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MSS, Skin & CT > Skin Pathology > Flashcards

Skin Pathology Flashcards

1
Q

What is a macule?

A

Flat lesion w/ well-circumscried change in skin color

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2
Q

What is a Patch?

A

macule >5mm Ex) large brithmark (congenital nevus)

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3
Q

What is a papule?

A

Elevated solid skin lesion < 5mm

Ex) Mole (nevus), acne

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4
Q

What is a Plaque?

A

Papule >5mm

ex) psoriasis

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5
Q

What is a vesicle?

A

Small fluid-containing blister

ex) Chickenpox (varicella), shingles (zoster)

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6
Q

What is Bulla?

A

Large fluid-containing blister >5mm

ex) Bullous pemphigoid

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7
Q

What is a pustule?

A

Vesicle containing pus

ex) Pustular psoriasis

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8
Q

What is a Wheal?

A

Transient smooth papule or plaque

ex) Hives (urticaria)

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9
Q

What is a Scale?

A

Flaking off of stratum corenum

ex) eczema, psoriasis, SCC

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10
Q

What is a Crust?

A

Dry exudate

ex) Impetigo

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11
Q

What is Hyperkaratosis?

A

Inc thickness of stratum corneum

ex) psoriasis

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12
Q

What is parakeratosis?

A

Hyperkaratosis w/ retention of nuclei in stratum corneum

ex) psoriasis

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13
Q

What is Acantholysis?

A

Separation of epidermal cells

ex) Pemphigus vulgaris

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14
Q

What is Acanthosis?

A

Epidermal hyperplasia (inc spinosum)

ex) Acanthosis nigricans

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15
Q

What is Dermatitis?

A

Inflam of the skin

ex) Atopic dermatitis

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16
Q

What is Albinism?

A

Normal melanocyte # w/ dec melanin production d/t dec tyrosinase activity. Can also be caused by failure of neural cress cell migration during dev. Ocular & oculocutaneous forms

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17
Q

What is Melasma (chloasma)?

A

Hyperpigmentation of cheeks assoc w/ pregnancy (“mask of preg”) or OCP use

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18
Q

What is Vitiligo?

A

Irreg areas of complete depigmentation

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19
Q

What causes Vitiligo?

A

Autoimmune destruction of melanocytes

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20
Q

What are Verrucae?

A

Warts common on hands & feet. Condyloma acuminatum on genitals

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21
Q

What causes Verrucae?

A

HPV infection of keratinocytes

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22
Q

What do Verrucae look like?

A

Soft, tan-colored, cauliflower-like papules w/ rough surface

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23
Q

Histo of verrucae

A

Epidermal hyperplasia, hyperkeratosis, koilocytes*

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24
Q

What are Melanoctic nevus?

A

Common mole: benign neoplasm of melanocytes

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25
Q

Prognosis of Melanocytic nevus

A

Benign, but mealonoma can arise in congenital or atypical moles via dysplastic nevus

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26
Q

What is an Intradermal nevi?

A

Papular nevus; junctional component lost; MC in adults

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27
Q

What is a Junctional nevi?

A
  • Flat macules
  • MC mole in children
  • Begin as nests of melanocytes at the dermal-epidermal junction
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28
Q

What is Urticaria?

A

Hives; pruritic wheals that form after mast cell degranulation

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29
Q

What is Ephelis?

A
  • Freckle
  • Normal # of melanocytes
  • Inc melanin pigment
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30
Q

What is Atopic dermatitis (eczema)?

A

Pruritic, erythematous, oozing rash w/ vesicles & edema commonly on skin flexures. Us. on the face in infancy & antecubital fossae therafter. Type I hypersensitivity rxn

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31
Q

What is Atopic dermatitis assoc w/?

A

Other atopic dz- asthma & allergic rhinitis

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32
Q

What is allergic contact dermatitis?

A

Type IV hypersensitivity reaction that follows exposure to allergen. Lesions occur at contact site (nickle, poision ivy, neomyocin). Tx by removal of agent & topical glucocorticoids if needed

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33
Q

What is Psoriasis?

A

Papules & salmon colored plaques w/ silvery scaling, esp on knees & elbows (extensor surfaces)

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34
Q

Histo of Psoriasis

A
  • Acanthosis- epidermal hyperplasia
  • Perakeratotiosis- keratinocyte nuclei retention in stratum corneum–called Munro microabscesses
  • Inc stratum spinousm & dec stratum granulosum.
  • Elongation of rete ridge (resembles comb)
  • Thinning of epidermis above dermal papillae
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35
Q

What is Auspitz sign?

A

Pinpoint bleeding spots from exposure of dermal papillae when scales are scraped off d/t epidermal thinning

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36
Q

What is Psoriasis assoc w/?

A

Nail pitting & psoriatic arthritis

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37
Q

What is Seborrheic keratosis?

A

Flat, greasy pigmented squamous epi prolif w/ keratin-filled cysts (horn cyts). Looks “stuck on”. Char by keartin pseudocytes on histo.

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38
Q

Where do Seborrheic keratosis lesions occur?

A

Head, trunk & extremities

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39
Q

Who gets Seborrheic keratosis?

A

Common benign squamous proliferation of older persons

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40
Q

What is Leser-Trélat sign?

A

Sudden appearance of multiple seborrheic keratoses, indicating an underlying malignancy (GI, lymphoid)

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41
Q

What is Pemphigus vlugaris?

A

Potentially fatal autoimmune skin disorder w/ IgG Ab against desmoglein 3 (1 &/or 3), a part of desmosomes (needed for cell adhesion) in stratum spinosum. Presents as skin & oral mucosa bullae.

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42
Q

What does immunofluorescense of Pemphigus vulgaris reveal?

A

IgG surrounding epidermal cells (keratinocytes) in a reticular or “fish net” pattern

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43
Q

What does the histo of Pemphigus vulgaris look like?

A
  • Acantholysis (separation) of stratum spinosum keratinocytes resulting in suprabasal blisters
  • Basal layers remain attached to BM via hemidesmosomes (“tombstone” appearance)
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44
Q

What is Nikolsky’s sign?

A

Separation of epidermis upon manual stroking of skin. Thin walled bullae rupture easily→ shallow erosions w/ dried crusts. + in Pemphigus vulgaris

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45
Q

What is bullous pemphigoid?

A

Autoimmune disorder w/ IgG ab against hemidesmosomes b/w basal cells & BM.

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46
Q

What does Bullous pemphigoid show on immunoflurorescence?

A

Highlights IgG along BM→ Linear pattern

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47
Q

What are the clinical characteristics of Bullous pemphigoid?

A
  • Eosinophils w/in the tense blisters (don’t rupture)
  • Similar to but less severe than pemphigus vulgaris- affects skin but spares oral mucosa.
  • Negative nikolsky’s sign
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48
Q

What is Dermatis herpetiformis?

A

Pruritic papules, vesicles & bullae that are grouped (herpetiform). Deposits of IgA at the tips of dermal papillae.

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49
Q

What is Dermatitis herpetiformis assoc w/?

A

Celica dz (resolves w/ gluten-free diet)

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50
Q

What is Erythema mutliforme assoc w/?

A

Infections (Mycoplasma pneumonia, HSV** MC), cancers, autoimmune dz (SLE) & drugs (penicllin, sulfonamides)

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51
Q

How does erythema muliforme present?

A

Hypersensitivity rxn char by multiple types of lesions- macules, papules, vesicles & target lesions

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52
Q

What does a target ring look like?

A

Targets w/ muliple rings & a dusky center showing epi disruption (d/t central epidermal necrosis surrounded by erythema)

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53
Q

What is Stevens-Johnson synd characterized by?

A
  • Fever
  • Bulla formation- oral mucosa/lip
  • Necrosis
  • Sloughing of skin
  • High mortality rate
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54
Q

What does Stevens-Johnson synd look like?

A

Typicaly 2 mucous mem involved & skin lesions maybe appear like targets as seen in erythema multiforme

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55
Q

What is Stevens-Johnson synd assoc w/?

A

Adverse drug reaction

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56
Q

What is Toxic epidermal necrolysis?

A

A more severe form of Stevens-Johnson synd w/ >30% of the body surface area involved. Destroys the epidermal-dermal junction causing diffuse sloughing of skin, resembling a large burn

57
Q

What is acanthosis nigricans?

A

Epidermal hyperplasia causing symmetrical, hyperpigmented, velvety thickening of skin, esp on neck, axilla or groin

58
Q

What is aconathosis nigricans assoc w/?

A

Hyperinsulinemia (DM, obesity, Cushing’s synd) & visceral malignancy (esp gastric CA)

59
Q

What is actinic keratosis?

A

premalignant lesions caused by sun exposure

60
Q

What does actinic keratosis look like?

A

Small, scaly/rough, erythematous or brownish papules or plaques often on face, back or neck

61
Q

What is actinic keratosis a risk for?

A

Risk of SCC is proportional to degree of epi dysplasia

62
Q

What is erythema nodosum?

A

Inflam lesions of SQ fat, usually on anterior shins

63
Q

What is erythema nodosum assoc w/?

A

Sarcoidosis, coccidioidomyocosis, histoplasmosis, TB, strep infections, leprosy & Chron’s dz

64
Q

What are the 6 P’s of Lichen Planus?

A

Pruritic, Purple, Polygonal Planar Papules & Plaques

Commonly on wrists, elbows & oral mucosa (Wickham striae)

65
Q

Histo of Lichen Planus

A

“Sawtooth” inflam infilitrate of lymphocytes at dermal-epidermal junction

66
Q

What is Lichen Planus assoc w/?

A

Hepatitis C

67
Q

What is Pitryiasis rosea?

A

“Herald patch” followed days later by “Christams tree” distribution. Multiple plaques w/ collarette scale.

68
Q

What is the clinical courseof Pityriasis rosea?

A

Self resolving in 6-8 weeks

69
Q

How does a sunburn occur?

A

UV irradiation causes DNA mut, inducing apoptosis of keratinocytes

70
Q

Which UV irradiation is dominant in tanning & photoaging?

A

UVA

71
Q

Which UV irradiation is involved in sunburns?

A

UVB

72
Q

What can sunburns lead to?

A

Impetigo & skin cancers (basal cell CA, SCC & melanoma)

73
Q

What is Impetigo?

A

Very superficial skin infection. Highly contagious. Common in children

74
Q

What causes Impetigo?

A

S. aureus or S. pyogenes

75
Q

What does Impetigo look like?

A

Presents as erythematous macules that progress to pustules,usually on the face. Rupture of pustules results in erosions & dry, “Honey-colored” crusting

76
Q

What is Bullous impetigo?

A

hass bullae & is caused by S. aureus

77
Q

What is Cellulitis?

A

Acute, painful, spreading infection of dermis & SQ tissues. Presents as red, tender swollen rash w/ fever

78
Q

What causes cellulitis?

A

S. pyogenes or S. aureus that starts w/ a break in skin from trauma, surgery or insect bite

79
Q

What is Necrotizing fascitis?

A

Necrosis of SQ tissue, usually from anaerobic bacteria or S. pyogenes. “Flesh-eating bacteria”

80
Q

What does Necrotizing fasciitis cause?

A

Results in crepitus (bubbles of gas under skin) from methane & CO2 production. Causes bullae & a purple color to the skin. Surgical emergency

81
Q

What is Staphylococcal scalded skin synd (SSSS)?

A

S. aureus exfolative exotoxins A & B destroy keratinocyte attachments in stratum granulosum only

82
Q

What is Staph scalded skin synd (SSSS) characterized by?

A

Fever & gen erythematous rash w/ sloughing of upper layers of the epidermis that heals completely

83
Q

Who is SSSS seen in?

A

Newborns & children

84
Q

What is hairy leukoplakia?

A

White painless plaques on the tongue that cannot be scraped off

85
Q

What is hairy leukoplakia mediated by?

A

EBV

86
Q

Who gets hairy leukoplakia?

A

HIV + pts

87
Q

What is the MC skin cancer?

A

Basal cell CA

88
Q

Where is Basal cell CA found?

A

Sun-exposed areas of body. Classic location is UPPER lip

89
Q

What is the clinical course of Basal Cell CA?

A

Locally invasive but almost never mets. Excellent prognosis

90
Q

What does Basal Cell CA look like?

A

Pink, pearly nodules*, commonly w/ telangiectasias*, rolled borders, & central crusting or ulceration. Also appear as nonhealing ulcers w/ infiltrating growth or as a scaling plaque (superficial BCC)

91
Q

What is the histo of Basal Cell tumors?

A

Nodules of basal cells w/ palisading peripheral nuclei*

92
Q

What is the 2nd MC skin cancer?

A

SCC

93
Q

What is SCC assoc w/?

A

Excessive exposure to sunlight, albinism, xeoderma pigmentosum, chronic inflam, immunosuppression, & occasionaly arsenic exposure

94
Q

Where does SCC occur?

A

Appears on face, LOWER lip, ears & hands

95
Q

What is the clincial course of SCC?

A

Locally invasive, but may spread to LN & will rarely mets. assoc w/ chronic draining sinuses

96
Q

What do SCC lesions look like?

A

Ulcerative red lesions/ nodular mass w/ freq scale

97
Q

What is the histopathology of SCC?

A

Keratin pearls

98
Q

What is Keratoacanthoma?

A

Well diff SCC variant that grows rapidly (4-6 weeks) & may regress spon over months. Presents as a “cup-shaped” tumor filled w/ keratin debris.

99
Q

What is Melanoma?

A

Common tumor w/ significant risk of mets. MC COD from skin cancer

100
Q

What is the tumor marker for Melanoma?

A

S-100

101
Q

What are the risk factors for melanoma?

A
  • Prolonged sunlight exposure
  • Albinism
  • Xeroderma pigmentosum
  • Dysplastic nevus synd
102
Q

What does the depth of melanoma correlate w/?

A

Risk of mets

103
Q

What are the ABCDEs of melanoma?

A
  • Asymmetry
  • Border irreg
  • Color variation
  • Diameter >6mm
  • Evolution over time
104
Q

What mut is melanoma driven by?

A

Activating mut in BRAF kinase

105
Q

What is the 1º tx of melanoma?

A

Excision w/ appropriately wide margins

106
Q

What can pts w/ melanoma w/ BRAF V600E mut be tx w/?

A

May benefit from vemurafenib, a BRAF kinase inhibitor

107
Q

What is the Epidermis composed of?

A

Keratinocytes & has 4 layers (basalis, spinosum, granulosum & corneum)

108
Q

What is the stratum basalis?

A

Regenerative (stem cell ) layer

109
Q

What is the stratum spinosum char by?

A

Desmosomes b/w keratinocytes

110
Q

What is the stratum granulosum char by?

A

Granules in keratinocytes

111
Q

What is the stratum corneum char by?

A

Keratin in anucleate cells

112
Q

What does the Dermis consist of?

A

CT, nerve endings, blood & lymphatic vessels & adnexal structures (hair shafts, sweat glands, & sebaceous glands)

113
Q

What is acne vulgaris?

A

Comedones (whiteheads/blackheads), pustules (pimples) & nodules (scars). Extremely common in adolescents

114
Q

What is the cause of acne vulgaris?

A
  • Hormone assoc inc in sebum production & excess keratin production blocks follicles forming comedones
  • Propionibacterium acnes infection produces lipases that break down sebum, releasing proinflam FA’s that resutls in pustule or nodule formation
115
Q

What is the tx of acne vulgaris?

A

Benzoyl peroxide (antimicrobial) & vit A derivatives (isotretinoin) which reduce keratin prod

116
Q

What is Wickham striae?

A

Lichen planus that looks like reticular white lines on the oral mucosa

117
Q

What is xeroderm pigmentosa?

A

AR defect in nucleated excisor enzymes needed to repair pyrimadine dimers (DNA damage) caused by UVB light exposure

118
Q

What is responsible for skin pigmentation?

A

Melanocytes in basal layer of epidermis

119
Q

Where are melanocytes derived from?

A

Neural crest

120
Q

How is melanin synthesized?

A

Synthesized in melanosomes* using tyrosine as a precursor molecule. Pass melanosomes to keratinocytes to cause skin pigmentation.

121
Q

What does Albinism inc risk of?

A
  • SCC
  • Basal Cell CA
  • Melanoma
  • Due to dec protection against UVB (inc pyrimidine dimers)
122
Q

What does a freckle look like?

A

Small, tan to brown macule; darkens when exposed to sunlight.

123
Q

What are freckles caused by?

A

Inc # of melanosomes (melanocytes are NOT inc)

124
Q

What is a compound nevi?

A

Benign nests of melanocytes extend from the epidermal-dermal junction into the dermis

125
Q

What is dysplastic nevus syndrome?

A

AD disorder char by formation of dysplastic nevi that may progress to melanoma

126
Q

What are the variants of melanoma?

A
  • Superficial spreading
  • Lentigo maligna melanoma
  • Nodular
  • Acral lentiginous
127
Q

What is superficial spreading melanoma variant?

A

MC subtype, dominant early raidal growth results in good prognosis

128
Q

What is the Lentigo maligna melanoma variant?

A

Letiginous proliferation (radial growth) w/ good prognosis

129
Q

What is the Nodular melanoma variant?

A

Early vertical growth that pushes the epidermis up to form a nodule; poor prognosis

130
Q

What is the Acral lentiginous melanoma variant?

A
  • Arises on the palms or soles; under proximal nail beds
  • Often in dark-skinned individuals (African Am, Asians)
  • NOT related to UV light exposure
131
Q

What is the radial growth of melanoma?

A

Horizontal growth along the epidermis & superficial dermis. Low risk of mets

132
Q

What is the Vertical growth of melanoma?

A

Growth deep into the dermis. Inc risk of mets

133
Q

What is Breslow thickness?

A

Most important prognostic factor in predicting melanoma mets–depth of tumor growth.

134
Q

What is Molluscum Contagiosum?

A

Firm, pink, umbillicated papules d/t poxvirus (DNA virus)

135
Q

What is the histo of Molluscum Contagiosum?

A

Affected keratinocytes show cytoplasmic inclusions (molluscum bodies*)

136
Q

Who gets Molluscum contagiosum?

A

Most often arise in children; also occur in sexually active & immunocompromised pts

137
Q

What is Daurier’s Sign?

A

Dermal edema resembling a hive from localized stroking of an area of skin w/ a pointed insturment (Uticaria; Type I hypersensitivity)

138
Q

What is Koebner’s phenomenon?

A

Rash develops in areas of trauma

MSS, Skin & CT (5 decks)

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