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Histo path > Skin > Flashcards

Skin Flashcards

1
Q

Layers of the epidermis

A 
'Come Let's Get Some Beers'
Stratum corneum
Stratum lucidum 
Stratum granulosum
Stratum spinosum
Stratum basale
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2
Q

In which layer of the epidermis are melanocytes found?

A

Stratum basale

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3
Q

Name the 4 inflammatory reaction patterns in the epidermis

A

Vesiculobullous, spongiotic, lichenoid, psoriasiform,

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4
Q

Name the 2 inflammatory reaction patterns in the dermis

A

Vasculitic, granulomatous

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5
Q

Name 3 conditions with a vesiculobullous reaction pattern

A

Bullous pemphigoid, pemphigus vulgaris, pemphigus foliaceus

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6
Q

Presentation of bullous pemphigoid

A

Elderly, autoimmune, high mortality rate (10-20%)
Sub-epidermal blisters as epidermis lifts off dermis
Flexor surfaces, tense bullae

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7
Q

Pathophysiology of bullous pemphigoid

A

IgG and C3 attack the basement membrane
• Detected by immunofluorescence
• IgG anti-hemidesmosome
Eosinophils recruited to release elastase
Elastase damages the anchoring proteins
Fluid fills up gap between BM and epithelium

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8
Q

Presentation of pemphigus vulgaris

A

Deep

Flaccid blisters, rupture easily

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9
Q

Where is affected in bullous pemphigoid?

A

Dermo-epidermal junction affected

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10
Q

Where is affected in pemphigus vulgaris?

A

Epiderma-epidermal junction affected (inter-epidermal)

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11
Q

Pathophysiology of pemphigus vulgaris

A

IgG attacks between the keratin layers (acantholysis) i.e. loss of intracellular connections
Common for many conditions; need immunofluorescence to confirm

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12
Q

Presentation of pemphigus foliaceus

A

Fairly superficial

Top layer is very thin so never blisters

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13
Q

Pathophysiology of pemphigus foliaceus

A

IgG-mediated – outer layer of stratum corneum shears off

Diagnose with immunofluorescence

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14
Q

Name 2 conditions with a spongiotic reaction pattern

A

Discoid eczema, contact dermatitis

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15
Q

Presentation of discoid eczema

A

Flexor surfaces

Very itchy; plaques form

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16
Q

Presentation of contact dermatitis

A

Red, sore, itchy
Itchy; latex and nickel
Itchy –> hyperparakeratosis (thickening)
Epidermis gets thicker –> lichenification

17
Q

Pathophysiology of eczema

A

Epidermis gets thicker
Eczema is spongiotic because there is oedema in between the keratinocytes (intercellular oedema)
T cell mediated and eosinophils are recruited
A differential for an eczematous reaction pattern is a drug reaction

18
Q

Name a condition with a psoriasiform reaction pattern

A

Plaque psoriasis

19
Q

Presentation of plaque psoriasis

A

Silver plaques on extensor surfaces

20
Q

Pathophysiology of psoriasis

A

Normal keratinocyte turnover time = 56 days
Psoriasis keratinocyte turnover time = 7 days
Rapid turnover –> epidermis thicker
A layer of parakeratosis forms at the top
Stratum granulosum disappears as not enough time to form it; and dilated vessels form
Munro’s microabscesses form, made up from recruitment of neutrophils

21
Q

Name 2 conditions with a lichenoid reaction pattern

A

Lichen planus, erythema multiforme

22
Q

Presentation of lichen planus

A

Itchy
Papules and plaques of purplish-red colour on the wrists and arms
In mouth it presents as white lines (Wickham striae)

23
Q

Pathophysiology of lichen planus

A

T cell-mediated

T-lymphocytes have destroyed bottom keratinocytes
Creates band-like inflammation
Cannot see where dermis finished, and epidermis starts

24
Q

Name a condition with a vasculitic reaction pattern

A

Pyoderma gangrenosum

25
Q

Presentation of pyoderma gangrenosum

A

Non-healing ulcer

Not actually gangrenous!
Often first presentation of a systemic disease e.g. colitis, hepatitis, leukaemia

26
Q

Presentation of seborrhoeic keratosis

A

“Cauliflower”, pigmented, gets caught on clothing (and taken off)
Stuck-on appearance, harmless and benign

27
Q

Pathophysiology of seborrhoeic keratosis

A

Lots of growth and ordered proliferation
Ordered and benign growth
“Horn cysts” – epidermis entrapping keratin

28
Q

Describe a sebaceous cyst

A

Transluminates, central punctum, circumscribed, hot

Squamous cell lining surrounding the cyst

29
Q

Presentation of a basal cell carcinoma

A

Rolled, pearly-edge, central ulcer, telangiectasia

“Rodent ulcer” as it burrows away

30
Q

Characteristics of BCC

A

Benign but can disfigure
Locally aggressive
Hardly ever metastasises
Occurs in sun-exposed areas

31
Q

Common mutation in BCC

A

PTCH mutation is a somatic mutation commonly seen in BCC (usually due to UV exposure but can be inherited)

32
Q

Histopathology of BCC

A

Dysplastic change
Cancer from keratinocytes at bottom of epidermis
Cannot break through the BM –> cannot metastasise

33
Q

What is Bowen’s disease?

A

Squamous cell carcinoma in situ [i.e. pre-cancerous]
Dysplasia
Keratinocytes become more pleiomorphic and larger with mitotic figures
Bowen’s disease name changes depending on location (i.e. anal vs. cervix)

34
Q

What is actinic keratosis aka solar keratosis?

A

Pre-malignant disease (dysplasia)
Sun damage
Thickening of epidermis as proliferating more than usual
Rough and scaly appearance

35
Q

Name 4 benign melanocytic conditions

A

(1) Café-au-lait spots = a form of melanocytic naevus

(2) Junctional nevus = melanocytes nest in the epidermis [pictured]
o Flat and coloured
o Normally, melanocytes sit in the basal layer of the epidermis
o Melanocytes can, however, physiologically exist in the dermis
o As you age, melanocytes usually drop into the dermis

(3) Compound nevus = nests in epidermis and dermis
o Raised area
o Surround by flat pigmented area

(4) Intradermal naevus = nests in the dermis
o Raised area
o Skin-coloured or pigmented

36
Q

Criteria for assessing melanoma

A 
ABCDE
Asymmetry 
Border (irregular)
Colour
Diameter
Evolution
37
Q

Describe pagetoid spread of melanoma

A

The junctional melanocytes are not normally maturing and dropping out of the dermis – they are moving up through the dermis instead = “Pagetoid spread” this is NOT normal

38
Q

Name and describe the staging system for melanoma

A

Staged by “Breslow Thickness” measured from granular layer to bottom of bottommost normal melanocyte
>4mm = BAD

39
Q

Name a common mutation in melanoma

A

BRAF v600e

Histo path (4 decks)

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