Robbins XXII - The Skin Flashcards
This term is the accumulation of edema fluid within the epidermis. Characterizes all forms of eczamatous dermatitis.
Spongiosis
An uncommon, usually self-limited disorder that seems to be a hypersensitivity response to certain infections and drugs. Patients present with an array of “multiform” lesions, including macules, papules, vesicles, and bullae, as well as the characteristic targetoid lesion consisting of a red macule or papule with a pale vesicular or eroded center.
Erythema Multiforme
In this skin disorder, there is marked epidermal thickening (acanthosis), and loss of the stratum granulosum with extensive overlying parakeratotic scale. The most typical lesion is a well-demarcated, pink to salmon-colored plaque covered by loosely adherent silver-white scale.
Psoriasis
This sign is described as bleeding upon removal of scales from the lesions of psoriasis.
Auspitz sign
Small aggregates of neutrophils within the parakeratotic stratum corneum in psoriasis.
Munro microabscesses
Small aggregates of neutrophils within the spongiotic superficial epidermis in psoriasis.
Pustules of Kogoj
Layer of the skin which is affected in psoriasis.
S. granulosum
“Pruritic, purple, polygonal, planar papules, and plaques” describes this disorder of the skin and mucosa. The pattern of inflammation of this disorder is characterized by angulated, zigzag contour (“sawtoothing”) of the dermoepidermal junction.
Lichen Planus
Anucleate, necrotic basal cells seen in the inflamed papillary dermis of patients with lichen planus are called?
Colloid bodies or Civatte bodies
Presents as roughening of the skin that takes on an appearance reminiscent of “lichen on a tree”. It is a response to local repetitive trauma such as continual rubbing or scratching.
Lichen Simplex Chronicus
Common lesions of children and adolescents, caused by human papillomavirus (HPV). Histologic features include epidermal hyperplasia that is often undulant in character, and cytoplasmic vacuolization (koilocytosis).
Verrucae (warts)
The most common type of wart. Occurs anywhere but are found most frequently on the hands, particularly on the dorsal surfaces and periungual areas, where they appear as gray-white to tan, flat to convex, 0.1- to 1-cm papules with a rough, pebble-like surface.
Verruca vulgaris
These warts are common on the face or dorsal surfaces of the hands. These warts are flat, smooth, tan macules.
Verruca plana/flat wart
These warts occur on the soles and palms. Described as rough, scaly lesions that may reach 1 to 2 cm in diameter, coalesce, and be confused with ordinary calluses.
Verruca plantaris and verruca palmaris
These warts occurs on the penis, female genitalia, urethra, and perianal areas.
Condyloma acuminatum (venereal wart)
A rare autoimmune blistering disorder resulting from loss of integrity of normal intercellular attachments within the epidermis and mucosal epithelium. Caused by a type II hypersensitivity reaction
Pemphigus
Common histologic denominator in all forms of pemphigus, described as the lysis of the intercellular adhesion sites.
Acantholysis
In this variant of pemphigus, acantholysis selectively involves the layer of cells immediately above the basal cell layer, giving rise to a suprabasal acantholytic blister. There is uniform deposition of immunoglobulin and complement along the cell membranes of keratinocytes, producing a characteristic “fishnet” appearance.
Pemphigus vulgaris
In this variant of pemphigus, acantholysis selectively involves the superficial epidermis at the level of the stratum granulosum.
Pemphigus foliaceus
An autoimmune disease in which the characteristic finding is linear deposition of IgG antibodies and complement in the basement membrane zone. Characterized by a subepidermal, nonacantholytic full-thickness epidermal fluid-filled blister.
Bullous pemphigoid
A rare disorder characterized by urticaria and grouped vesicles. Fibrin and neutrophils accumulate selectively at the tips of dermal papillae, forming small microabscesses, which coalesce to form a subepidermal blister. On immunofluorescence, granular deposits of IgA are localized at the tips of dermal papillae.
Dermatitis herpetiformis
These common epidermal tumors occur most frequently in middle-aged or older individuals. The lesions consist of an orderly proliferation of uniform, benign basaloid keratinocytes with a tendency to form keratin microcysts (horn cysts), which has a “stuck-on” appearance on the skin.
Seborrheic keratosis
These are rare tumors that primarily occur in the head and neck region of older individuals. They usually present as flesh-colored papules and can be a marker for an internal malignancy.
Sebaceous Adenoma
These lesion is usually the result of chronic exposure to sunlight and is associated with hyperkeratosis. The dermis contains thickened, blue-gray elastic fibers or “solar elastosis” which is the result of chronic sun damage.
Actinic keratoses
Acronym for remembering the histologic features of actinic keratoses.
“Sunny” SPAINS - solar elastoses (dermal sun damage)P - parakeratosisA - atypia (keratinocytic)I - inflammationN - not full thickness atypia
A common tumor arising on sun-exposed sites in older people, with higher incidence in women. Arise from prior actinic keratoses. Characterized by highly anaplastic, rounded cells with foci of necrosis and only abortive, single-cell keratinization (dyskeratosis).
Squamous cell carcinoma
This is the most common human cancer, which is a slow-growing tumor that rarely metastasizes. tends to occur at sites subject to chronic sun exposure and in lightly pigmented people. h
Basal cell carcinoma
These tumors present as pearly, smooth-surfaced papules, often containing prominent, dilated subepidermal blood vessels (telangiectasia). The cells have scant cytoplasm, small hyperchromatic nuclei, and a peripheral palisade with clefting from the stroma.
Basal cell carcinoma
This refers to any benign congenital or acquired neoplasm of melanocytes.
Melanocytic nevus
These are large nevi and may occur as hundreds of lesions on the body surface. They are flat macules to slightly raised plaques, with a “pebbly” surface. Considered as a marker of melanoma risk.
Dysplastic nevi
This cancer of the skin may develop from a dysplastic nevus, and results from excessive sun exposure. Malignant cells have large nuclei with irregular contours having chromatin characteristically clumped at the periphery of the nuclear membrane and prominent eosinophilic nucleoli often described as “cherry red”. Has both radial and vertical growth phases.
Melanoma
This determines the biologic behavior of melanomas.
Nature and extent of the vertical growth phase
What is the most common type of all autoimmune blistering disordering of the skin (pemphigus)?
Pemphigus Vulgaris
Histologically, what is the most common denominator in all forms of pemphigus?
Acantholysis
Morphology: Subepidermal nonacantholytic blisters
Bullous Pemphigoid
Morphology: Suprabasal acantholytic blister
Pemphigus Vulgaris
Morphology: Characteristically, fibrin and neutrophils accumulate selectively at the tips of the dermal papillae forming small microabscesses
Dermatitis Herpetiformis
Morphology: accumulation of neutrophils beneath the stratum corneum
Impetigo
Munro microabscesses is classically seen in?
Psoriasis
Auspitz sign is associated with what condition?
Psoriasis
Pearly papules often containing prominent, dilated subepidermal blood vessels (telangiectasias)
Basal Cell Carcinoma
What is the most commonly accepted exogenous cause of squamous cel carcinoma of the skin?
Exposure to UV light
Cutaneous horns are seen in what condition?
Actinic Keratosis
What factor is the most important in the determining the biological behavior of malignant melanoma? Vertical or Radial growth?
Vertical growth
Morphology: characterized by loss of melanocytes
Albinism
In albinism, melanocytes are present but melanin pigment is not produced due to what enzyme deficiency or defect?
Tyrosinase
Q: + for melanocyte-associated proteins such as tyrosinase or Melan-A or S
Vitiligo
The early developmental stage in melanocytic nevi is called?
Junctional nevi
Most junctional nevi grow into the underlying dermis as nests or cords of cells and are calle
compound nevi
When all the epidermal nests of compound nevi are lost entirely they form what
intradermal nevi
Appears to play an important role in the development of skin malignant melanoma
Sunlight
What are the 5 clinical warning signs of melanoma?
- enlargement of a pre-existing mle2. itching or pain in pre-existing mole3. development of a new pigment lesion during adult life4. irregularity of the borders of a pigment lesion5. variegation of color within a pigmented
Morphology: proliferations of basaloid cells with formation of prominent keratin filled “horn” cysts
Seborrheic keratosis
Appears clinically as flesh-colored, dome shaped nodules with central, keratin filled plug, imparting a crater like topography
Keratoacanthoma
Morphology: Central, keratin filled crater surrounded by proliferating epitheal cells that extend upward in a lip-like fashion over the sides of the crater and downward into the dermis as irregular tongues
keratoacanthoma
The most important clinical sign of malignant melanoma
change in color, size, or shape in a pigmented lesion
In Malignant Melanoma, what type of growth indicated the tendency of a melanoma to grow horizontally within the epidermal and superficial dermal layers, often for a prolonged period of time?
Radial growth
In Malignant Melanoma, what are the determinants of a more favorable prognosis?
- Tumor depth of less than 1.7 mm2. Absence or low numbers of mitoses3. Presence of a brisk TIL response (Tumor Infiltrating Leukocytes)4. Absence of regression 5. Female gender6. Location on extremity skin
