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YR5 Histopathology > Skin > Flashcards

Skin Flashcards

1
Q

Describe the normal layers of the epidermis from top to bottom

A

Stratum CORNEUM
Stratum LUCIDUM
Stratum GRANULOSUM
Stratum SPINOSUM
Stratum BASALE

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2
Q

What nmeumonic can be used to remember the layers of the epidermis in order?

A

Come
Lets
Get
Some
Beers

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3
Q

What lies at the bottom and below the epithelium?

A

Basement membrane
Dermis
Subcutaneous tissue: connective tissue, fat, vessels

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4
Q

What happens to the epidermis and collagen in the subcutaneous tissue with age?

A

Epidermis: thins
Collagen + elastic fibres: weaken

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5
Q

What lies within the dermis?

A

Blood vessels
Sweat glands
Hair follicles
Sebaceous glands
Nerve fibres

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6
Q

Give examples of why location of skin is important

A

Face: more sebaceous glands
Palmar-plantar: no sebaceous glands, very thick corneal layer

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7
Q

What 4 patterns of inflammation can occur in the epidermis?

A

Spongiotic
Lichenoid
Psoriasiform
Vesiculobullous

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8
Q

What 2 patterns of inflammation can occur in the dermis?

A

Vasculitic
Granulomatous e.g. Sarcoid

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9
Q

What pattern of inflammation can occur in the sub cutis?

A

Panniculitis e.g. erythema nodosum

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10
Q

Define hyperkeratosis

A

Thickening of stratum CORNEUM

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11
Q

Define parakeratosis

A

Abnormal retention of keratinocyte nuclei in stratum corneum

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12
Q

Define Acanthosis

A

Thickening of stratum SPINOSUM

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13
Q

Define Acantholysis

A

Separation of keratinocytes in epidermis due to loss of adhesion between them

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14
Q

Define Spongiosis

A

Widening of INTERcellular spaces between keratinocytes due to INTERcellular oedema

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15
Q

Define Lentiginous

A

Linear pattern of melanocyte proliferation within epidermal basal cell layer
Reactive or neoplastic

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16
Q

Define Lichenoid

A

Sheeny plaque appearance on surface of skin

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17
Q

Define Psoriaform

A

Thickened skin

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18
Q

Give an example of a spongiotic reaction

A

Eczema

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19
Q

List 6 types of eczema

A

Atopic dermatitis: IgE mediated
Contact dermatitis: Type IV hypersensitivity
Dyshidrotic eczema
Nummular eczema
Seborrheic dermatitis
Statis dermatitis

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20
Q

What histological features characterise eczema?

A

Spongiosis: fluid collection in dermis
Eosinophil infiltrate in dermis
Dilated dermal capillaries

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21
Q

What is eczema/. dermatitis?

A

Interchangeable terms to describe disorders with same histology with inflamed, dry, itchy rashes

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22
Q

Give an example of Lichenoid inflammation

A

Lichen Planus

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23
Q

Describe the pathophysiology of Lichen Planus

A

T lymphocytes destroy basement membrane
Creates band-like inflammation
Cannot see where dermis finishes + epidermis starts

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24
Q

Give 2 signs of Lichen Planus

A

Shiny, purple, itchy papules + plaques on wrists + arms
White lacy lines in mouth= Wickham striae

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25
What are the 6ps of lichen planus?
Purple Polygonal Plaques Papules Pruritic Planar
26
In which group of diseases is there a slightly lichenoid pattern of inflammation?
Erythema multiforme Steven Johnson's syndrome Toxic epidermal necrolysis
27
Describe the presentation of erythema multiforme
Annular target lesions classically on extensor surface of hands + feet Pleomorphic lesions; combination of macules, papules, urticarial wheals, vesicles, bullae + petechiae
28
Name 2 infectious causes of erythema multiforme
HSV Mycoplasma
29
Name 5 drugs that can cause erythema multiforme. What mnemonic can be used to remember these?
SNAPP Sulphonamides NSAIDs Allopurinol Penicillin Phenytoin
30
What occurs in SJS/TEN?
Derm emergency Sheets of skin detachment Nikolsky sign +ve: slight rubbing causes shearing of skin Mucosal involvement prominent
31
Give an example of a psoriaform reaction
Psoriasis
32
Describe the pathophysiology of plaque psoriasis
Rapid turnover: thicker epidermis Layer of PARAKERATOSIS forms at top Stratum granulosum disappears as not enough time to form it + dilated vessels form MUNRO's MICROABSCESSES form, from recruitment of neutrophils
33
What is psoriasis?
Chronic inflammatory dermatosis with erythematous, well-dermarcated scaly plaques Bi-modal distribution 15-25 + 50-60
34
Describe the pathophysiology of psoriasis
1. Type IV T cell hypersensitivity reaction in epidermis 2. Further T cell recruitment 3. Release of pro-inflammatory cytokines 4. Keratinocyte hyper proliferation 5. Epidermal thickening
35
List the 5 types of psoriasis
Chronic plaque Flexural Guttate Erthrodermic/ pustular Koebner phenomenon
36
Describe chronic plaque psoriasis
Salmon pink plaques + silver scales Affects extensor aspects of knees, elbows + scalp
37
Psoriasis is associated with which 3 nail changes?
POSH Pitting Onycholysis Subungual Hyperkeratosis
38
Psoriasis is associated with which 4 forms of arthritis?
DIP disease Arthritis mutilans "telescoping" Spondylopathy Symmetrical polyarthritis
39
Name 3 AI vesiculobollous patterns of inflammation
Bullous pemphigoid Pemphigoid vulgaris Pemphigoid folliaceus
40
Give 4 facts about presentation of bullous pemphigoid
Large tense bullae on erythematous base Often flexural surfaces ELDERLY Bullae don't rupture as easily as pemphigus
41
Describe the pathophysiology of bullous pemphigoid
1. IgG + C3 bind to hemidesmosomes of basement membrane 2. Eosinophils recruited to release elastase 3. Epidermis lifts off + fluid accumulates in space
42
What bullae are seen in bullous pemphigoid and pemphigus vulgaris?
BP: SUBepidermial bulla PV: INTRAepidermal bulla
43
Give 3 facts about presentation of pemphigus vulgaris
Flaccid blisters, rupture easily- raw red surface Found on skin + mucosal membranes Nikolsky's sign +ve
44
Describe the pathophysiology of pemphigus vulgaris
IgG bind to desmoglein 1+3 BETWEEN keratinocytes in stratum Spinosum- loss of intracellular connections- Acantholysis
45
What is seen on immunofluorescence in bullous pemphigoid and pemphigus vagaries?
BP: Linear deposit of IgG at dermal-epidermal junction PV: Intercellular deposits of IgG "Chicken wire" pattern
46
How does pemphigus foliaceus differ to pemphigus vulgaris?
PF: Superficial PV: Deeper in epidermis
47
Aetiology of seborrhoeic keratoses
Skin ageing
48
5 features of seborrhoeic keratoses
1. Flat/ raised papule/plaque. "Stuck on" 2. mm-cm's diameter 3. Skin coloured, yellow, grey, brown, black or mixed 4. Smooth, waxy or warty surface 5. Solitary or grouped
49
Describe the histology of seborrhoeic keratoses
Keratin horns in epidermis Ordered benign proliferation
50
What is this?
Sebhorrhoeic keratosis
51
What is the correct term for sebaceous cyst?
Epidermoid cyst (originate from epidermis, don't contain sebum)
52
Give 4 features of epidermoid cysts
1. Firm, fleshy/ yellowish papule/ nodule fixed to skin surface but typically mobile over deeper layers 2. Diameter 1–3 cm 3. A central punctum 4. Foul-smelling cheesy debris can be expressed from central punctum.
53
What is this?
Epidermoid cyst
54
Most common skin cancer
BCC
55
3 characteristics of BCC
Slow growing Locally invasive Rarely metastasise
56
4 characteristics of appearance of BCC
Pearly white/ pink papule-nodule or firm plaque Rolled edge Shiny Associated telangiectasias
57
What are BCCs also known as?
"Rodent ulcers" Locally destructive
58
Describe the histology of BCCs
Mass of basal cells pushing down into dermis Palisading (nuclei align in outermost layer)
59
What is this?
Basal cell carcinoma
60
Cells involved in BCC
Cells in epidermis + follicular epithelium
61
Cells involved in SCC
Keratinocytes
62
2nd most common skin cancer
SCC
63
List 4 characteristics of SCC
1. Non-healing ulcerated lesion with hard, raised edges. 2. Slow-growing ulcer or reddish skin plaque. 3. May bleed 4. Metastatic potential
64
Growth rate of SCC and BCC
SCC develop + grow over 3-6 months BCC are slower
65
Describe the histology in SCCs
Atypia/dysplasia throughout epidermis Nuclear crowding + spreading through basement membrane into dermis
66
What are Actinic Keratoses?
Dry, rough, adherent scaly lesions Pink/ skin coloured/ red Non-malignant (low risk transformation to SCC) AKA Solar keratoses
67
Describe the histology of Actinic Keratosis
SPAIN Solar elastosis Parakeratosis Atypical cells Inflammation Not full thickness
68
What is Bowens disease?
Red scaly patches Intraepidermal (in situ SCC) Arises in outer layers of epidermis Pre-cancerous: 3% risk of progression to invasive SCC
69
Describe the histology in Bowens disease
Full thickness atypia/ dysplasia Basement membrane intact: i.e. not invading the dermis
70
HPV is a risk factor for which skin carcinoma
SCC
71
Name a benign lesion originating from melanocytes
Melanocytic naevi (moles) Junctional, compound or intradermal
72
What is this?
SCC
73
Describe the 3 types of benign naevus
Junctional: melanocytes in epidermis. Flat + coloured Compound: melanocytes in epidermis + dermis. Raised + surrounded by flat patch Intradermal: melaoncytes in dermis. Raised with pedunculated/ smooth surface.
74
5 signs of malignant melanoma
A; asymmetrical B; irregular border C; >1 colour D; diameter >6mm E; Evolving/ elevating
75
3 further signs from ABCDE that indicate nodular melanoma
Elevated Firm to touch Growing
76
Describe the histology in malignant melanomas
1. Atypical melanocytes with mitotic figures; initially grow horizontally in epidermis 2. Melanocytes migrate into upper epidermis (pagetoid spread) + are scattered among epithelial cells in a “buckshot” manner 3. Vertical growth downwards, penetrate dermal-epidermal junction = invasive
77
6 risk factors for malignant melanoma
MMRISK Moles- atypical >5 Moles- common >50 Red hair Inability to tan Sunburn Kindred
78
What is used to stage Melanoma?
Breslow thickness (most important prognostic factor, based on depth) (+Clark Scale) TNM
79
What are 4 types of melanoma?
Superficial (60%): irregular borders, variation in colour Nodular (>50s): most aggressive Lentigo maligna (Elderly) Acral lentiginous malignant (dark skinned): rare

YR5 Histopathology (27 decks)

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