Skin Flashcards

Question

ulceration

Answer 1

focal, complete epidermal loss

Answer 2

vacuoles within or adjacent to keratinocytes

Answer 3

pigmented lesions of childhood, 1-10mm tan-red to brown macules Morph: melanocyte density normal, hyperpigmentation result of focal melanin over-production and/or enhanced pigment donation to basal keratinocytes

Answer 4

Benign hyperpigmented macule common in infancy and childhood - no change with sun exposure Morph: hyperpigmented linear basal melanocyte hyperplasia often with rete ridge elongation and thinning

Answer 5

Congenital or acquired melanocyte neoplasms, well demarcated, uniformly tan-brown papules Morph: basal melanocytes derived - junctional nevi - nests of nevus cells at dermoepidermal junction - compound nevi - nests or cords of melanocytes extending into dermis - dermal nevi - epidermal component is lost --> maturation Path: BRAF or NRAS involved in RAS signaling to p16/INK4a

Answer 6

Larger than most acquired - flat macules to raised plaques with variegated pigmentation and irregular borders in both sunexposed and protected skin - low risk of malignant transformation Morph: compound nevi with cytologic and architectural atypia - enlarged and fused nests of nevus cells, lentiginous melanocyte hyperplasia, linear papillary dermal fibrosis Path: auto dom disorder often associated with mutations in protein with cell cycling

Answer 7

Skin, oral, anal surfaces, esophagus, meninges, eyes Clinical sx: changes in size, shape, or color of cutaneous skin, can be irregular or notched Morph: large cells with expanded irregular nuclei containing peripherally clumped chromatin and eosinophilic nucleoli - radial growth --> lentigo maligna, indolent lesion that may not progress for decades --> superficial spreading, most common form involving sun exposed skin --> acral/mucosal lentiginous, melanoma unrelated to sun exposure - vertical growth --> dermal invasion of clonal mass of cells, can metastasize Diagnostic factors: breslow thickness, mitosis, regression, tumor-infiltrating lymph, gender, location, micrometastasis Path: sun exposure, familial inheritance or genes - dysplastic nevus syndrome, RAS and PI3K/AKT, BRAF, RB

Answer 8

Age: middle to older individuals Path: leser-trelat - paraneoplastic syndrome due to TGF alpha and FGFR Morph: Grossly - uniform, tan-brown, velvety or granular plaques Micro - sharply demarcated and exophytic with hyperplasia of variably pigmented basaloid cells and hyperkeratosis, horn cysts

Answer 9

thickened, velvety hyperpigmented plaques in flexural areas - benign or malignant conditions --> benign is 80% and arises through puberty, auto dom --> malignant type in middle and older indiv with adenocarcinomas Morph: hyperkeratosis with rete ridges and basal hyperpigmentation

Answer 10

acrochordon, squamous papilloma or skin tag - found on face, neck, trunk or intertriginous zones Morph: soft flesh colored tumors attached by slender fibrovascular stalk Assoc: pregnancy, diabetes, intestinal polyposis

Answer 11

Common lesions as well-circumscribed firm subcutaneous nodules formed by downgrowth and cystic expansion of epidermal or follicular epithelium Morph: filled with keratin and lipid and debris from sebaceous secretions - epidermal inclusion cyst --> wall identical to normal epidermis - pilar (trichilemmal) cyst --> wall follicular epithelium - dermoid cyst --> wall similar to epidermis but has multiple skin appendages - steatocystoma multiplex --> wall resembles sebaceous gland ductal epithelium

Answer 12

Nondescript, flesh-colored benign papules or nodules - subset can be malignant - cowden syndrome for visceral malignancies in tumor suppressor gene PTEN - -> cylindromas - scalp and forehead, islands of basaloid cells with apocrine or eccrine differerntation - -> syringomas - mutliple, small, tan papules near lower eyelids and are composed of basaloid epithelium - -> sebaceous adenomas - lobular proliferations of sebocytes with frothy lipid filled cytoplasm - -> trichoepitheliomas - proliferations of basaloid cells that form hair follicle-like structures - -> pilomatrixomas - proliferations of basaloid cells that show hair-like differentatiation - -> apocrine carcinomas - axilla and scalp with ductal differentation

Answer 13

premalignant dysplastic lesion with chronic sun exposure Morph: grossly - lesions 1 cm, tan-brown, red, flesh colored micro - cytologic atypia in lower epidermis frequently with basal cell hyperplasia and dyskeratosis --> hyperkeratosis and parakeratosis exhibit thickened, blue-gray elastic fibers

Answer 14

Second most common tumor of sun-exposed skin of older individuals Gender: men more than women Morph: grossly - in situ sq cell carcinomas well demarcated, red, scaling plaques; invasive lesions are nodular micro - in situ carcinoma full thickness epidermal atypia; invasive tumors vary from well differentated to highly anaplastic with necrosis - keratoacanthoma - spontaneously resolving rapid growing lesion grossly - lesions are symmetric, cupshaped nodules micro- lobules of glass squamous cells keratinize progressing through a granular layer Path: UV radiation is greatest predisposing factor by inducing DNA damage by dampening immune functioning of langerhans cells Risks: industrial carcinogens, chronic skin ulcers, old burn scars, osteomyelitis, ionizing radiation, tobacco - p53 mutations

Answer 15

Most common invasive human cancer - slow growing and rarely metastasize - immunosuppression and defects in DNA repair Morph: - grossly, pearly papules often with prominent telangiectatic vessels - micro, monotonous basal cell proliferation multifocal superficial growths of skin or as nodules Path: nevoid basal cell carcinoma syndrome - -> rare auto dom disorder by multiple basal cell CA - medulloblastomas, ovarian fibromas, odontogenic keratocysts - PTCH, SHH

Answer 16

Heterogenous group of indolent neoplasms of dermal fibroblasts and histiocytes in adults - legs of young women - trauma and aberrant healing Morph: grossly - lesions firm tan-brown tender papules micro - dermatofibromas most common, spindle-shaped fibroblasts is a well-defined mid-dermal mass

Answer 17

Well-diffrentiated slow growing fibrosarcoma locally aggressive but rarely metastasizes Morph: tumors are firm nodules as protuberant and ulcerated aggregates within an indurated plaque micro - lesions are cellular and composed of radially oriented fibroblasts Path: balanced transolcation between collagen 1A1 and PDGFbeta

Answer 18

Cutaneous T cell lymphoma, mycosis fungoides d'emblee more aggressive - can involve into generalized lymphoma - with erythroderma with sezary syndrome Morph: grossly - eczema and arise on trunk, progress to scaly, red-brown patches, scaling plaques or fungating nodules Micro - sezary lutzner cell, malignant CD4+ cell with hyperconvoluted or cerebriform nucleus

Answer 19

Rare disorders characterized by increased numbers of cutaneous mast cells Sx: consequences of mast cell degranulation, histamine release causes pruritus, flushing, rhinorrhea, dermal edema and erythema Morph: grossly - skin lesions multiple, round-oval, nonscaling redbrown papules and plaques micro - dermal fibrosis, edema, eosinophils

Answer 20

Disorders of epidermal maturation leading to chronic excessive keratin accumulation resembling fish scales x-linked autosomal recessive and auto dom forms, acquired variants can be associated with various malignancies Morph: micro - lesions exhibit stratum corneum with minimal inflammation, thickness of epidermis or stratum granulosum

Answer 21

focal mast cell degranulation with histamine mediated dermal edema and pruritus - angioedema has dermal and subcutaneous fat Morph: grossly - small, pruritic papules to large edematous plaques micro - sparse mononuclear perivascular infiltrates Path: IgE independent urticaria can occur through chemical induced mast cell degranulation or by suppression of prostaglandin synthesis

Answer 22

Types: - allergic contact dermatitis, atopic dermatitis, drug-related eczematous dermatitis, photoeczematous dermatitis, primary irritant dermatitis Morph: grossly - pruritic, red, and papulovesicular to blistered, oozing, and crusted --> can go to psoriasis micro - early spongiosis progresses to frank fluid accumulation, splaying keratinocytes apart and forming intraepidermal vesicles Path: eczema constitute a cutaneous delayed type hypersensitivity response driven by langerhands cell presentation of antigens acquired at the epidermal surface

Answer 23

Uncommon self-limited hypersensitivity response triggered to drugs, infections, malignancy, or collagen vascular disorders Stevens-johnson syndrome - severe febrile form occurring in children, erosions and hemorrhagic crusting of the lips, oral mucosa, conjunctiva, urethra, anogenital regions toxic epidermal necrolysis - variant, characterized by diffuse mucocutaneous epithelial necrosis and sloughing Morph: grossly - multiform lesions include macules papules, vesicles and bullae micro - dermal-epidermal and perivascular lymph infiltrates with dermal edema and focal basal keratinocyte degeneration and necrosis Path: immunologic cutaneous disorders, epi cells injured by skin-homing CD8+ cytotoxic T lymph

Answer 24

1-2% of population Assoc: arthritis, myopathy, enteropathy, spondylitic join disease, AIDS Areas: elbows, knees, scalp, lumbosacral region, intergluteal cleft, glans penis, nail changes Morph: grossly - well demarcated, salmon pink plaques with silvery scaling, annular linear gyrate or serpiginous micro - marked acanthosis with downward rete elongation and with mitosis well above basal layer --> stratum granulosum is thinned or absent with overlying parakeratosis --> auspitz sign, spongiform pustules or munro microabscesses Path: HLA types at Koebner phenomenon

Answer 25

seborrhea affects 1-3% of population Areas: scalp, forehead, nasolabial folds, presternum Lenier disease - seborrhea, diarrhea, failure to thrive Morph: grossly - lesions macules or papules on greasy, yellow erythematous base with scaling and crusting micro - spongiotic dermatitis, later lesions acanthotic psoriasis Path: lipophilic yeasts may be involved

Answer 26

self limited disease leaving only postinflammatory hyperpigmentation oral lesions may persist longer Morph: grossly - pruritic, purple, polygonal planar papules, plaques --> lesions have wickham striae micro - dense, bandlike dermal-epidermal junction lymph infiltrate with basal cell degeneration and necrosis and jagged rete sawtoothing Path: T cell infiltrates with langerhans cell hyperplasia suggest cell-mediated immune injury

Answer 27

autoimmune disorder Age: 30-60 Tx: immunosuppression to reduce titers of pathogenic autoantibodies Types: pemphigus vulgaris - 80% oral mucosa, scalp, face, intertriginous zones, trunk, pressure points --> superficial easily ruptured blisters with shallow crusted erosions Pemphigus vegetans - large moist verrucous plaques studded with pustules pemphigus foliaceus - benign form on face, scalp, upper trunk, bullae superficial pemphigus erythematosus - localized milder variant of pemphigus foliaceus, malar paraneoplastic pemphigus - non hodgkin lymphoma Morph: micro - acantholysis with intercellular clefting and intraepi blisters with variable inflammatory infiltrate --> above basal layer (suprabasal blister) leaving an intact tombstone like layer Path: IgG against desmoglein components

Answer 28

Autoimmune blistering disease of skin and mucosa affecting elderly individuals - bullae do not rupture as easily as in pemphigus and if uninfected heal without scarring Morph: grossly - lesions are 2-8 cm tense bullae containing clear fluid --> thigh, forearm flexor surfaces, lower abdomen, intertriginous zones, oral mucosa micro - subepidermal non-acantholytic blister with linear dermoepidermal juntion path: autantibodies against hemidesmosome

Answer 29

Pruritic urticaria and grouped vesicles associated with celiac disease and responds to gluten-free diet Path: immune complex deposition in skin or gliadin antibodies cross-reacting with junction-anchoring components Morph: grossly - plaques and grouped vesicles bilateral and symmetric involving extensor surfaces, upper back, buttocks micro - neutrophils and fibrin accumulate at tips of dermal papillae with overlying basal vacuolization coalescing to large subepidermal blisters

Answer 30

common chronic lesion of hair follicles sebaceous glands Age: middle to late adolescence Gender: males more than female Assoc: hormonal changes and alterations in hair follicle maturation Morph: grossly - noninflammatory acne by open comedones and closed comedones, inflammatory acne with erythematous papules, nodules, pustules micro - comedones composed of expanding masses of lipid and keratin at midportion of hair follicles Path: bacterial (propionibacterium acnes) lipase degradation of sebaceous oils to form highly irritating fatty acids and incite the early inflammatory lesions

Answer 31

3% of US pop with a predilection for middle aged women Morph: grossly - flushing, erythema and telangiectasia, pustules and papules, rhinophyma micro - nonspecific perifollicular lymphocyte infiltrate with dermal edema and telangiectasia Path: innate immune system with inappropriate activation

Answer 32

Most common form of panniculitis - associated with drugs, infections, sarcoidosis, IBD, visceral malignancy Sx: ill-defined tender erythematous nodules with fever and malaise

Answer 33

uncommon panniculitis affecting adolescents and menopausal women - primary vasculitis of subcutaneous fat with inflammation and necrosis Sx: erythematous tender nodule that ulcerates and scars weber-christian disease - febrile nodular panniculitis rare lobular form of panniculitis with erythematous plaques or nodules

Answer 34

Caused by HPV - verruca vulgaris, most common typically found on hand dorsum - verruca plana, hand or face as flat, smooth, tan papules smaller than verruca vulgaris - verruca plantaris or palmaris, rough scaly that can coalesce and be confused with calluses - condyloma acuminatum, soft tan cauliflower like masses measuring up to many centimeters in diameter Morph: micro - epidermal hyperplasia and superficial keratinocyte perinuclear vacuolization koilocytosis Path: HPV 6,11,16

Answer 35

Poxvirus infection Morph: grossly - firm, pruritic, pink to skin-colored, umbilicated papules micro - cuplike verrucous epidermal hyperplasia with pathognomonic molluscum bodies

Answer 36

staph aureus and strep - highly contagious involves face and hands - bullous in children Morph: grossly - erythematous macules that progress to small pustures with honey colored crust micro - subcorneal pustules filled with neutrophils and gram pos cocci Path: epidermal bacterial infections with destructive innate immune repsonse