Derm Path Handout Flashcards
How is vitiligo different from albinsim?
Vitligo is an autoimmune destruction of melanocytes whereas albinism involves a loss of (usually) tyrosinase such that melanin cannot be produced.
These tumors present as pearly papules with telangiectasias
basal cell CA
What is the possible sequela of GABHS impetigo? Pharyngitis?
Impetigo = glomerulonephritis only; pharyngitis = either glomerulonephritis or rheumatic fever
Which metachromatic stains can be used to stain for mast cells?
toluidine blue or Giemsa
What are the most common infections to cause erythema multiforme?
HSV and mycoplasma
What races are affected by vitiligo?
all races just shows up more in dark skinned
When will melasma resolve?
After pregnancy
What is the commonality of the Leser-Trelat sign and the malignant form of acanthosis nigricans?
Both are associated with an underlying malignancy
What syndrome is associated with multiple trichilemmomas and breast CA?
Cowden’s syndrome
What is another name for SCC in situ?
Bowen’s disease
What does the nucleus of a Sezary cell look like?
Cerebriform (Recall: Seastone said just think that Mr. Sezary is a smart guy)
What 2 stains did he mention can stain for fungi?
methenamine silver or PAS
T/F: you can distinguish SLE from Discoid lupus on the basis of skin lesions alone
false because many pts with SLE will develop discoid lesions; however, they will also have systemic Sx
How is the appearance of malignant melanoma cells as they invade into the dermis different from what you would find in the melanocytes of a benign melanocytic nevus as its cells went deeper into the dermis?
An important feature here is that nevi show maturation as they “invade” deeper but malignant melanoma does not
What is the most aggressive form of basal cell CA?
morphea subtype
Which part of the body is usually affected by panniculitis?
lower extremities
Actinic keratosis on the lips is called _____
Actinic chelitis
What are 3 associated “environmental” hazards that may lead to development of actinic keratosis?
Arsenicals, ionizaing rad, and hydrocarbons
What is a rodent ulcer?
A description of how SCC can invade nearby structures
T/F: there is acantholysis in PEM-PHI-GUS?
TRUE
Name the 3 subtypes of Epidermolysis bullosa
Junctional (at lamina lucida); Scarring dystrophic type (beneath lamina densa); simplex type which is loss of the basal layer
What is the most common type of wart?
verruca vulgaris
Name the 4 subtypes of epithelial cysts
epidermal inclusion cyst, pilar or trichilemmal cyst, dermoid cyst, and steatocystoma multiplex
Main cell in a xanthoma
foamy histiocyte
Describe the histology of seborrheic keratosis
proliferation of benign basaloid keratinocytes with hyperkeratosis and horn pseudocyst
What are the genetics of basal cell nevus syndrome?
autosomal dominant
Which type of epithelial cyst is most likely to undergo dystrophic calcification?
Pilar or trichilemmal cyst
How is the histology of acanthosis nigricans different from a benign melanocytic nevus?
there is acanthosis of the basal layer of epidermis leading to the hyperpigmentation, there is no melanocytic hyperplasia though as there would be in a nevus (which is characterized by nests of melanocytes)
What are the four types of PEM-PHI-GUS?
Those would be PEM-PHI-GUS vulgaris, PEM-PHI-GUS foliaceus, PEM-PHI-GUS vegetans, and PEM-PHI-GUS erythematosus
What is most likely associated with a sudden onset of several seborrheic keratoses? What is this called?
usually a GI carcinoma (notes just say underlying malignancy)? This is the Sign of Leser-Trelat
What is it called when eczematous dermatitis develops in response to a tinea?
an ID reaction
The dysplastic nevus syndrome shows which form of mendelian inheritance? What chromosome?
AD, 1 (short arm)
This is a disorder that involves benign linear melanocyte hyperplasia with benign acanthosis
Lentigo
What are betel nuts associated?
Chewing on these is associated with SCC
T/F: ocular melanoma occurs in the pigment layer of the retina
False. Even though it seems like it should be true. It actually arises in the uvea (iris, ciliary body, and choroid)
What are the white dots and lines on the papules of lichen planus known as?
Wickham’s striae
What is the HALLMARK of TEN and Stevens-Johnson syndrome?
necrotic keratinocytes in the epidermis
What antibody is present in PEM-PHI-GUS, PEM-PHI-GOID, and dermatitis herpetiformis?
PEM-PHI-GUS and PEM-PHI-GOID are IgG, DH is IgA
What is the term for separation of the nail bed from the nail as may occur in psoriasis?
onycholysis
What are the 4 tumors of the dermis?
Benign fibrous histiocytoma, xanthoma, dermatofibrosarcoma protruberans, and the dermal vascular tumors
Name the 4 general chronic inflammatory dermatoses?
Psoriasis vulgaris, Lichen planus, SLE, Acne vulgaris
Describe the 5 Clark’s levels of invasion of malignant melanoma
I) tumor in epidermis II) tumor invading into but not filling papillary dermis III) tumor invading/filling papillary dermis IV) tumor invading reticular derms V) tumor in adipose of subcutis
Explain why both malignant melanoma and schwannomas are S-100 positive but glioblastomas are not
melanoma and schwannomas are from neural crest which is what S-100 stains for. Astrocytes are from neuroectoderm and GBM’s are astrocytomas thus they are not S-100 positive
What lesion of the integumentary system is characterized bya fibrovascular core covered by epithelium (i.e. epidermis)?
skin tag = acrochordon
This is the “mask of pregnancy”
melasma
Describe the histology of keratoacanthomas
central keratin-filled crater that is surrounded by a benign proliferation of epithelial cells
What are the severe forms of erythema multiforme that are more common in drug reactions?
Stevens-Johnson syndrome and Toxic Epidermal Necrolysis
T/F: discoid lupus is associated with systemic Sx
false (usually)
In panniculitis what are the two histologic areas that can be inflamed?
connective tissue septa between fat lobules or the fat lobules themselves
What will you see on direct immunofluorescence of PEM-PHI-GUS vs. PEM-PHI-GOID?
In PEM-PHI-GUS it follows the keratinocytes; in PEM-PHI-GOID it is LINEAR and at the DE jxn
What are the two histologic subtypes of melasma?
Epidermal type with increased melanin in basal layer of dermis; Dermal subtype in which MACROPHAGES in the dermis have melanin pigment in the cytoplasm
Which form of acne can result in sinus tract formation?
acne congoblata
This is HMB-45 positive
malignant melanoma (along with S-100)
What causes scabies?
Sarcoptes scabiei
What is the term for intraepidermal edema?
spongiosus
What results from excess elastic fibers in the dermis?
Solar elastosis–the basis of wrinkles? By the way, if you took the burqa comment as either anti-muslim or sexist, you’re probably not the sharpest tool in the shed.
If you were to get ocular malignant melanoma which would you want? Which would you not want?
Ocular Spindle Cell malignant melanoma has higher survival rates than ocular epithelioid malignant melanoma
What is erythema induratum?
A type of panniculitis that occurs secondary to vasculitis supplying fat
Enzyme deficient in porphyria cutanea tarda?
Uroporphyrinogen deaminase
How is a pilar cyst different from an epidermal inclusion cyst?
They are lined by the epithelium of the hair follicle but rather than having keratin filling they have eosinophilic material that can undergo dystrophic calcification
What is the tick that carries lyme Dz?
Ixodes dammini
What ist he pathognomonic structure in a MCV infection (not umbilication, but microscopic finding)?
MOLLUSCUM BODY, a homogenous red-blue cytoplasmic inclusion
T/F: there is acantholysis in PEM-PHI-GOID
FALSE acantholysis occurs within the dermis but here the lesion is at DE jxn
What is Darier’s sign?
localized area of dermal edema and erythema (i.e. a wheal) that occurs when the lesional skin is rubbed
Where are the 3 histologic locations for the nests of melanocytes to be located in a benign melanocytic nevus?
Junctional (at DE jxn), intradermal, or compound which is in dermis and DE jxn
How is angioedema different from urticaria?
Angioedema involves the deeper dermis and SubQ fat
What are clusters of malignant CD4 positive T cells in the skin called?
Pautrier’s microabscesses
What is the target lesion of lyme dz called? What about the one by Mycoplasma pneumoniae?
Erythema migrans, Erythema multiforme (more commonly HSV)
What is the significance of actinic keratosis regarding the outcome for the patient?
It is a premalignant lesion for SCC similar to CIN in the cervix
What disease are Munro’s microabscesses and spongiform pustules of Kogoj associated with?
psoriasis
What are the 2 non-inflammatory blistering diseases?
Porphyria (cutanea tarda) and epidermolysis bullosa
What tumor, similar to a fibrous histiocytoma also has many benign blood vessels and hemosiderin deposits?
Sclerosing hemangioma
What is Lentigo? What is Vitiligo?
Lentigo is a benign proliferation of melanocytes (benign linear melanocyte hyperplasia) typically with benign acanthosis?. Vitiligo involves loss of color due to a loss of melanocytes from autoantibody destruction
T/F: nests of melanocytes below the stratum basale can be identified in an ephelis
False. An ephelis is a freckle. There is more melanin but there aren’t more melanocytes
This is the most common malignant tumor arising on sun-exposed sites in elderly patients
SCC
What does it mean to say that melanocytic nevus lesions are undergoing “maturation”?
They are going deeper and into the dermis
Which topical chemotherapeutic is used in actinic keratosis
topical 5-FU
What is it called when there is inflammatory infiltrate in the subcutis in SLE?
lupus profundus (“deep lupus” since it is normally at the DE jxn)
What is Cowden’s Syndrome
multiple trichilemmomas and breast CA
Name the 7 major disorders of pigmentation and melanocytes (no subtypes)
1) Vitiligo 2) Melasma 3) Lentigo, 4) Ephelis 5) Benign melanocytic nevus 6) Dysplastic nevus 7) Malignant melanoma
Can lichen planus become CA?
Yes rarely, oral lichen planus can degenerate to SCC
name the 2 types of xanthomas
eruptive and tuberous
What is a Civatte body?
necrotic colloidal epidermis in lichen sclerosis
Immunosuppressed patients or those with xeroderma pigmentosum are at risk for ____________
SCC (and probably others obviously but SCC and immunosuppression is a pretty big deal!)
What is Sezary syndrome?
seeding of the blood with malignant T cells from mycosis fungoides that results in diffuse erythema
How do you treat the epidermal subtype of melasma?
Hydroquinone (a topical bleaching agent)? You may have heard of people bleaching their anus. Don’t know why they do it but this is what they use. Don’t ask me why I know that.
T/F: the Koebner phenomenon can occur in both psoriasis and lichen planus
TRUE
This is a type of panniculitis that occurs secondary to vasculitis of vessels supplying fat tissues
Erythema induratum
What kind of cells are malignant in mycosis fungoides/sezary syndrome?
CD4
What describes new lesions of psoriasis at sites of trauma?
Koebner phenomenon
What is the term for a flat wart? Specifically on the foot?
Verruca planis, verruca plantaris (hand = palmaris)
What is the sign of Leser-Trelat?
A sudden onset (explosive) of several seborrheic keratoses often associated with underlying GI CA
Though fibroepithelial polyps are typically benign they have been associated with ________ and __________
DM and Intestinal polyposis
What is Weber-Christian disease?
relapsing febrile nodular panniculitis, a lobular nonvasculitic panniculitis
Which form of PEM-PHI-GUS presents with moist verrucous plaques?
PEM-PHI-GUS vegetans
What is dermatosis papulosa nigra?
small seborrheic keratoses on the faces of blacks
What is a follicular keratosis?
When seborrheic keratosis involves the hair follicles and grows in an endophytic fashion
What kind of lymphocytes are present in erythema multiforme?
CD8
Types of HPV for genital warts. Types for SCC
6 and 11; 16 and 18
Which disease has blisters that rupture more easily: PEM-PHI-GUS or PEM-PHI-GOID?
pemphigus
What ages and races are affected by lentigo?
all, and the pathogenesis is unknown
Where will you see IgG antibodies under direct immunoflouresence in PEM-PHI-GUS (any type)?
along the borders of keratinocytes
What depth of invasion is associated with a good prognosis in malignant melanoma?
0.76 mm
Name the 3 major diseases that arise from cellular immigrants to the skin
Histiocytosis X, Mycosis fungoides, and Mastocytosis
What is lichen planus primarily affecting the hair follicles of the scalp known as?
Lichen planopilaris
What is xanthelasma?
essentially xanthomas on the eyelids
Name the 4 general inflammatory dermatoses
urticaria, eczematous dermatitis, erythema multiforme, and panniculitis
Name the 6 benign epithelial tumors
Seborrheic keratosis, Acanthosis nigricans, Fibroepithelial polyp, Keratoacanthoma, Epithelial cyst, Adnexal (appendage) tumors
How is lentigo histologically different from a benign melanocytic nevus?
lentigo is linear proliferation of melanocytes WITHOUT nesting. A nevus involves nests of melanocytes
What ist he most common form of panniculitis?
erythema nodosum
What accounts for the color of a blackhead?
Oxidation of keratin
Describe the Auspitz sign
the dermal papillae are closer to the epidermis than normal so there will be bleeding if it is peeled off
What kind of panniculitis results from injecting foreign substances or self-injury?
Factitial panniculitis
What is the term for melanin pigment in the macrophages of the dermal subtype of melasma?
Melanin incontinence
What 2 antigens is malignant melanoma positive for?
S-100 and HMB-45
This involves the proliferation of benign basaloid keratinocytes with HORN PSEUDOCYSTS
seborrheic keratosis
Which type of basal cell CA has marked desmoplasia?
morphea subtype, worst prognosis
What are seborrheic keratoses on the faces of “blacks” called?
Dermatosis papulosa nigra
What is usually left after lichen planus resolves?
A zone of post-inflammatory hyperpigmentation
What is the localized cutaneous form of mastocytosis?
urticaria pigmentosa
Which cutaneous carcinoma is neuroendocrine?
Merkel cell CA
Name the 4 (no subtypes) premalignant and malignant tumors of epidermis (this does not include melanoma)
Actinic keratosis, SCC, Basal cell CA, and Merkel Cell CA
What is the term for superinfection of eczematous skin by bacteria to produce a yellow crust
impetiginization
This skin neoplasm has a rapid onset, mimics SCC, but can go away on its own
keratoacanthoma
Which 2 subtypes of malignant melanoma involve prolonged radial growth? What does that mean for staging?
Lentigo maligna (sun-exposed surfaces on elderly) and Superficial Spreading? This is good for prognosis because staging is by the Breslow thickness, obviously these won’t be very thick
Describe the pathogenesis of vitiligo
It is autoantibody destruction of melanocytes
This tumor has atypical fibroblasts in a storiform pattern
Dermatofibrosarcoma protruberans
What are 3 ways you get the benign type of acanthosis nigricans?
as an AD trait, associated with obesity or endocrine disorder, as part of a number of rare congenital syndromes
An epithelial cyst (Wen) develops from the downgrowth of ___________
epidermis (downgrowth and cystic expansion)
Synonym for fibroepithelial polp
acrochordon (also skin tag and squamous papilloma)
Where is ocular malignant melanoma most likely to spread?
the liver
What is hereditary angioneurotic edema?
inherted deficiency of C1 activator (C1 esterase inhibitor)
