporis

tinea imbricata ## Footnote *Trichophyton concentricum*

tinea pedis

Erosio interdigitalis blastomycetica ## Footnote *Candida*

onychomycosis

median rhomboid glossitis ## Footnote *Candida*

madura foot bacteria (*actinomycotic mycetoma or actinomycetomas*) and fungi (*eumycetomas or mycotic mycetoma*)

histoplasmosis

mucormycosis

cryptococcosis

paracoccidiomycosis

negative DIF

ichthyosis bullosa of siemens / ichthyosis exfoliativa keratin 2

progeria

pemphigus vulgaris DSG 1 / 3

paraneoplastic pemphigus

bullous pemphigoid may be drug-induced

dermatitis herpetiformis

epidermolysis bullosa

mitten deformity dystrophic EB

Hailey-Hailey

Darier's

acanthosis nigricans

notalgia paresthetica

polymorphic eruption of pregnancy

pustular psoriasis (of pregnancy)

Sweet syndrome

dermatomyositis

multicentric reticulohistiocytosis

cryoglobulinemia

necrobiosis lipoidica

alopecia areata

trichotillomania

CCLE

Beau's lines mechanical trauma, proximal fold disease, chemo, systemic illness

leukonychia

Mee's lines arsenic, thallium, heavy metal poisoning

onycholysis

Terry's nails liver failure

yellow nail syndrome + lymphedema, pulmonary disease (bronchiectasis, pleural effusions)

lichen planus

stinging nettle leaf (urticaceae) * most common cause of nonimmunologic (toxic) urticaria* * trichomes contain* *histamine, serotonin, Ach*

stinging nettle trichomes (urticaceae) * most common cause of nonimmunologic (toxic) urticaria* * trichomes contain histamine, serotonin, Ach*

phytophotodermatitis ## Footnote * Direct toxic immunogenic reaction* * UVA + photosensitizers + oxygen → reactive O2 species → epi/dermal damage → hyperpigmentation in linear streaks*

prickly pear (opuntia spp.) ## Footnote * most common cause of mechanical irritant contact* * may --\> bacterial inoculation*

century plant / agave americana / aloe ## Footnote * family Asparagaceae* * calcium oxalate*

century plant ## Footnote * family Asparagaceae* * calcium oxalate*

daffodil * family amarillydacea / lilacea, narcissus spp.* * calcium oxalate*

dumb cane (diffenbachia) ## Footnote * family araceae* * calcium oxalate*

hyacinth ## Footnote * family amarillydacea / lilacea* * calcium oxalate*

rhubarb ## Footnote * family Polygonaceae* * calcium oxalate*

buttercups ## Footnote * family Ranunculaceae* * protoanemonin, ranunculin*

cashew ## Footnote * anacardiacea* * urushiol / cashew nut shell oil*

poison ivy rash ## Footnote * family Anacardaciae, toxicodendron spp.* * allergen: urushiol* * sensitizer: pentadecylcatechol*

poison ivy contact dermatitis ## Footnote * family Anacardaciae, toxicodendron spp.* * allergen: urushiol* * sensitizer: pentadecylcatechol*

poison ivy plant ## Footnote * family anacardaciae, toxicodendron spp.* * allergen: urushiol* * sensitizer: pentadecylcatechol*

poison oak ## Footnote * family Anacardaciae, toxicodendron spp.* * allergen: urushiol* * sensitizer: pentadecylcatechol*

poison oak ## Footnote * family anacardaciae, toxicodendron spp.* * allergen: urushiol* * sensitizer: pentadecylcatechol*

poison sumac ## Footnote * family anacardaciae, toxicodendron spp.* * allergen: urushiol* * sensitizer: pentadecylcatechol*

chrysanthemum * family asteraceae* * sensitizer: sesquiterpene lactone* * cross-react: permethrin* */ pyrethrins*

daisy ## Footnote * family asteraceae* * sensitizer: sesquiterpene lactone* * cross-react: permethrin / pyrethrins*

ragweed ## Footnote * family asteraceae* * sensitizer: sesquiterpene lactone* * cross-react: permethrin / pyrethrins*

peruvian lily ## Footnote * family Alstromeriaceae* * sensitizer: tuloposide / tulipalin A* * Most common cause of finger dermatitis in florists/ gardeners handling tulip bulbs*

primrose ## Footnote * family Primulaceae* * sensitizer: primin, turpentine* * Cross-reacts w/Balsam of Peru*

puss moth caterpillar wound ## Footnote * Dermatitis w/characteristic “tram-track” hemorrhage* * Spines contain high concentration of oak tannins*

gypsy moth caterpillar

io moth caterpillar

saddleback caterpillar

puss moth caterpillar ## Footnote * Dermatitis w/characteristic “tram-track” hemorrhage* * Spines contain high concentration of oak tannins*

giant silkworm moth (caterpillar) ## Footnote *Local & severe systemic reaction (renal failure, bleeding diathesis)*

pine processionary caterpillar ## Footnote * Urticaria (immunologic), angioedema, anaphylaxis* * Lytic bone lesions of the digits*

black widow ## Footnote * α-Latrotoxin → depolarizes neurons* * Acute pain & edema at bite site (no necrosis)* * Latrodectism: Chills, vomiting, cramps, spasms, priapism* * Rx: Antivenin, benzodiazepines, IV calcium gluconate*

brown recluse ## Footnote * Sphingomyelinase D* * Erythema and edema → vesicle → necrosis and eschar* * Severe: hemolytic anemia, DIC* * Rx: Rest, ice, elevation; avoid surgery*

hobo spider ## Footnote * Atracotoxins* * Painless bite → induration, erythema, numbness → necrotic eschar* * Severe: Headache, visual disturbances, MI* * Rx: Supportive*

wolf spider ## Footnote * Histamine* * Very painful bites → lymphangitis or eschar* * Rx: Supportive*

jumping spider ## Footnote * Hyaluronidase* * Painful bite* * Rx: Supportive*

sac spider ## Footnote * Lipase* * Painful bite* * Rx: Supportive*

tarantula ## Footnote * Hairs can penetrate skin --\> wheal and flare* * Ophthalmia nodosa can lead to blindness* * Rx: Supportive*

brown recluse bite sphingomyelinase D

lone star tick * Human monocytic ehrlichiosis * Southern tick-associated rash illness (STARI) * RMSF * Tularemia

Dermacentor tick * D. variabilis (dog tick): Major vector for RMSF * D. andersoni (wood tick): Major vector for Colorado tick fever and RMSF * Both can cause tick paralysis from release of neurotoxin if attached \>4 days

dermacentor / wood tick * D. variabilis (dog tick): Major vector for RMSF * D. andersoni (wood tick): Major vector for Colorado tick fever and RMSF * Both can cause tick paralysis from release of neurotoxin if attached \>4 days

deer tick * Lyme disease * Babesiosis * Human granulocytotropic anaplasmosis

brown dog tick * RMSF * Boutonneuse fever

Soft tick * Borrelial relapsing fever

scabies burrow

scabies

crusted scabies

scabies mite

chigger bites

pediculus humanus

phthirus pubis

pediculus humanus

body lice nits

tunga penetrans infestation ## Footnote *Endemic in Central and South America, Africa, India, Pakistan*

tunga penetrans ## Footnote *Endemic in Central and South America, Africa, India, Pakistan*

wound myasis - Infestation of skin by fly larvae ## Footnote *Caused by screw worm (Cochliomyia hominivorax). Eggs are deposited directly on wound, especially on scalp, and may burrow into brain tissue*

fire ant bites ## Footnote *Inject venom (solenopsin D) --\> histamine release*

blister beetle --\> cantharidin

bedbug bites ## Footnote *Possible vector for hepatitis B and Chagas disease*

bed bugs ## Footnote *Possible vector for hepatitis B and Chagas disease*

triatomine reduviid bug ## Footnote * Vector for American trypanosomiasis, Chagas disease* * Romaña’s sign: Unilateral eyelid swelling*

xenopsylla cheopis (fleas) ## Footnote *Vector for cat scratch disease, endemic (murine) typhus, tungiasis, melioidosis, plague*

sandfly * Sandfly transmits leishmaniasis * Blackfly transmits onchocerciasis and tularemia * Deer fly, mango fly, horse fly transmit loiasis and tularemia * Tsetse fly transmits African trypanosomiasis

black fly * Sandfly transmits leishmaniasis * Blackfly transmits onchocerciasis and tularemia * Deer fly, mango fly, horse fly transmit loiasis and tularemia * Tsetse fly transmits African trypanosomiasis

centipede ## Footnote *Painful bite wounds Venom contains metalloproteases*

millipede ## Footnote *Do not bite but cause chemical contact dermatitis due to cyanide and quinones*

rattlesnake * Immediate pain / edema at bite site → necrosis, hemorrhage * Systemic sxs: Hypotension, respiratory distress, neuromuscular blockade depending on species

coral snake * Immediate pain / edema at bite site → necrosis, hemorrhage * Systemic sxs: Hypotension, respiratory distress, neuromuscular blockade depending on species

leeches * Interfere w/platelet aggregation → purpura and bleeding * Medical leeches associated with Aeromonas hydrophila wound infection

podophyllum peltatum ## Footnote *podophyllotoxin*

sea anemone (cnidaria) * Have cnidocytes that contain nematocysts = stinging capsule * Seabather’s eruption: Dermatitis under bathing suit caused by larvae of any cnidarian spp.

jellyfish (cnidaria) * Have cnidocytes that contain nematocysts = stinging capsule * Seabather’s eruption: Dermatitis under bathing suit caused by larvae of any cnidarian spp.

sea urchin (echinodermata) ## Footnote *spicules cause ICD and foreign body reaction from calcite crystals*

blue ringed octopus (mollusca) ## Footnote *Tetrodotoxin: Deadly neurotoxin in some cone snails, blue-ringed octopus, and pufferfish*

sea bather's eruption stings from nematocysts of larval forms of sea anemones / thimble jellyfishes

neonatal lupus

neonatal cephalic pustulosis

congenital facial milia Basan syndrome

erythema toxicum neonatorum

seb derm

jacquet's erosive diaper dermatitis irritant

perianal pseudoverrucous papules and nodules (PPPN) chronic irritation

bullous impetigo

psoriasis

spinal dysraphism

aplasia cutis

branchial cleft cyst

supernumerary nipples

staph scalded skin

atopic dermatitis

nummular atopic dermatitis

atopic dermatitis

molluscum

lichen spinulosus

pityriasis rubra pilaris

pityriasis lichenoides chronica

PLEVA

congenital melanocytic nevus

spitz nevus HRAS or BAP-1 mutations pink-red papulonodule vs ink-spot S-100+, melan-A+, p16+

becker's nevus smooth mm hamartoma + increased basal melanocytes

halo nevus lymphs mingle with melanocytes

epidermal nevus hamartoma epi / pap dermis

nevus sebaceous

nevus comedonicus ## Footnote *FGFR2 hamartoma*

Buschke-Ollendorf ## Footnote * LEMD3 mutation (AD) --\> incr TGF-B signaling* * dermatofibromatosis lenticularis disseminata (collagen-type nevus) + osteopoikilosis*

spitz nevi

collagenoma MEN-1

fibrous hamartoma of infancy

mastocytoma

urticaria pigmentosa

langerhans cell histiocytosis

JXG

blue nevus

ulcerated infantile hemangioma

LUMBAR syndrome ## Footnote * L - Lower segmental hemangioma* * U - Urogenital anomalies/ulcerations* * M - Myelopathy* * B - Bony deformities* * A - Anorectal defects* * R - Renal anomalies*

PHACE ## Footnote * P - Posterior fossa malformations* * H - Hemangioma, segmental (V1-V3)* * A - Arterial anomalies (carotid, cerebral)* * C - Cardiac anomalies (coarctation)* * E - Eye anomalies (cataracts, exophthalmos)*

congenital hemangioma

port win stain

microcystic lymphatic malformation / lymphangioma circumscriptum ## Footnote *post-excision recurrence common*

venous malformations ## Footnote *associations: maffucci syndrome, blue rubber bleb nevus, multiple cutaneous & mucosal venous syndrome*

CM-AVM

varicella

hand foot mouth

median nail dystrophy

X-linked recessive syndromes

X-linked dominant syndromes

mitten deformity dystrophic EB

collodion baby

lamellar ichthyosis ## Footnote * Type 1: transglutaminase 1 defect* * Type 2: ABCA12 (copper-binding protein) defect*

sparse eyebrows in Netherton Synd ## Footnote * SPINK5 defect --\> LEKTI serine protease inhibitor* * Ichthyosis linearis circumflexa + Trichorrhexis invaginata (most common eyebrows) + Atopy*

Erythrokeratoderma variabilis ## Footnote *GJB3 mutation --\> gap junction proteins (connexins)*

Ichthyosis linearis circumflexa in Netherton Synd ## Footnote * SPINK5 defect --\> LEKTI serine protease inhibitor* * Ichthyosis linearis circumflexa + Trichorrhexis invaginata (most common eyebrows) + Atopy*

facial angiofibromas in tuberous sclerosis

penile lentigines in PTEN hamartoma tumor syndrome

axillary freckling and CALM in NF-1 ## Footnote *neurofibromin mutation*

plexiform neurofibromas and CALM in NF-1

dermal melanocytosis

hyperextensible skin / "fishmouth" scars in Ehlers-Danlos

Ectrodactyly in Goltz syndrome (focal dermal hypoplasia) ## Footnote *XLD, defect in PORCN*

pilomatricoma ## Footnote * multiple assoc w/: myotonic dystrophy, Rubinstein-Taybi, Turner Synd, Gardner Synd, Trisomy 9* * path: "shadow cells" or "ghost cells"*

congenital triangular alopecia ## Footnote *nonscarring, often bilateral*

pachyonychia congenita ## Footnote * Type 1: Jadassohn-Lewandowski, KRT 6A & 16* * Type 2: Jackson-Lawler, KRT 6B & 17* * +PPK, hypERhidrosis, plantar pain*

congenital malalignment of toenail ## Footnote *lateral deviation of great toenails, usually b/l*

sensory innervation of face

facial nerve branches and danger zones

temporal nerve danger zone: where to undermine?

Undermine in the **superficial fat** above the superficial musculoaponeurotic system (SMAS) to avoid injury

Trigeminal trophic syndrome

anesthesia, paresthesia, and erosion of the nasal ala (may clinically mimic BCC) ## Footnote *damage to CN V at the gasserian ganglion (surgery, injury, encephalitis, leprosy)*

Frey’s syndrome (auriculotemporal syndrome)

Pain, vasodilation, and hyperhidrosis of cheeks when eating (gustatory sweating) ## Footnote * occurs following parotid gland surgery* * thought to involve haphazard nerve regeneration whereby parasympathetic fibers (rather than sympathetic) reinnervate sweat glands and blood vessels of skin*

Cranial Nerve V - name, branches, and function

trigeminal nerve ## Footnote * 3 branches: primarily sensory, but also motor supply to muscles of mastication* * ophthalmic (V1), maxillary (V2), and mandibular (V3)*

Cranial Nerve VII - name and function

Facial nerve * motor innervation to muscles of facial expression * sensory innervation to conchal bowl and anterior tongue * taste through chorda tympani branch * tactile sensation through lingual nerve branch

branches of facial nerve

Muscles supplied by temporal branch of facial nerve

Muscles supplied by posterior auricular branch of facial nerve

Muscles supplied by zygomatic branch of facial nerve

Muscles supplied by buccal branch of facial nerve

Muscles supplied by marginal mandibular branch of facial nerve

Muscles supplied by cervical branch of facial nerve

sensory innervation of ear

arterial supply to face

The six major arteries supplying the face

1. Facial * angular aa anastomoses w/dorsal nasal --\> connection btwn ICA + ECA 2. Superficial temporal: from ECA * branches: transverse facial, frontal 3. Maxillary: from ECA * branches: infraorbital, buccal, inferior alveolar (mental) 4. Posterior auricular: from ECA 5. Occipital: from ECA 6. Ophthalmic: from ICA * branches: supraorbital, supratrochlear, palpebral, lacrimal, dorsal nasal --\> anastomoses w/ECA

sensory innervation of leg and foot

nerve blocks for foot

motor innervation of hand

external anatomy of penis

internal anatomy of penis

external anatomy of vulva

topographic nail unit anatomy

subcutaneous nail unit anatomy

O'Brien scissors ## Footnote *suture removal*

straight suture scissors

Gradle scissors ## Footnote *Delicate sharp tips, i.e., skin tag removal*

Westcott scissors ## Footnote *Delicate, spring-loaded tissue scissors with sharp tips, ideal for small delicate sites (eyelid)*

Iris scissors ## Footnote *tissue cutting*

Baby Metzenbaum ## Footnote *sharp or blunt undermining*

Metzenbaum ## Footnote *fine tissues and blunt dissection*

bandage scissors

Halsey needle holder ## Footnote * smooth or serrated jaws* * ideal for small needles and fine suture material (facial reconstruction)*

Mayo needle holder ## Footnote * Larger, more durable* * for larger needles and suture material (trunk reconstruction)*

Castroviejo needle holder ## Footnote *commonly used in eye surgery and microsurgery*

round knurled scalpel handle ## Footnote *allows control by twisting rather than rocking motion*

Beaver blade handle ## Footnote *Can be rolled with fingertips, providing greater precision and control*

#3 blade handle ## Footnote *Most frequently used in dermatologic surgery*

#7 blade handle ## Footnote *Textured → better control and comfort, cutting angle may be changed by rolling handle with fingers*

#10 blade ## Footnote *Wide & curved, for larger excisions*

#15 blade ## Footnote *Curved, used for most dermatologic surgery*

#15c blade ## Footnote *Curved with finer tip, more delicate areas*

#11 blade ## Footnote *Tapered sharp tip, for I&D*

Jeweler's forceps ## Footnote *Sharp tip, used for suture removal*

Adson forceps w/o teeth ## Footnote *Standard large forceps used for excisional surgery on trunk and proximal extremities*

Adson forceps w/teeth ## Footnote *Standard large forceps used for excisional surgery on trunk and proximal extremities*

Bishop-Harmon forceps ## Footnote *very lightweight, fine-tipped, ideal for delicate work on face and hand*

Freer septum elevator (nail elevator) ## Footnote *thin curved blades that facilitate atraumatic nail avulsion*

English nail splitter ## Footnote *Cutting blade opposed to a flat anvil-like surface, used for partial longitudinal nail avulsion*

single-pronged skin hooks ## Footnote *used for elevating tissue atraumatically*

double-pronged skin hook ## Footnote *used for elevating tissue atraumatically*

Fox dermal curette ## Footnote *Labeled by size, used for tumor removal and debulking*

chalazion clamp ## Footnote *used for immobilizing structures during procedures*

mosquito hemostat ## Footnote *clamping vessels*

relaxed skin tension lines of face

relaxed skin tension lines of anterior body

relaxed skin tension lines of posterior body

post-Mohs defect

Inferiorly-based rotation flap with dimpling at site of periosteal tacking stitch to the maxilla (red star) ## Footnote *used to support weight of flap and counteract downward forces. Over time, dimpling becomes imperceptible as suture is resorbed.*

polyglactin 910: brand name

vicryl

polyglycolic acid: brand name

dexon

polydioxanone: brand name

PDS

glycolic acid: brand name

Maxon

poliglecaprone 25: brand name

monocryl

Absolute indications for prophylactic abx for surgery

* Artificial heart valve (mechanical, bioprosthetic, and homograft valves) * artificial joint within 2 years * history of endocarditis * history of rheumatic fever (RF) * mitral valve prolapse (MVP) with holosystolic murmur

Local anesthetics

Recommended maximum dose of lidocaine in adults

* 4.5 mg/kg without epinephrine * 7.0 mg/kg with epinephrine * 55 mg/kg tumescent

Recommended maximum dose of lidocaine in children

* 1.5 to 2 mg/kg without epi * 3 to 4.5 mg/kg with epi

Phases of wound healing

1. Vascular phase 2. Inflammatory phase 3. Proliferative phase 4. Maturation / Wound contracture and remodeling

chemical mediators of inflammation that play a role in wound healing

Tip stitch

AKA half-buried horizontal mattress suture ## Footnote *designed to align tissue at corner of a flap and prevent vascular compromise (i.e., bringing together more than two skin edges)*

tip stitch

post-mohs defect of chin

O-T or A-T advancement flap

island pedicle / V-Y advancement flap

post-Mohs defect of R alar sulcus

Island pedicle/V-Y advancement flap

post-mohs defect

O-L advancement flap

H-plasty

post-mohs defect

H-plasty

post-staged excision defect of L nasal ala/sidewall

crescentic advancement flap

post-mohs defect

bilateral rotation flap (O-Z) elevated at level of galea

bilateral rotation flaps held in position w/skin hooks

bilateral rotation flaps, closed

Mustarde - laterally based rotation flap

post-mohs defect of nasal tip

dorsal nasal rotation flap

Z-plasty

post-mohs defect, L preauricular

rhombic transposition flap

post-mohs defect, R nasal ala

bilobed transposition flap

post-mohs defect, L nasal ala

Nasolabial transposition flap (w/underlying cartilage graft from antihelix to support alar rim)

paramedian forehead flap

post-mohs defect, L nasal ala

Staged melolabial interpolation flap w/pedicle in place (cartilage graft/strut from antihelix supporting alar rim) in 3 weeks this pedicle is divided and the donor cheek area is linearly closed

Full thickness defect of L helix & antihelix

mastoid/retroauricular interpolation flap

Mastoid/retroauricular interpolation flap s/p pedicle division and healing via secondary intent

post-mohs defect of nasal tip and supratip

Full-thickness skin graft for nasal tip harvested from R preauricular cheek

flap necrosis in smoker

surgical wound infection w/dehiscence

trapdoor deformity

keloid

cutaneous horn

actinic cheilitis ## Footnote *hypopigmented, scaly plaque with fissures involving lower lip of a male patient*

Common peels

Electrosurgery types

sunscreen blocking spectrum

ocular risk with laser types

light wavelength and ocular damage

laser wavelength and structures damaged

AK, lower magnification ## Footnote *Focal parakeratosis alternating w/orthokeratosis. Neoplasm confined to epidermis. Prominent solar elastosis in subadjacent papillary dermis. Tumor spares hair follicles.*

AK, higher magnification ## Footnote *Marked parakeratosis and absence of granular layer. Pleomorphism of atypical keratinocytes within basal layer of epidermis.*

SCCIS (pink scaly plaque)

SCCIS ## Footnote *Neoplasm confined to epidermis. Atypical keratinocytes proliferating in all layers of epidermis. Some dyskeratotic cells with pyknotic nuclei in upper layers of epidermis. White line: multinucleated tumor cell.*

high-risk SCC on lower lip

Large, fungating, poorly-differentiated SCC on occipital scalp w/invasion of muscle and bone

SCC w/cutaneous horn

Invasive, well-differentiated SCC with keratin pearl formation ## Footnote *Generally: proliferation of cells as slender, long strands or as bulky masses. Individual cells have glassy eosinophilic cytoplasm with large nuclei. Also w/mitotic figures and horn pearls*

nodular BCC

superficial BCC

nodular BCC

multiple pigmented BCCs

morpheaform BCC

BCC with squamous differentiation ## Footnote *Metatypical variant = basosquamous carcinoma: Merging of basaloid tumor areas with squamoid areas with keratinization*

AJCC-8 staging for cutaneous SCC

BWH staging for cutaneous SCC

nodular melanoma with regression

acral lentiginous melanoma

Pagetoid melanoma. ## Footnote *Neoplastic proliferation of melanocytes forming irregular nests in the basal layer. Single atypical melanocytes are spreading within all the layers of the epidermis. Cells have large atypical nuclei and abundant eosinophilic cytoplasm and a surrounding halo resembling cells of Paget disease.*

merkel cell carcinoma

Small cell MCC ## Footnote *Basophilic aggregates of small-round cells. The tumor cells have prominent round, vesicular nuclei and scant, ill-defined cytoplasm. Occasional mitoses are present. The neoplastic cell islands connect to each other via anastomosing cords.*

dermatofibrosarcoma protuberans

AJCC melanoma staging

melanoma margins

large multinodular DFSP

DFSP ## Footnote *monomorphic spindle cells arranged in “storiform” or “cartwheel” pattern. Some cells may show slight atypia. At later stages, cells infiltrate SQ adipose tissue --\> honeycomb pattern of entrapped adipocytes*

DFSP, higher magnification ## Footnote *Neoplasm composed of ill-defined, dense, spindle cells w/i reticular dermis extending toward SQ fat. Tumor cells are monomorphic and may be arranged in whorl-like pattern. Neoplastic cells invade SQ fat lobules in lace-like fashion.*

microcystic adnexal carcinoma

MAC ## Footnote *Keratocysts and variably-sized basaloid tumor nests and ducts surrounding nerves within a fibrotic desmoplastic stroma*

MAC ## Footnote *Higher magnification reveals neoplastic cells with prominent oval nuclei*

Extramammary Paget’s disease presenting as erythematous, well-demarcated, scaly plaque on suprapubic area

Angiosarcoma ## Footnote *Ill-defined neoplastic proliferation of plump, cuboidal, mostly pleomorphic endothelial cells intermingled with slit-like spaces with many erythrocytes*

Kaposi's sarcoma

patch and plaque Kaposi's sarcoma

traditional vertical sectioning/breadlofing of specimen

FDA-approved molecular therapies for cutaneous malignancy

best biopsy technique for suspected tumor type

Mohs specimen sectioning

infections transmitted by plant contact

plants that cause irritant contact dermatitis

plants that cause allergic contact dermatitis

Cross-reactants to Anacardiaceae

other mites of significance

important genera of mosquito

1. Anopheles transmits malaria 2. Culex transmits filariasis 3. Aedes transmits yellow fever, dengue

Acute spongiotic dermatitis * Spongiosis (intercellular edema) and basket-weave stratum corneum (acute) * Intraepidermal vesicles filled with mononuclear cells * May see lymphocyte exocytosis * Perivascular lymphocytes ± interstitial eosinophils

Subacute spongiotic dermatitis * Epidermal acanthosis with spongiosis * Parakeratosis * May see lymphocyte exocytosis * Perivascular lymphocytes ± interstitial eosinophils

Eosinophilic spongiosis * Epidermis may show features of acute or subacute spongiotic dermatitis * Eosinophils are seen percolating between epidermal keratinocytes

Chronic dermatitis (lichen simplex chronicus) * Acanthosis and hypergranulosis * Stratum corneum resembles acral skin but hair follicles are evident * May not see any spongiosis * Vertical streaking of the collagen in papillary dermis

Pityriasis rosea * Subacute spongiotic dermatitis (spongiosis may be basilar and not always full thickness) * Mounds of scale with parakeratosis * Erythrocyte extravasation in the papillary dermis * Lymphocyte exocytosis

Stasis dermatitis * Subacute spongiotic dermatitis * Nodular proliferation of vessels in the papillary dermis * Interstitial hemosiderin