Pathology, skin 1 Flashcards
What are the 5 layers of the epidermis?
stratum basale, stratum spinosum, stratum granulosum, stratum lucidum, stratum corneum
What are the 4 thing in the dermis?
Dermal papillae, hair follicle, basaL. Cell, sebaceous gland, desmosome
Name 4 disorders of pigmentation
vitiligo,
Melasma,
Freckles (ephelides,
Benign lentigo.
Name the three non-malignant melanocytic tumors.
Congenital melanocytic tumor (birthmark),
Nevocellular Nevus (mole),
Dysplastic Nevi,
Name 4 malignant melanomas.
lentigo Maligna melanoma,
Superficial spreading melanoma,
acral lentiginous melanoma,
nodular melanoma
What is the prognosis for malignant melanoma?
Level 1 - 100%, Level 2 - 93%, Level 3 - 71%, Level 4 - 59%, Level 5- 36%
How is malignant melanoma treated? Three ways
wide surgical excision, or
chemo if systemic,
may resolve spontaneously
What melanoma has the worst prognosis?
Nodular Melanoma,
What are used to help ID nodular melanoma?
Elevation,
Firm and
Growing, EFG
Most common melanoma in darker skinned people?
Acral lentiginous Melanoma
Where does acral lentiginous melanoma affect?
Palms,
under nails,
soles, and
sublingual
What is the most common melanoma over all?
superficial spreading melanoma
Pattern for growth of spreading malignant melanoma?
Horizontal growth, not deep.
What malignant melanoma has best prognosis?
Lentigo maligna melano, ususally found on face and neck
What is the danger of a giant gongenital nevi?
They have an increased risk of developing melanoma
What disorders of pigmentation has a loss of melanocytes?
vitiligo
What disorder of pigmentation has proliferation of melanocytes on the face?
melasma
What pigment disorder is caused by hormones?
melasma
What pigment order doesn’t change or get better?
vitilago, once melanocytes are gone you won’t have pigment
What causes freckles?
Same number of Melanocytes are making more pigment, melanin
What is the other name for freckles?
ephelides
what pigmentation disorder has melanocytic hyperplasia?
benign lentigo, it?s the local proliferation of melanocytes that you are not born with.
what is a benign tumor of melanocytes?
Mole, Nevocellular Nevus
What are the three types of Nevi?
Junctional,
compound,
intradermal
gross appearance of a mole or nevocellular nevus
uniform color,
defined borders,
stable size and shape,
What can look like a dysplastic Nevi?
cutaneous melanoma
What is dysplastic nevus syndrome?
specific gene causes one to have multaple dysplastic nevi and an increased risk of melanoma
What is a dysplastic nevi?
Large, irregular shape and color.
What does dysplastic nevi show microscopically?
cytological and archeticular atypia
Risk factors for Malignant melanoma?
sunburns, chronic uv exposure, fair skin, dysplastic nevus syndrome, familia mutation of tumor supressor gene.
what location generally gets the least malignant melanoma?
head
where do men get malignant melanoma most?
trunk, upper back
Woman, malignant melanom most oftern?
back and legs.
what melanoma is often found in the face or neck of older individuals and has the best prognosis?
lentigo Maligna melanoma,
what melanoma has a horizontal growth pattern?
superficial spreading melanoma
what melanoma is most common in darker skinned people and sublingually?
acral-lentiginous melanoma
what is the melanoma that you don?t want the most?
Nodular Melanoma,
describe nodular melanoma
nodular tumor, vertical growth patter that allows it to spread fast.
List epidermal - dermal lesions
Acanthrosis nigricans - seborrheic Keratosis - Psoriasis - pempigus - Bullous emhigoid - Ichthyosis vulgaris - xerosis - Eczema - polymouphus light eruption - Chronic cutaneous lupus erythematous - erythema multiforme - Pityriasis Rosea - Granuloma Annulare - erythema Nodosum - Epidermal inclusion cyst -
What should hold adjacent epidermal cells together?
Desmosomes
Acanthosis Nigricans looks like what?
thickened hyperpigmented skin at neck, armpit and groin
Ring around the collar
what skin conditon is assciated with obesity and hyperisnulinism?
acanthosis nigricans.
What more dangerous pathology could be associatate with acanthosis nigricans?
stomach and gastrointestinal malignancies.
what is the key feature of Seborrheic Keratosis?
stuck on appearance.
How would Seborrheic keratosis look microscopically?
basaloid epidermal hyperplasia - horn cysts.
what could sudden development of suborrheic keratosis accompany?
underlying malignancy
where would the middle aged and elderly develop suborrheic keratosis?
trunk,
head,
neck
extreamities.
Seborrheic keratosis
benign squamoproliferative neoplasm -
stuck on -
old/middle aged -
Leser trelat, underlying malignancy
What % of population is affected by Psoriasis?
One %
most common form of Psoriasis?
Psorisis vulgaris
What can psorisis also be associated with?
arthritis,
enteropathy,
myopathy
Psoriasis
autoimmune disorder accompanied by increased proliferation and turnover of epidermal keratinocytes
Common Psoriasis sites?
knees,
elbows,
scalp
What would psoriasis look like?
well demarcated erythematous plaque with silvery scale
What is auspitz sign?
scraping off scales and the layer below causing pinpoint bleeding
Under microscope what would elongation of the dermal ridges indicate?
psoriasis
What pathology has hyperkeratinization with parakeratosis?
psoriasis
How is psoriasis treated?
steroids,
UV radiation
methotrexate
What skin pathologies cause blisters?
- Pemphigus both vulgaris and foliaceus,
- bullous Pemphigoid
- dermatitis herpetiformis
What sign can indicate pemphigus?
Nikolski’s sign, blister border expands and its easily torn
What type of disorder is pemphigus?
autoimmune, pemphigus vulgaris is the most common,
What type of Antibodies that attack desmosomes in pemphigus?
IgG
acantholysis is what?
loss of intercellular adhesions
What is pemphigus?
rare autoimmune disorder, potentially fatal, blisters, acantholysis,
Is pemphigus or bullous pemphigoid more common?
Bullous pemphigoid
What is bullous pemphigoid?
autoimmune disorder of older people, Separation of the epidermis from dermis causing subepidermal blister formation, so they are hard to pop
What could indicate the difference betweem pemphigus and bullous pemphigoid?
Pemphigus blisters tear easily and the edges spread, bullous pempigoid blisters do not tear easily
What is the antibody that attacks epidermal junction in buuous pemphigus?
IgG
what is dermatitis herpetiformis often associated with?
- celiac sprue
- subepidermal blisters often in a line that form at tips of dermal papille
what antibodies attack gliadin and other antigens that deposit in tips of papillae?
IgA
what skin disorder can be treated with gluten free diet?
dermatitis herpetiformis
what conditon looks like aligator?
ichthyosis vulgaris
how does one get ichthyosis vulgaris?
common inherited disorder
what is ichthyosis vulgaris?
characterized by thickened stratum corneum and nearly absent granulosum. Hyperkeratotic fry skin -palm -soles and -extensor areas
what is Xerosis?
Abnormal dryness of the skin or musus membranes
eczema
group of inflammatory skin disoriders characterized by pruitus (iching)
what is puritus?
Another word for iching
types of Eczema?
acute,
chronic,
atopic dermitius,
contact dermitiis
What does acute eczema cause?
vesicular erythematous (red) rash
What does erythematous mean?
Red, so a red rash
what does chronic eczema look like?
chronic scratching followed by dry, thickened hyperkeratonic skin.
What mediates atopic dermititus hypersensitivity?
IgE mediated, causes dry skin and eczema
what is the most common form of photodermatosis?
polymorphous light eruption
polymouphous light eruption,
erythematous(red) macules,
papules,
plaques, or
vesicles on exposure to sun
macule
change in surface color w/o elevation or depression.
Papule
solid elevation of skin with no visible fluid
Plaque
solid raised flat topped leison greater than 1 cm
vesicule
small fluid filled sacks that form on skin
What does chronic cutaneous lupus erythematous cause?
epidermal atrophy, DNA anti DNA complexes in basment membrane of epideris.
How does lupus often appear?
butterfly rash on face - red, erythematous maculopapular eruption
Erythema multiforme?
hypersensitivity skin reaction to infection that gives bullseye rask
How is erythema multiforme characterized?
bullae (blisters),
targetoid red lesions, and
vesicles.
Bullae
blister bigger than 1 cm.
pityriasis Rosea
Christmas tree,
puritic rash,
herald patch,
following upper respiratory infection
Granuloma annulare
rare,
autoimmune reddish bumps in
form of ring
Granuloma is caused by an overproductive what?
WBC - leukocyttosis - they can flow freely the clump.
who is more likely to have granuloma annulare?
women
Erythema nodosum?
raised erythematous (red) painful nodules of subcutaneous fat, anteror shins.
How is erythema nodosum treated?
pain killers and it ususally resolves spontaneously in 3-6 weeks
On what age is erythema nodosum found mostly
12 -20 years
What is filled with keratin debries?
epidermal inclusion cyst
What are the types of malingant tumors?
- squamous carcinoma -
- basal cell carcinoma -
What can be a precursor or basal cell carcinoma?
actinic keratosis - old people hands
actinic keratosis characteristics?
- rough, red papules on face, arms and hands,
- induced by sun
What is happenning cellularly in actinic keratosis?
sun induced dysplasia of keratinocytes
Characteristic of squamous cell carcinoma?
tan nodular mass which commonly ulcerates
Microscopic squamous cell carcinoma?
nests of atypical keratinocytes that invade dermis, keratin pearls,
Keratoacanthoma
horn, rapidly growing domeshaped nodules with a central keratin filled crater
what is the normal prognosis for squamous cell carcinoma?
rarly metastazie, cut out will cure
What is the most common tumor in adults in the western world
basal cell carcinoma
where does basal cell carcinoma arise from?
basal cells of hair follicles
what does basal cell carcinoma look like?
sun exposed surfaces, pearly papules, nodules with translucent borders, telangiectasia, ulceration
what does basal cell carcinoma look like microscopically?
invasive nests of basoloid cells with palisading groth pattern
Prognossis for basal cell carcinoma?
slow growing, rarly metastasize
treatment for basal cell carcinoma?
complete excision
What is histocytosis X?
proliferation of langerhans cells, which are normally in epidermis.
variants of histocytosis X?
unifocal, multifocal, acute diseminated.
What are 4 main points about Psorisis?
Autoimmune with increased proliferation and turnover of epidermal keratinocytes
- effects 1% of pop
- genetic component
- associated with arthritis, enteropath and myopathy
Main characteristics of Actinic keratosis (old lady hands)
- SUn induced dysplasia of keratinocytes
- possible precursor to SCC
- rough red papules on face arms and hands
Vitilago characteristics
- irregular patches of depigmentation
- possible genetic component
- missing melanocytes
Pemphigus character
- rare but possibly fatal
- pemphigus vulgaris is most common
- autoantibodies: acantholysis
- attack desmoglein 3 of desmosime
Acantosis Nigricans
- thickened hyperpigmented skin at neck and pits
- hyperinsulenism
- obesity
- malignancy , (digestive tract)
Dysplastic nevi
- increased risk of melanoma
- cmm1 gene, chromosome 1, autosomal dominant
- may have more than one
Malignant melanoma
- increasing in US
- fair skinned more common
- familial form, loss of function in p16 tumor suppressor gene on chromosome 9
Nevocellular Nevi
- sharp well defined borders
- stable shape and size
- malignant transformation uncommon
- uniform color
