skin pathology Flashcards
1
Q
excoriation
A
traumatic lesion breaking the epidermis and causing a raw linear area
2
Q
lichenification
A
thickened and rough skin usually d/t rubbing/scratching
3
Q
macule/patch
A
circumscribed flat lesion distinguished from surrounding tissue by color
macule 5mm
4
Q
onycholysis
A
separation of nail from bed
5
Q
papule/nodule
A
elevated dome-shaped or flat topped lession
papule 5mm
6
Q
plaque
A
elevated flat topped lesion usually >5mm
7
Q
pustule
A
discrete pus filled raised lesion
8
Q
scale
A
dry, horny, platelike excrescence
usually result of imperfect cornification
9
Q
blister/vesicle/bulla
A
blister- any fluid-filled raised lesion
vesicle 5mm
10
Q
wheal
A
itchy, transient, elevated lesion w/variable blanching and erythema
11
Q
acantholysis
A
loss of intracellular cohesion btwn keratinocytes
12
Q
acanthosis
A
diffuse epi hyperplasia
13
Q
dyskeratosis
A
abnormal permature keratinization w/in cells below stratum granulosum
14
Q
erosion
A
discontinuity of skin showing incomplete loss of epi
15
Q
exocytosis
A
infiltration of epi by inflammatory cells
16
Q
hydropic swelling
A
intracellular edema of keratinocytes
often seen in viral infections
17
Q
hypergranulosis
A
hyperplasia of stratum granulosum
often d/t intense rubbing
18
Q
hyperkeratosis
A
thickening of stratum corneum
often associated with qualitative abnormality of keratin
19
Q
lentiginous
A
a linear pattern of melanocyte proliferation w/in epi basal cell layer
20
Q
papillomatosis
A
surface elevation caused by hyperplasia and enlargement of contiguous dermal papillae
21
Q
parakeratosis
A
keratinization w/retained nuclei in stratum corneum
on mucous membranes parakeratosis is normal
22
Q
spongiosis
A
intracellular edema of epidermis
23
Q
ulceration
A
discontinuity of skin showing complete loss of epidermis revealing dermis or subcutis
24
Q
vacuolizaton
A
formation of vacuoles w/in adjacent to cells often refers to basal cell BM membrane zone area
25
fibroepithelial polyps (FEP)
aka: skin tags, acrochordon, fibroma molle, squamous papilloma
occur usually 30+ more in obese
associated with areas of rubbing of clothes
26
epithelial inclusion cyst aka
epithelial cyst
follicular cyst
wen
27
epithelial inclusion cyst
- common
- occur on face, scalp, and upper trunk where there are a lot of hair follicles
- caused by obstruction of hair follicle above infundibulum
- filled with keratinous debris and lined by squamous granular cells
- if ruptured provoke chronic inflammation rxn w/ granuloma
28
seborrheic keratosis
```
proliferation of epidermal basal cells
common in middle-aged and older
'postage stamp' appearance
slightly elevated plaque
on non-sun exposed areas
removed b/c can sometimes lead to malignant melanoma
many have mutations in FGFR3
```
29
sign of lesser-trelat
acute onset of SKs w/malignancies (GI)
30
seborrheic keratosis aka
horn cysts
| pseudocysts
31
acanthrosis nigricans
hyperpigmentation flexural regions
epidermal hyperplasia of stratum spinosum
80% benign
32
benign acanthrosis nigricans
occurs in childhood or puberty
AD w/variable penetrance
associated with obesity or endocrine issues
33
malignant acanthrosis nigricans
underlying malignant adenocarcinoma stimulates epi to undergo hyperplasia
arises in middle-aged and older
usually GI adenocarcinoma
34
adnexal neoplasms
overwhelming majority 99% are benign
arise from ductal and glandular epi cells in:
-sweat glands and ducts
-hair-bulb germinal epi and sebaceous glands
-apocrine glands and ducts
35
benign adnexal tumors
symmetrical
small (<1cm)
superficial
vertical in orientation
36
malignant adnexal tumors
asymetrical, large, deep, wide
| sebaceous carcinoma most common
37
what are the 4 adnexal tumors that arise from hair follicles
trichoepithelioma
trichofolliculoma
tricholemmoma
pilomatricoma
38
hair follicle adnexal tumors clinical
cowden syndrome:
| -multiple tircholemmomas w/dominant inheritance usually have multiple GI tumors as well
39
sebaceous adnexal tumors
sebaceous adenoma
| sebaceous epithelioma
40
sebaceous gland tumors histo
cytoplasmic lipid vacuoles
41
sebaceous gland tumors clinical
muir-torre syndrome
sebaceous adenomas w/associated colorectal malignancy
variant of Lynch syndrome
rounded nodule can appear yellowish
42
syringocystadenoma papilliferum
apocrine gland tumor
43
syringocystadenoma papilliferum clinical
may develop in mixed epidermal-adenexal hamartomas of face and scalp termed nevus sebaceous
44
eccrine gland tumors
syringioma (lower eyelids)
cylindroma (forehead and scalp)
poroma (palmar or plantar region)
45
eccrine gland tumors histo
eccrine ducts lined by membrnaous eosinophilic cuticles tadpole like epi structures
46
eccrine gland tumors clinical
may be confused with basal cell carcinoma
| turban tumor
47
pilomatrixma
anucleate 'ghost cells"
| no granular layer
48
hemangiomas in kid
infants have extra mitotic activity and tumors can be very cellular, but usually regress
49
benign fibrous histocytoma/dermatofibroma
- benign soft tissue neoplasm seen in adults, frequently on legs of young-middle aged women
- tan-brown papules which are usually small (>1cm) and may be tender
50
increased melanin in keratinocytes w/NO increase in number of melanocytes
sun tan
freckles
cafe au lait spots
melasma
51
increased melanin in keratinocytes and small increase in number of melanocytes
solar lentigo
52
loss of melanin in keratinocytes
vitiligo, acute transient
| albinism
53
loss of melanocytes permanent
vitiligo, chronic
54
sun tan
tanning d/t UV exposure increase melanin in keratinocytes w/o increasing # of melanocytes
increased protection against solar radiation
55
melasma/cholasma/mask of prego
hypermelanosis characterized by development of sharply demarcated blotchy, brown macules on face
symmetrical distribuation
d/t increased E
can also be seen in OCPs and menopause
56
solar lentigo/lentigo senilis/lentigo simplex
benign discrete hyperpigmented macule occuring on chronically sun exposed skin in adults
increased melanin pigmetn in kertinocytes with variable increase in # of jnx melanocytes
57
lentigo maligna
name given to an in situ melanoma arising in sun exposed skin of face
58
acute vitiligo
loss of melanin in keratinocytes
59
albinism
loss of melanin in keratinocytes
defect in tyrosine
an enzyme necessary for melanin production
60
chronic lack or loss of melanocytes
chronic vitiligo
61
melanocytic nevi
benign neoplams of melanocytes
| acquired mutation in RAS: NRAD and BRAF
62
junctional nevi
maculopapular visible appearance
63
compound nevi
papular visible appearance
64
intradermal nevi
frequently nodular visible appearance
65
congenital nevus
deep dermal and sometimes subQ growth around adnexa, NV bundles
66
clinical significance of congenital nevus
present at birth
| large variants have increased melanoma risk
67
blue nevus
non nested dermal infiltration often with associated fibrosis
68
blue nevus cytological features
highly dendritic
| heavily pigmented nevus
69
blue nevus clinical significance
black-blue nodule
| often confused w/melanoma
70
spindal and epithelioid cell nevu aka spitz nevus
fasicular growth
large pump cells cel pink-blue cyto
fusiform cells
71
spitz nevus clinical
common kin kids
red-pink nodule
often confused w/melanoma and hemangiomas
72
halo nevus
lymphocytic infiltration surrounding nevus cells
73
halo nevus clinical
host immune response against nevus cells and surrounding normal melanocytes
74
dysplastic nevus
coalescent intraepi nests
| cytological atypia
75
dysplastic nevus clinical
potenitla marker/precursor of melanoma
76
blue nevus
thin delicate melanocytes that may be in a dense fibrotic stroma with abundant melanin pigment
completely benign with no increased risk for melanoma
77
Dysplastic nevus
```
sporadic not prone to malignancy
familial: AD dysplastic nevus syndrome
gross appearance worrisome if
-asymmetric
-border irregular
-color uneven
-diameter >6mm
occurs on sun or non-sun areas
```
78
familial dysplastic nevus syndrome
AD
CDKN2A and CDK4 mutations
50% chance of CA by 60
79
histo of dysplastic nevus
prominent proliferation of melanocytes arranges in nests at tips of rete ridges
rete tips often 'bridged'
papillary dermis frequently has increased fibrosis
80
malignant melanoma
derived from cells capable of forming melanin
may occur in any part of body (eye, mucous membranes)
primarily in adults (3rd decade+)
aggressive with significant mortality
81
subtypes of malignant melanoma
lentigo maligna (in situ sun exposed areas)
lengitgo maligna melanoma (invasive)
superficial spreading (in situ or invasive with mostly horizontal growth)
nodular (invasive mostly vertical)
acral lentifinous (palms, soles, and subungual; non-caucasian, in situ, invasive)
82
familial melanomas
10-15%
many have dysplastic nevi
increased telomerase activity from mutated TERT gene
KIT mutations in non-sun areas
P16 disinhibition by CDKN2A and CDK4 mutations
83
ABCD
asymmetry
border irregularity
color variation
diameter (>6mm)
84
solar lentigo
focal autonomous overproduction of melanosomes with resultant sustained increase in melanin keratinocytes
85
solar elastosis
'sailor or farmer' skin
| permanent incremental damage to reticular collagen (elastosis) with loss of texutre (leathery skin) and wrinkling
86
actinic keratosis
neoplastic proliferation of keratinocytes that have not yet involved the full thickness; characterized by increased keratin production (scaling) and underlying dermal increase in vascularity (redness)
87
actinic keratosis clinical
precancerous
scalp, face, dorsum of forearms, and hands
aka solar or senile keratosis
45-65
erythematous, reddish-brown macules, or mininmally elevated papules with overlying cales
mm-cms
may be tender
88
cutaneous horn
severe actinic keratosis
89
squamous cell carcinoma
malignant proliferation of epidermal keratinocytes which has potential for mets to regional nodes or distant sites if its not sun related
penetrates into dermis
90
Bowen disease
SCC in situ
91
SCC etiology
long term sun exposure risk
| immunosupression increases incidence
92
causes of SCC
HPV
chronic ulcers and draining fistulas (osteomyelitis)
burns/radiation
chimney sweepers (scrotal CA)
chemicals (tars, arsenic, tabacco and betel nut)
genetic syndromes
93
syndromes associated with SCC
```
epidermodysplasia verruciformis (HPV 5&8)
xeroderma pigmentosa (nucleotide excision repair pathway)
```
94
SCC clinical
sun exposed areas
early invasive SCC is usually small, firm, skin-colored, or red nodule with indistinct margins)
may be granular and bleed
may be smooth, verrucous, or papillomatous
become invasive and central ulceration may occur
low mortality
95
keratoacanthoma
```
rapidly growing (days-wks) neoplasm
occurs on sun-exposed areas of older adults
M>W
often clears spontaneously 3-4 months
grade I, but should still be removes
```
96
keratoacanthoma histo
idenitcal to SCC so aka SCC keratoacanthoma type
97
BCC
several types of skin neoplasms originating from basal epi of epidermis that virtually never metastasizes
98
types of BCC
nodular
sclerosing
both have potential for local invasion and destruction of adjacent dermis
show preference for hair-bearing skin with sun exposure
99
gorlin syndrome
```
nevoid basal cell carcinoma syndrome
AD
multiple BCCs before 20
palms and soles
odontofenic keratocyts
medulloblastomas
ovarian fibromas
```
100
BCC clinical
85% head and neck
remainder on trunks and limbs
rodent ulcers
101
nodular BCC
traditional or classic appearance
dome-shaped pearly papule/nodule
prominant surface dilated dermal vessels (telangiectasia)
easily Tx with excision
102
sclerosing BCC
```
morpheafoam
face
rodult ulcers
porrly defined margins
difficult to excise, high recurrence rate
MOHS surgery
```
103
superficial BCC
mutlifocal erythmatous scaly plaque, elevated rolled edges
non-sun exposed areas on proximal limbs or trunk
dermal-epi jnx
easily excised, but frequently recur
do not invade or met
may be confused with malanoma
104
dermatofibrosarcoma protuberans
malignant superficial fibroblastic neoplams
locally aggressive, but rare mets
translocation of COL1A1 & PDGFB -> increased PDGFB
105
bednar tumor
is pigmented variant of dermatofibrosarcoma protuberans
106
cutaneous T-cell lymphomas
erythematous plaques with scaling and ulceration
| infiltrate of atypical lymphocytes that accumulates beneath and invades epi
107
T-cell subtypes
mycosis fungoides
| sezary syndrome
108
mycosis fungoides
CD4+ T cell lymphoma of skin
CLA, CCR4, & CCR10
aggressive neoplasm with medial survival 8-9yrs
M>F
109
phases of mycosis fungoides
- inflammatory erythrodermic pre-mycotic patch
- plaque
- tumor
110
sezary syndrome
variant which skin involvement is manifest as generalized exfoliative erythroderma
cerebriform nuclei Sezary cells- survival <3yrs
111
mastocytosis
numerous ovoid cells with uniform centrally located nuclei in dermis
giemsa stain- purple metachromatic granules w/in cyto of mast cells
112
acute inflammatory dermatoses
urticaria (hives)
eczema
erythema multiforme
113
chronic inflammatory dermatoses
```
seborrheic dermatitis
psoriasis
lichen simplex chronicus
lichen planus
discoid lupus erythematosus
rosacea
```
114
blistering/bullous diseases
pemphigus
bullous pemphigoid
dermatitis herpetiformis
115
panniculitis dermatoses
erythema nodosum
| erythema induratum
116
infectious dermatoses
viral: verrucae and molluscum
bacterial: acne and impetigo
superficial fungal infections: tinea
117
infestations dermatoses
ticks
chiggers
lice
mites
118
non-inflammatory dermatoses
ichthyosis
epidermolysis bullosa
porphyrias
119
acute urticaria mast cell and IgE dependent
acute allergic rxn- med emergency
most common onset 20-40
acute onset- minuntes
severe discomfort profound itching
120
acute urticaria mast cell dependent and IgE independent
usually drug ro other substance triggers mast cells directly
| opiates, contrast media
121
acute urticaria mast cell independent and IgE independent
aspirin induced vasodilation
| hereditary angioneurotic edema (C1-inhibitor deficiency)
122
all types of acute urticarias
systemic anaphylaxis
laryngeal edema
Tx with anti-histamines, subQ epi, and IM injection, corticosteroids
or if C1 inhibitor deficiency Tx with C1 inhibitor, kallikrein inhibitor, or fresh frozen plasma)
123
acute urticaria classic skin lesion
abrupt appearance of wheal with intesete pruitis
| usually resoves in 24hrs, but can persist for months
124
eczema aka
spongiotic dermatitis
125
eczema
epidermal edema with prominant lymphocytes in dermis and epi
most common in kids
acute onset of red, papulovesicular lesions with 'boiling over' appearance which may ooze or crust
T cell mediated type IV
126
erythema mulitforme
IV rxn to drugs
infections
malignancy
collagen vascular disorders
127
infections which cause erythema mulitforme
herpes simplex
deep fungal (histo)
salmonella typii
leprosy
128
drugs which cause erythema mulitforme
abx
salicylates
anti-malarias
129
erythema mulitforme
mutliforme b/c wide variety of clinical presentations
| characteristic target lesions
130
stevens-johnson syndrome
severe, systemic febrile form of erythema mulitforme with mucosal involvement
131
toxic epidermal necrolyssi
is form of erythema mulitforme with diffuse necrosis and sloughing of skin and mucosae
132
seborrheic dermatitis
chronic dermatitis more common than psoriasis
involves skin regions with high density of sebaceous glands (scalp, nasolabial folds, skin of auditory canal, intergluteal folds)
excessive dandruff of scalp
not d/t sebaceous gland abnormality
133
seborrheic dermatitis Tx
antifungals -> therefore infection with superficial mallassezia furfur may be underlying pathology
134
psoriasis
chronic skin condtion
assocaited with arthritis occuring over affected joints
elbows, knees, scalp, lumbosacral area, intergluteal cleft and glans penis
135
koeber phenomonon
trauma can induce psoriatic lesions in predisposed peopl
136
typical psoriasis lesion
well demarcated pink-salmon plaque
| many different clinical presentations
137
what HLA is assocaitedw ith psoriasis
HLA-Cw*0602
| increased CDE sensitized cells
138
lichen simplex chronicus
d/t chronic rubbing or scratching
| if nodular= pruigo nodularis
139
lichen planus
self-limiting chronic inflammatory condition of skin and mucous membranes
usually spontaneously resolves 1-2 yrs
multiple plaques that are symmetrically distributed
140
lichen planus buzz words
wickham striae
sawtoothing
civatte bodies
koebner phenomenon
141
discoid lupus erythematosus
localized cutaneous manifestations of SLE w/no systemic manifestations and usually does not progress to systemic SLE
1/3 of pts with skin manifestations will have systemic SLE
malar erythema and discoid (coin-like) scaling plaques
142
lupus erythmatosus clinical
chronic plaques showing thinned and glistening epidermis and ears with dilated tortuous dermal vessels
central hypopigmentaton with peripheral hyperpigmentation
143
lupus erythmatosus histo
infiltrate of lymphocytes w/in superficial and deep dermis, marked thinning of epidermis w/loss of normal rete ridges and hyperkeratosis
144
band tests
granular deposits of immunoglobulin (IgG) and C'3 at dermal-epidermal jnx
lupus erythematosus
145
rosacea
```
females 30-60
uncertain pathophys (numerous triggers, abnormal cathelicindin may cause inflammation)
```
146
stages of rosacea
pre-rosacea (flushing)
erythematotelengiectatic
papulopustular
phymatous
147
blistering/bullous diseases
common friction blister
immune-mediated
genetic-congenital
148
common friction blister
intraepidermal blister, usually benath granulosum with scant or not inflammation in papillary dermis
149
immune mediated
pemphigus group
bellous pehmphigoid
dermatitis herpetiformis
150
genetic-congenital
epidermolysis blullosa
| porphyrias
151
pemphigus group of disease
autoimmune skin disease
| IgG autoabs to desmosomes (spinous processes) of squamous epi cells
152
types of pemphigus group of disease
```
pemphigus vulgaris
pemphigus vegetans
pemphigus foliaceus
pemphigus erythematosus
paraneoplastic pemphigus
```
153
pemphigus vulgaris
80%
involves mucosa, scalp, face, axilla, groin and other pressure points
Abs against Dsg1&3 -> deep suprabasal epi
reticular/fishnet pattern of Ab deposition
154
pemphigus vegetans
rare
verrucous plaques instead of blisters
axilla, groin, flexural surfaces
155
pemphigus foliaceus
more benign course
face, scalp, chest, back, spares mucous membranes
epidemic in south america
Abs only against Dsg1 -> superficial subcorneal blister
156
pemphigus erythematosus
mild form of foliaceus which primarily involves malar area of face
157
paraneoplastic pemphigus
with malignancies, usually lymphoma
158
bullous phemphigoid
Abs against BPAG1&2 component of hemidesmosomes -> blisters at lamina lucinda of BM
linear deposition of Abs
blisters look like friction blisters, but larger and burst easier
159
dermatitis herpetiformis
IgA Abs against fibrils that anchor hemidesmosomes to dermis
160
dermatitis herpetiformis
IgA to gliadin attacks reticulin in dermal papillae fibrils
rare
M>F
3-4th decades
161
dermatitis herpetiformis is associated with what?
celiacs disease
| anti-gliadin Abs x-react with reticuin in anchoring fibrils in dermal papillae
162
dermatitis herpetiformis clincal
intensetly pruitic plaques and vesicles
| extensor surfaces, elbows, knees, upper back, buttocks
163
panniculitis
inflammation of Sub-Q fatty tissue
| septal or lobular
164
types of panniculitis
```
erythema nodosum
erythemia induratum
weber-christian disease
factitial panniculitis
lupus
```
165
erythema nodosum
acute septal inflammation associated with infection by many agents: strep, TB, sarcoidosis, IBS, malignacies, drugs (sulfonamides, oral contraceptives)
166
erythema induratum
uncommon lobular panniculitis of unknown etiology
167
weber-christian disease
relapsing febrile nodular panniculitis in kids and adults
168
factitial panniculitis
self-induced lobular panniculitis traumatic injury
169
verruca vulgaris
common in kids and adolescents
| generally self-limited (6months-3yrs)
170
verruca vulgaris etiology
HPV:
cutaneous 2/4
anogenital 6/11
171
verruca vulgaris clinical
distinct gray-white to tan
.1-1cm papules
firm consistency 'cobble-stone' roughed surface, firm to palpation
172
condyloma plantaris and palmis
on sole of foot or palm of hand
| tend to be elongated broad and flat larger 1-2cm plauqes
173
condyloma acuminatums
anogenital
| cauliflower like
174
molluscum contagiosum
common self-limited viral disease caused by poxvirus
spread by direct contact
.2-.4 nodules on face, trunk, and anogenital area
175
acne vulgaris
chronic smoldering infection of the hair follicle by lipase producing propionibacterium acnes
176
Tx for acne vulgaris
retin-A and abx
| retin-A alters chemical composition of sebum and P.acnes cannot thrive and completely eradicated by abx
177
Impetigo
common superficaial infection of skin
highly contagious
hands and face
178
forms of impetigo
```
impetigo contagiosa (non-bullous)
impetigo bullosa
```
179
etiology of impetigo
staph aureus can cause both types
bacterial toxins cleabe desmoglein1
honey colored crust highly infectious
historically beta-strep caused contagiosa and S. aureus was bullosa
180
superficial fungal infections
infections by dermatophyte species of fungi
infections confined to corneum of epi
thrive in keratin of cornified layer
181
predisposing condition for superficial fungal infections
```
high moisture content of immediate skin environment
lack of exposure to sunlight
increased temp in skin region
enclosed space such as shoes or groin
use of communal showers
```
182
tinea
superficial fungal infections of skin
183
tinea capitis
scalp in kids
184
tinea corporis
ringworm
185
tinea cruris
inguinal skin adjacent to genitalia
| obese men in hot weather
186
tinea pedis
athletes foot
187
tinea barbae
beard in men
188
onychomycosis
fungal infection of nail beds
189
tinea versicolor
yeast
| malassezia furfur infection
190
direct injurious effect/insect part/sections
mosquitoes
| chigger
191
acute or delayed hypersensitivity rxn
bee
| wasp
192
direct toxin effect
brown recluse spider
193
vectors for disease
mosquitoes: malaria, west nile, dengue
ticks: lyme, RMSF
194
non-inflammatory dermatoses
ichthyosis
epidermolysis bullosa
porphyrias
195
ichthyosis
ususally genetic abnormalitiy leading to hyperkeratosis
196
epidermolysis bullosa
genetic abnormalities in structural proteins -> massive bullae
197
porphyrias
usually AD
defects in heme synthesis -> increased intermediates somehow causing urticaria and subepidermal vesicles
worse with sun exposure
198
types of epiderolysis bullosa
simplex
junctional
dystrophic
mixed
199
simplex type of epiderolysis bullosa
keratin 14 or 5 mutations leads to suprabasalar lesions
200
junctional type of epiderolysis bullosa
defect at lamina lucinda
201
dystrophic types of epiderolysis bullosa
anchoring fibril defect leading to problems at lamina densa
202
types of porphyrias
- acute neurovisceral with GI and neural symptoms
- acute neurovisceral with cutaneous problems
- non-acute cutaneous with light induced lesion
