Pathology: Dermatopathology Flashcards by Amanda Kroymann

Functions of Normal Skin

barrier protection
thermoregulation
perception - touch, pain, pressure
immunoregulation

How well did you know this?

Not at all

Perfectly

Normal Skin - Divisions

epithelial - epidermis, adnexa
dermis
subcutis

How well did you know this?

Not at all

Perfectly

Epidermis Layers

statum corneum
granular layer
spinous (malpighian) layer
basal cell layer (melanocytes)

How well did you know this?

Not at all

Perfectly

Stratum Corneum

anucleated keratinocytes

parakeratosis

How well did you know this?

Not at all

Perfectly

Granular Layer

keratohyal granules

filagrin precursor

How well did you know this?

Not at all

Perfectly

Spinous Layer

numerous “spiny” process - desmosomes

glassy, eosinophilic cytoplasm

How well did you know this?

Not at all

Perfectly

Basal Layer

higher N:C ratio
basophilic
hemidesmosomes

How well did you know this?

Not at all

Perfectly

Melanocytes

UV barriers
pheomelanin (red), eumelanin (yellow, brown, black)
skin color depends on location and density of melanosomes

How well did you know this?

Not at all

Perfectly

Actinic Keratosis Clinical

very common
sun exposed areas
scaly, erythematous plaques
10-20% transform
cumulative exposure to sunlight

How well did you know this?

Not at all

Perfectly

Actinic Keratosis Histopathology:

parakeratosis 
hypogranulosis 
downward budding epidermis
keratinocyte atypia
solar elastosis
SCC in situ

How well did you know this?

Not at all

Perfectly

Squamous Cell Carcinoma Clinical

2nd most common skin cancer
sun damaged skin
areas of chronic inflammation
organ transplant patients (renal)
older patients 
shallow ulcers with keratinous crust
UV-B radiation most important factor, less important UV-A, radiation, arsenic, coal tar, hydrocarbons

How well did you know this?

Not at all

Perfectly

Squamous Cell Carcinoma Histopathology

nests of squamous cells - from epidermis
eosinophilic cytoplasm
vesicular nuclei
horn pearl formation
can have acantholysis

How well did you know this?

Not at all

Perfectly

Basal Cell Carcinoma

most common skin cancer (5:1 with SCC)
sun exposed skin, fair complexion
have one, increased risk for more
older people
slow growing, non-aggressive
etiology: UV-B; arsenic, x-rays, stasis, PUVA therapy, immunosuppression

How well did you know this?

Not at all

Perfectly

Basal Cell Carcinoma Clinical

papulonodular with pearly translucent edge
ulcer
pale plaque
erythematous plaque
some pigmented
clinical accuracy - 60-70%

How well did you know this?

Not at all

Perfectly

Basal Cell Carcinoma Types

multifocal superficial
nodular
micronodular
infiltrating
desmoplastic

How well did you know this?

Not at all

Perfectly

Basal Cell Carcinoma Histopathology

islands/nests basaloid cells
peripheral palisading
attachment to epidermis
myxoid stroma
retraction artifact

How well did you know this?

Not at all

Perfectly

Nevoid Basal Cell Carcinoma

young - can be prior to puberty
multiple BCC
odontogenic keratocysts
pits on palms/soles
cutaneous cysts
skeletal and neurologic anomalies

Nevoid Basal Cell Carcinoma Syndrome - Clinical

autosomal dominant
9q
BCC occur anywhere, harmless
few to hundreds of BCC

Solar Lentigo

not melanocytic
small dark brown macules
sun exposed skin
middle age to elderly
multiple

Solar Lentigo - Histopathology

elongated rete ridges - bulb shaped/finger like
basal hyperpigmentation - dirty feet, increased melanocytes
solar elastosis

Melanocytic Nevi

develop during childhood and adolescence
increased with sun
boys > girls
fair skin > darker skin

Melanocytic Nevi - Maturation

flat macular (junctional) - uniform, symmetrical
cells "drop off" (compound) - elevated
intradermal - most by early adult, less pigment

Melanocytic Nevi - Clinical

less nevi with age
young adult: 15-40
more nevi&raquo_space; risk

Malignant Melanoma

lifetime risk 1/87
early treatment is key
risk factors:
multiple moles
atypical moles
freckling
history of severe sunburn
easy burning
light hair with blue eyes

Familial Atypical Mole and Melanoma Syndrome

melanoma in 1st or 2nd degree relative >50 moles, some atypical histologically atypical 9p deletion

Malignant Melanoma - Clinical

``` Asymmetry Border Irregularity Color variegation Diameter Elevation, enlargement, rapid change ```

Malignant Melanoma - Lentigo Maligna (5-15)

face of elderly

Malignant Melanoma - Superficial Spreading (50-75%

any party of body

Malignant Melanoma - Nodular Melanoma (15-35%)

polpoid

Malignant Melanoma - Arcal Lentigous (5-15%)

palmar, plantar, subungul | African-American, Japanese

Malignant Melanoma - Desmoplastic (rare)

head and neck | indurated

Malignant Melanoma - Histopathology

``` asymmetry confluent spread pagetoid spread cytologic atypia lack of maturation dermal mitotic figures ```

Predictive Factors for Melanoma | poorer prognosis

tumor thickness - greater thickness mitotic rate - faster inflammation - absent anatomic site - subungal

Psoriasis

hyperproliferation of epidermis (7 vs. 53 days)

Psoriasis Clinical

2% of population ~25 years old signs: well circumscribed erythematous patches with white scale, Auspitz sign locations: extensor surfaces, sacral region, scalp, nails, sites of trauma (Koebner reaction) -polyarthritis -chronic course

Psoriasis Clinical Variants - Guttate - Erythrodermic - Sebopsoriasis

guttate: small papules, strep A erythrodermic: high morbidity

Psoriasis Histopatholgoy

``` psoriasiform acanthosis thin suprapapillary plates mounds/confluent parakeratosis hypogranulosis munro microabsecess - intracorneal neutrophils ```

Bullous Pemphigoid

``` #1 subepidermal bullous disorder elderly erethmatous macules - tense bullae - rupture = crusted erosions, urticarial plaques ```

Bullous Pemphigoid - Clinical Features

``` lower abdomen, groin, flexor surface oral cavity (10-40%) other mucosal surfaces are rare chronic course - autoimmune (BP AG1 - 90%, hemidesmosomes or BP AG2 - transmembrane protein) ```

Bullous Pemphigoid - Histology

subepidermal blister | eosinophils - prominent dermis/cavity