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LR Dermatology > Pathology of Skin Lesions > Flashcards

Pathology of Skin Lesions Flashcards

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Dermatology Board Prep flashcards
1
Q

Define…

  • hyperkeratosis
  • parakeratosis
  • acanthosis
A

Hyperkeratosis = increased thickness of the keratin layer

Parakeratosis = persistence of nuclei in the keratin layer

Acanthosis = increased thickness of the epithelium

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2
Q

What does parakeratosis signify?

A

That the epidermis is turning over too quickly

This is because the nuclei are usually lost before they reach the keratin layer

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3
Q

Define…

  • papillomatosis
  • spongiosis
A

Papillomatosis = irregular epithelial thickening

Spongiosis = areas of oedema between the squamous cells of the epidermis

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4
Q

Which disease is spongiosis characteristic of?

A

Eczema

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5
Q

What are the 4 main classifications of inflammatory skin disease?

A
  • Spongiotic
  • Psoriasiform
  • Lichenoid
  • vesiculobullous
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6
Q

Describe the following inflammation patterns:

  • Spongiotic
  • Psoriasiform
  • Lichenoid
  • vesiculobullous
A
  • Spongiotic = oedema in the epidermis e.g., eczema
  • Psoriasiform = elongation and clubbing of the epidermal ridges e.g., psoriasis
  • Lichenoid = basal layer damage e.g., lichen planus
  • Vesiculobullous = blistering conditions e.g., pemphigoid
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7
Q

What are cytoid bodies?

A

Dead keratinocytes

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8
Q

How would you describe the histology of lichenoid inflammation?

A
  • Sawtoothed dermo-epidermal junction
  • Cytoid bodies in the basal layer
  • Hyperkeratosis
  • Hypergranulosis
  • Inflammatory infiltrates in the upper dermis
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9
Q

What are immunobullous diseases? Give 3 examples

A

Diseases that have blisters as their primary feature

Pemphigus, bullous pemphigoid, dermatitis herpetiformis

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10
Q

Which pathological process is found in all variants of pemphigus?

A

Acantholysis

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11
Q

What is acantholysis?

A

Loss of communication between epidermal cells

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12
Q

What is the difference between the location of the blisters seen in pemphigus vulgaris and bullous pemphigoid?

A

Pemphigus vulgaris = in the upper layers of the epidermis

Bullous pemphigoid = subepidermal blister (under the dermis)

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13
Q

Early in embryogenesis, melanoblasts migrate from the neural crest to the… (3)

A
  • Skin
  • Uveal tract (middle layer of eye)
  • Leptomeninges (2 innermost membranes surrounding the brain and spinal cord)
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14
Q

In the basal layer, what is the ratio of melanocytes to keratinocytes? (roughly)

A

1:5 to 1:10

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15
Q

Individuals with darker skin have more melanocytes. T/F

A

False

Melanocyte ratio is constant irrespective of race - it is the melanin content within them that differs

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16
Q

Which gene determines the balance of pigment in the skin and hair?

A

MC1R gene

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17
Q

What does 1 faulty copy of MC1R cause?

What does 2 copies cause?

A

1 copy: freckling

2 copies: red hair and freckles

18
Q

What are ephilides?

A

Freckles

19
Q

Why do freckles occur?

A

After sun exposure due to the clumpy distribution of melanocytes

20
Q

What are actinic lentigines and what are they caused by?

A

‘Age’ or ‘liver’ spots most commonly found on the face and dorsal hands

They are related to UV exposure

21
Q

What are the 4 main types of malignant melanoma?

A
  • Superficial spreading (most common, affecting trunk and limbs)
  • Acral/mucosal lentiginous (affecting mucosal and peripheral parts)
  • Lentigo maligna (affecting sun-damaged areas)
  • Nodular (varied sites but often trunk)
22
Q

Describe the 2 growth phases of a non-nodular melanoma

A

Radial growth phase (RGP) - grows horizontally either entirely in-situ or with dermal microinvasion

Vertical growth phase (VGP) - melanoma cells invade the dermis, forming an expansile mass with mitoses

23
Q

Melanomas can metastases in radial and vertical growth phase. T/F?

A

False

They can only metastases in VGP

24
Q

Why can melanomas only metastases in VGP?

A

They have access to lymphatics and blood vessels in the dermis

25
Q

How is the growth of a nodular melanoma different from that of a non-nodular one?

A

Nodular melanomas do not have a RGP

They are exclusively VGP tumours which makes them more aggressive

26
Q

The non-nodular melanomas can form nodules if left too late. T/F?

A

True

27
Q

Where are malignant melanomas most likely to metastasise to?

A
  1. Local dermal lymphatics
  2. Regional lymph nodes
  3. Blood spread to organs (heart and GI tract most common)
28
Q

Invasion of local dermal lymphatics can lead to which visible presentation?

A

Satellite deposits of malignant melanoma in the skin (lots of black dots surrounding the lesion)

29
Q

Mutations in which genes are most common for melanomas on…

  • sun-exposed skin
  • the peripheries (acral melanoma
A

Sun-exposed - BRAF mutation

Acral - c-kit mutation

30
Q

What does BRAF mutation result in in the cell?

A

Over-activation of the MAP/ERK pathway, causing excess cell growth and proliferation

31
Q

Which 2 types of medication are often given in the case of BRAF mutation and why?

A

BRAF inhibitor e.g., dabrafenib, vemurafenib

+ MEK inhibitor

The combination makes it harder for the cancer to evolve to overcome the BRAF inhibitor

32
Q

Name 3 precancerous epidermal dysplasias of SCC and state where they are most commonly found

A

Bowen’s disease - legs

Actinic keratosis - head/neck

Viral lesions - anogenital skin

33
Q

What are the 3 main subtypes of basal cell carcinoma?

A

Nodular
Superficial
Infiltrative (morphoeic)

34
Q

Which is the most invasive type of BCC?

A

Infiltrative (morphoeic)

35
Q

What does ‘morphoeic’ refer to when describing infiltrative BCC?

A

The lesion looks like a scar

36
Q

What is the classic appearance of a nodular BCC?

A

Small, shiny nodule with telangiectasia

37
Q

What is meant by ‘peripheral palisading’ when referring to histology of a nodular BCC?

A

The DEJ looks like a Pickett fence

38
Q

A scaly plaque specifically stated as being found on an elderly woman’s older leg is a sign of…

A

Bowen’s disease (due to cumulative sun-exposure in that area for this group)

39
Q

Which virus are viral precancerous lesions associated with?

A

Human papillomavirus

40
Q

Which sites for SCC typically have the poorest prognosis?

A

Scalp, ear and nose

41
Q

Name some miscellaneous skin tumours

A

Dermatofibroma

Angioma

Angiosarcoma

Merkel cell carcinoma

Mycosis fungoides (cutaneous T-cell lymphoma)

Cutaneous B-cell lymphoma

LR Dermatology (11 decks)

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