Skin Flashcards
Histology with spongiosis accumulation of fluid in upper epidermis and dermal inflammation?
Atopic eczema
Which inflammatory cells are seen in atopic eczema?
Lymphocytes with occasional mast cells
Define acanthosis
Epithelial hyperplasia
Histology of acanthosis, hyperkeratosis, chronic inflammation of dermis?
Chronic plaque psoriasis
Disease associated with HSV and targetoid lesions
Erythema multiforme
What cells are seen in drug reactions?
EOSINOPHILS
Band-like chronic inflammatory cell infiltrate along dermal-epidermal junction
Lichen planus
What is lichen sclerosis called?
BXO- balantis xerotica obliterans
Histology: Band of hyalinisation in the superficial dermis
Lichen sclerosis
True/false: Lupus and dermatomyosits have similar histology
True, chronic inflammation along dermal-epidermal junction
Which autoantibodies are seen with pemphigus vulgaris?
Anti-desmosome
Where does IgG immunofluorescene positivity appear in pemphigus vulgaris?
On epithelial cell surface, chicken wire pattern
Which autoantibodies are present in bullous pemphigoid?
Anti-basement membrane
Where does IgG immunofluorescene positivity appear in bullous pemphigus?
Basement membrane
Which disease is associated with dermatitis herpetiformis?
Coeliac
Antibodies in dermatisis herpetiformis? (hint:coeliac)
IgA TTG (tissue transglutaminase)
IgA anti EMA (endomysial antibodies)
Categorise the following into intra or sub-epidermal blisters:
Pemphigus vulgaris, bullous pemphigoid, dermatitis herpetiformis
Pemphigus vulgaris: Intra-epidermal
Bullous pemphigoid and d. herpetiformis: Sub-epidermal
Presentation of cutaneous sarcoidosis
Papules and plaques anywhere on body
Histology: non-caseating granulomatous inflammation and special stains for fungus and mycobacterium are -ve
Cutaneous sarcoidosis
Difference between granuloma annulare and necrobiosis lipoidica symptoms?
Granuloma annulare: annulare round pink-purple batches on BONY anatomical sites
Necrobiosis lipoidica: tender, yellow brown patches on lower legs
True/false: grannuloma annulare and necrobiosis lipodica have a similar histology
True
Both have necrobiotic granulomatous inflammtion: Zones of degenerate collagen surrounded by rim of histiocytes or macrophages
Histology: Intra-epidermal blister with intracellular viral inclusions
HSV
Histology for molluscum contagiosum?
Rarely needed, but will show intracellular viral inclusions at higher magnification
Disease associated with mycobacterium marinum?
Fish tank granuloma
Granulomatous inflammation and POSITIVE ziehl-neelsen (because of mycobacteria)
Which stain is used for fungal infections?
PAS stain (periodic acid-Schiff)
Anatomy of cutaneous cyst?
Epithelial lining containing ceratin
Most common type of cyst? Epidermal inclusion cyst or pilar?
Epidermal inclusion cyst
Pilar is on scalp
What is Leser Trelat?
Multiple rapidly appearing seborrhoeic keratoses, sign of malignancy
Another name for fibroepithelial polyp?
SKin tag
What is a papilloma?
Benign epithelial tumour usually on squamous epithelium
Also in breast, nasal cavity, larynx
Another name for benign glandular tumours?
Adenoma
Histology: Fibroblastic proliferation within the dermis
Dermatofibroma
Histology: Loss of epidermis, and granulation tissue with mix of new BVs and inflammatory cells
Ulcer
What is a pyogenic granuloma?
BENIGN vascular tumour. Polypoid proliferation of small blood vessels. Bleeds easy.
Misnomer- not infectious or granulomatous
Histology: fragmented hair shaft material within a sinus tract in the dermis, surrounded by inflammatory cells and fibrous scar tissue
Pilonidal sinus
Where do pilonidal sinuses occur? Which occupation is at risk?
Sacral area/cleft of buttocks of obese or hairy men.
Hairdressers at risk
Histology of freckle?
Increase in basal pigmentation but NO increase in melanocytes
Histology of solar lentigo?
Increase in basal pigmentation
Increase in basal melanocytes with NO nuclear atypia
Histology: Large number of melanocytes, nuclear polymorphism and atypia, mitotic figues and pagetoid spread
Lentigo maligna
Pagetoid=upward spread
Junctional naevus
Nests of benign melanocytes within epidermis
Intradermal naevus
Nests of benign melanocytes in dermis
Compound naevus
Features of junctional naevus and intradermal
Halo naevus
Melanocytic lesion with surrounding LYMPHOCYTES due to immune-mediated naevus regression
Blue naevus
Intradermal naevus which looks blue
Very heavily pigmented melanocytes with a spindle shape
Spitz naevus
Looks like a melanoma in children but acts benign
Dysplasia
Risk factors for dysplasia (AK, Bowen’s)
Sunlight, immunosuppression, previous irradiation, chemical carcinogens
Risk factos for skin cancer in groin?
HPV
Dysplastic naevus
Melanocytic lesion with dysplasia but no invasion
Can run in families or be sporadic
Melanoma in situ
Severe dysplasia of melanocytes WITHIN dermis
Also called lentigo maligna
Paget’s disease of nipple
Atypical GLANDULAR proliferations in epidermis. Pagetoid spread
Migration from underlying DCIS through lactiferous duct
Confirmed to be glandular with IHC stains
Extramammary Paget’s
Seen in hairy parts of body like groin or axilla
Same histology
Rare to have underlying adenocarcinoma
Most common skin cancer?
BCC
Does BCC metastasise?
Almost never
Does SCC metastasise?
Potentially, more aggressive than BCC
WHat is upward spread of malignant melanoma called?
Pagetoid
Another term for horizontal spread
Radial
Define Breslow depth
Distance between granular layer of epidermis and the deepest malignant cell
Most important prognostic factor
What is a BRAF mutation related to?
Malignant melanoma, 40% of cases have this oncogene
Patients can be treated with vermurafenib
What are mycosis fungiodes and Sezay syndrome examples of?
Cutaneous T cell lymphoma
Describe Mycosis fungiodes
NOT a fungal infection
Cutaneous T cell lymphoma involving epidermis and dermis
Low grade malignancy and resembles eczema
What is sezary syndome?
When tumour cells of mycosis fungiodes enters the circulation
Which HSV causes Kaposi sarcoma?
HSV 8
