Skin Flashcards
Benign epithelial tumors
Seborrheic ketatosis
acanthosis nigricans
epidermal cyst
Seborrheic ketatosis
loos like melanoma
older indiv
light brow/flat - pale brown w/ pink tones to dark brown/black
velvety or waxy to finely verrucous surface
looks stuck on, Crumbles with scraping
Leser trelat - eruptive, multiple assoc w/ internal malignancy
Subtype in African americans: dermatosis papulosa nigra
Histo:
- exophytic
- basaloid cells
- pigmented
- exuberant keratin production
- HORN CYSTS (keratin filled)**
- loose lamellar “shredded-wheat” or “onion-skin” keratin
Dermatosis papulosa nigra
-
acnathosis nigricans
Benign vs malignant
- hyperpigmentation
- hyperplasia - spinosum layer – thick and velvety
- folds - neck axilla groin
Benign - childhood/puberty - endocrine abnormality (DM)
Malignant - middle-age/older - visceral malignancy (cancer)
indication of underlying disorder
Epidermal cyst
-
Melanoma
Superficial spreading Lentigo maligna Nodular Acral Amelanotic
Superficial spreading
a
Lentigo maligna
a
Nodular
a
Acral
a
Amelanotic
a
Disorders of pigmentation and melanocytes
Hypopigmentation
Hyperpigmentation
Hypopigmentation
a
Vitiligo
a
Hyperpigmentation
Freckle Lentigo Melanocytic nevi spitz nevus Dysplastic melanocytic nevus melanoma
Freckle
a
Lentigo
a
Melanocytic nevi
a
spitz nevus
a
Dysplastic melanocytic nevus
large, oval, multiple
irregular pigment
Fading border “fried egg” - central papule with surrounding macule
Histo: compound, concentric papillary dermal fibrosis
Horizontally oriented nests w/ bridging of adj rete
nests are at tips/sides of rete
cytologic atypia: hyperchromatic, enlarged nuclei
potential precursor for melanoma
Premalignant and malignant epidermal tumors
Actinitic keratosis
nonmelanoma skin cancer
Actinic keratosis
Premalignant lesion assoc w/ sun exposure
earliest identifiable lesion that can develop into SCC (60%) - patient will follow up in 2-3 mo with ulcerated/thickened lesion
palpation key to diagnosis
Rough or “gritty” skin, discrete, scaly, feels like “broken glass” - surface lesion
found on sun exposed areas - face, scalp, ears, posterior neck, forearms, legs
Histo:
- parakeratosis in corneum
- hyperplasia and cytologic atypia of basal layer
- solar elastosis in superficial dermis
must BIOPSY to distinguish between AK and SCC
Nonmelanoma skin cancer
Squamous cell carcinoma
Keratoacanthoma
Basal cell carcinoma
Squamous cell carcinoma
Oral
Verrucous
Keratoacanthoma
benign epithelial tumor
looks like SCC
sudden on actinically-damaged skin
rapid growth
spontaneosly regresses in few months
Red to flesh colored, dome-shaped papule w/ central crater filled w/ keratin plug
Histo
- large, red, glassy squamoid cells
- neutrophil microabscess common
- eosinophils and lymphocytes in surrounding infiltrate
cant transform into SCC
Mohs micrographic surgery - remove tumor and thin rim of normal appearing skin around the diefect – sectioned and labeled, frozen so examine while patient is in the office. Best long- term cure rate of any treatment modality
Basal cell carcinoma
Nodular
Superficial
Morpheaform
Most common malignancy
pluripotent cells in basal layer or follicular structures slow growing. rarely metastasize local destruction if neglected excellent prognosis non-healing lesion that bleeds
UV radiation imp risk factor
Histo:
- nests of basaloid cells that palisade at the border of the nest
- nests in fibromyxoid stroma
- nodules attach to undersurface of the epiderpis
- STROMA SEPERATES FROM TUMOR NODULES
Nodular BCC
MC - 60%
Face
Waxy w/ central depression Pearly erosion, ulceration, or crusting bleeding w/ minor trauma rolled border translucency Telangiectasia
Superficial BCC
Trunk
scaly
light red color
atrophic center with fine translucent micropapules on rim
Tumors of the dermis
Dermatofibroma
Dermatofibrosarcoma protuberans
Dermatofibroma aka
Benign fibrous hisiticytoma
Very common
lower legs
slow growing
flesh colored-pigmented
“Dimple-sign”
pruritic
past trauma
Fibroblasts with collagen , hyperkeratosis and hyperpigmentation - reddish brown color
dermatofibrosarcoma protuberans
- primary fibrosarcoma of skin
- locally aggressive but rarely metastasize
- Hypercellular
- thinned epidermis
- into subcut fat “honeycomb” pattern
- fibroblasts in pinwheel pattern
Tumors of cellular migrants to the skin
Mycosis fungoides
Mastocytosis
Mycosis fungoides
T-cell lymphoma
trunk
3 stages
3rd - nodule - tumor w/ systemic spread. deep into dermis
Histo:
sezary-lutzner cells - bands in superficial DERMIS (cd4+)
Pautrier microabscess - single/small cluster of invading cells in epidermis
Mastocytosis
Urticaria pigmentosa
Systemic mastocytosis
- Darier sign: wheal when lesion is rubbed
- Dermatographism: hive when normal skin is stroked
Sx - due to release of histamine, heparin, other mast cell contents
Mastocytoma: histo-
- metachromatic granules w/in dendritic mast cells
- monomorphous dermal infiltrate
- NO epidermotropism
- “Fried egg cells”
- Giemsa stain: purplish mast cells in dermis - the granules are purple
Urticaria pigmentosa
Children usually
> 50% of mastocytosis
- multiple mastocytoma - round to oval, red-brown papules and plaques, pruritic, blister. shortly after birth
systemic mastocytosis
Adults usually
only abt 10% of of mastocytosis
similar to urticaria pigmentosa PLUS multi-organ mast cell infiltration: BM, liver, spleen, LN
Pruritis and flushing due to certain foods, drugs, EtOH, temp changes
Disorders of epidermal maturation
Icthyosis
Ictyosis
impair epidermal maturation
thick corneum w/ loss of basket weave
thick granular layer
except with icthyosis vulgaris - no granular layer
Congenital
Acquired
Congenital icthyosis
a
Acquired icthyosis
a
Acute inflammatory dermatoses
Urticaria
Acute eczematous dermatitis (aka spongiotic dermatitis)
Erythema multiforme (SJ, TEN, pitryiasis rosea)
Stasis dermatitis
Urticaria
Histo
- perivenular infiltrate - neuts then mononuclear cells
- Collagen bundles more widely spaced bc of edema fluid
- Dilated lymphatics
- no epidermal changes
Spongiotic dermatitis
Contact dermatitis
- irritant: direct toxic effect. not immunogenic. crust
- allergic: cell mediated. Type IV. produce urushiol. nickel. papule and scale
Atopic dermatitis - worse in winter. Very itchy. dry with oozing. diaper area, face. CHRONIC - lichenification - epidermal thickening and skin lines
begins at 1st yr of life. babies, children, adults - just different areas
Nummular dermatitis
- coin shaped, red plaques, young adults
Asteatotic dermatitis
- “winter itch”
- older people in winter. dry and cracked, itchy
Histo:
- spongiosis - intERcellular edema
- Exocytosis of lymphocytes in epidermis
Erythema multiforme
CD8+ attack
early -
superficial perivascular lymph infiltrate
dermal edema
lymphocytes at dermo-epi junction w/ degenerating and necrotic keratinocyte
later-
lymph migrate into epidermis, necrosis of epi and blister forms
target lesions
Stevens johnson
involves mucous membrane, mouth and conjunctiva
children > adults
fever, renal failure, sepsis, difficulty eating
sulfa, anticonvulsant
TEN
necrotic epidermis lifts off dermis - supepidermal bulla
macules
w/ or w.o target lesions
Pitryiasis rosea
HHV-7
herald patch - resembles ringworm
christmas tree pattern
patient feels well
not on face
trunk,upperarms, thigh
ithcy
spongiosis w/ erythrocyte extravasation
spontaneously remits - 6wks
Stasis dermatitis
- venous incompetence
inc hydrostatic pressure and extravasation of rbc
middle aged, older
incomp valves in lower legs
hyperpigmentation, edema, itchy, scaly, infl
ulceration above medial malleolus
Histo:
- chronic intercellular epidermal edema
- rbc extrav – hemosiderin to collect –> thickened rough brown appearance
Chronic inflammatory dermatoses
Psoriasis
Seborrheic dermatitis
Lichen planus
SLE
Psoriasis
Auspitz sign - pinpoint bleeding
symmetrical
Koebner phenomenon-trauma and stress cause exacerbation
thin granulosum layer and parakeratosis in corneum
- nail involvement. oil spotting - brown, onycholysis - distal separation. also pitting and subungual hyperkeratosis
- arthritis
pencil in cup
Seborrheic dermatitis
cradle cap
dandruff
yellow, scaly, greasy patch w. erythema
common in parkinsons, hiv
parakeratosis near follicles
Lichen planus
5 Ps: pruritic PURPLE polygonal planar papules plaques
wrists/ankles/mucous membrane
Wickham’s striae: fine, reticulated white lines
Koebner phenomenon
Hep C assoc
Histo:
- interface dermatitis - dense infiltrate of lymphocytes along dermoepidermal junction. the junction is more angulated zigzag (saw toothing)
- degeneration/necrosis of basal keratinocytes (Civatte bodies - incorporation into inflamed papillary dermis)
Self-limited.
mucous mem inv - longer course
SLE
african americans
females
30-40
sun, weightloss, cns, arthralgia
Malar rash - “butterfly” - macular eruptions w/ clear borders
multi sys involvmnt
SPARES nasolabial folds
immune complex deposit
False pos - RPR and VDRL
lichenoid interface dermatitis,
epidermal atrophy with thickened basal membrane
Blistering disease
Inflammatory
Non inflammatory
Inflammatory blistering disease
Pemphigus vulgaris
Bullous Pemphigoid
Dermatitis herpetiformis
Pemphigus vulgaris
IgG
Bullous pemphigoid
IgG
Dermatitis herpetiformis
IgA
Noninflammatory blistering disease
Epidermolysis bullosa
Porphyria cutanea tarda
Epidermolysis bullosa
a
Porphyria cutanea tarda
a
Disorders of epidermal appendages
Acne vulgaris
Acne rosacea
Acne vulgaris
a
Acne rosacea
a
Panniculitis
Erythema nodosum
Erythema nodosum
a
Infection
Verrucae
Molluscum contagiosum:
self-limited, spontaneously remits in a few months. skin-skin, h. contagious. flesh colored/translucent. Cheesy core. anywhere in kids/genitals sexually active adults. Histo: cup-shaped, verrucous acanthosis - epidermal hyperplasia, molluscum bodies in corneum and granulosum - ovoid, homogenous, cytoplasmic inclusion bodies
Impetigo
Scabies
Verrucae
Vulgaris
plana
plantaris
condyloma acuminatum
Verruca vulgaris
a
Verruca plana
a
Verruca plantaris
a
Condyloma acuminatum
anogenital wart
Xanthelasma
a
Mongolian spot
a
Chediak-higashi syndrome
a
Cherry angioma
a
Hemangioma of infancy
a
Wiskott-Aldrich syndrome
a
Alopecia
a
Albinism
a
Xeroderma pigmentosum
a
