XXII - The Skin Flashcards
This term is the accumulation of edema fluid within the epidermis. Characterizes all forms of eczamatous dermatitis.
Spongiosis(TOPNOTCH)Robbins Basic Pathology, 8th ed., p 839
An uncommon, usually self-limited disorder that seems to be a hypersensitivity response to certain infections and drugs. Patients present with an array of “multiform” lesions, including macules, papules, vesicles, and bullae, as well as the characteristic targetoid lesion consisting of a red macule or papule with a pale vesicular or eroded center.
Erythema Multiforme (TOPNOTCH)Robbins Basic Pathology, 8th ed., p 840
In this skin disorder, there is marked epidermal thickening (acanthosis), and loss of the stratum granulosum with extensive overlying parakeratotic scale. The most typical lesion is a well-demarcated, pink to salmon-colored plaque covered by loosely adherent silver-white scale.
Psoriasis(TOPNOTCH)Robbins Basic Pathology, 8th ed., p 841
This sign is described as bleeding upon removal of scales from the lesions of psoriasis.
Auspitz sign(TOPNOTCH)Robbins Basic Pathology, 8th ed., p 841
Small aggregates of neutrophils within the parakeratotic stratum corneum in psoriasis.
Munro microabscesses(TOPNOTCH)Robbins Basic Pathology, 8th ed., p 841
Small aggregates of neutrophils within the spongiotic superficial epidermis in psoriasis.
Pustules of Kogoj(TOPNOTCH)Robbins Basic Pathology, 8th ed., p 841
Layer of the skin which is affected in psoriasis.
S. granulosum(TOPNOTCH)Robbins Basic Pathology, 8th ed., p 841
“Pruritic, purple, polygonal, planar papules, and plaques” describes this disorder of the skin and mucosa. The pattern of inflammation of this disorder is characterized by angulated, zigzag contour (“sawtoothing”) of the dermoepidermal junction.
Lichen Planus (TOPNOTCH)Robbins Basic Pathology, 8th ed., p 841
Anucleate, necrotic basal cells seen in the inflamed papillary dermis of patients with lichen planus are called?
Colloid bodies or Civatte bodies(TOPNOTCH)Robbins Basic Pathology, 8th ed., p 841
Presents as roughening of the skin that takes on an appearance reminiscent of “lichen on a tree”. It is a response to local repetitive trauma such as continual rubbing or scratching.
Lichen Simplex Chronicus (TOPNOTCH)Robbins Basic Pathology, 8th ed., p 842
Common lesions of children and adolescents, caused by human papillomavirus (HPV). Histologic features include epidermal hyperplasia that is often undulant in character, and cytoplasmic vacuolization (koilocytosis).
Verrucae (warts)(TOPNOTCH)Robbins Basic Pathology, 8th ed., p 843
The most common type of wart. Occurs anywhere but are found most frequently on the hands, particularly on the dorsal surfaces and periungual areas, where they appear as gray-white to tan, flat to convex, 0.1- to 1-cm papules with a rough, pebble-like surface.
Verruca vulgaris(TOPNOTCH)Robbins Basic Pathology, 8th ed., p 844
These warts are common on the face or dorsal surfaces of the hands. These warts are flat, smooth, tan macules.
Verruca plana/flat wart(TOPNOTCH)Robbins Basic Pathology, 8th ed., p 844
These warts occur on the soles and palms. Described as rough, scaly lesions that may reach 1 to 2 cm in diameter, coalesce, and be confused with ordinary calluses.
Verruca plantaris and verruca palmaris(TOPNOTCH)Robbins Basic Pathology, 8th ed., p 844
These warts occurs on the penis, female genitalia, urethra, and perianal areas.
Condyloma acuminatum (venereal wart) (TOPNOTCH)Robbins Basic Pathology, 8th ed., p 844
A rare autoimmune blistering disorder resulting from loss of integrity of normal intercellular attachments within the epidermis and mucosal epithelium. Caused by a type II hypersensitivity reaction
Pemphigus (TOPNOTCH)Robbins Basic Pathology, 8th ed., p 845
Common histologic denominator in all forms of pemphigus, described as the lysis of the intercellular adhesion sites.
Acantholysis (TOPNOTCH)Robbins Basic Pathology, 8th ed., p 845
In this variant of pemphigus, acantholysis selectively involves the layer of cells immediately above the basal cell layer, giving rise to a suprabasal acantholytic blister. There is uniform deposition of immunoglobulin and complement along the cell membranes of keratinocytes, producing a characteristic “fishnet” appearance.
Pemphigus vulgaris(TOPNOTCH)Robbins Basic Pathology, 8th ed., p 845
In this variant of pemphigus, acantholysis selectively involves the superficial epidermis at the level of the stratum granulosum.
Pemphigus foliaceus(TOPNOTCH)Robbins Basic Pathology, 8th ed., p 845
An autoimmune disease in which the characteristic finding is linear deposition of IgG antibodies and complement in the basement membrane zone. Characterized by a subepidermal, nonacantholytic full-thickness epidermal fluid-filled blister.
Bullous pemphigoid (TOPNOTCH)Robbins Basic Pathology, 8th ed., p 846
A rare disorder characterized by urticaria and grouped vesicles. Fibrin and neutrophils accumulate selectively at the tips of dermal papillae, forming small microabscesses, which coalesce to form a subepidermal blister. On immunofluorescence, granular deposits of IgA are localized at the tips of dermal papillae.
Dermatitis herpetiformis (TOPNOTCH)Robbins Basic Pathology, 8th ed., p 846
These common epidermal tumors occur most frequently in middle-aged or older individuals. The lesions consist of an orderly proliferation of uniform, benign basaloid keratinocytes with a tendency to form keratin microcysts (horn cysts), which has a “stuck-on” appearance on the skin.
Seborrheic keratosis(TOPNOTCH)Robbins Basic Pathology, 8th ed., p 849
These are rare tumors that primarily occur in the head and neck region of older individuals. They usually present as flesh-colored papules and can be a marker for an internal malignancy.
Sebaceous Adenoma (TOPNOTCH)Robbins Basic Pathology, 8th ed., p 849
These lesion is usually the result of chronic exposure to sunlight and is associated with hyperkeratosis. The dermis contains thickened, blue-gray elastic fibers or “solar elastosis” which is the result of chronic sun damage.
Actinic keratoses(TOPNOTCH)Robbins Basic Pathology, 8th ed., p 850
Acronym for remembering the histologic features of actinic keratoses.
“Sunny” SPAINS S - solar elastoses (dermal sun damage)P - parakeratosisA - atypia (keratinocytic)I - inflammationN - not full thickness atypia(TOPNOTCH)Robbins Basic Pathology, 8th ed., p 850
A common tumor arising on sun-exposed sites in older people, with higher incidence in women. Arise from prior actinic keratoses. Characterized by highly anaplastic, rounded cells with foci of necrosis and only abortive, single-cell keratinization (dyskeratosis).
Squamous cell carcinoma (TOPNOTCH)Robbins Basic Pathology, 8th ed., p 851
This is the most common human cancer, which is a slow-growing tumor that rarely metastasizes. Tends to occur at sites subject to chronic sun exposure and in lightly pigmented people. h
Basal cell carcinoma (TOPNOTCH)Robbins Basic Pathology, 8th ed., p 852
These tumors present as pearly, smooth-surfaced papules, often containing prominent, dilated subepidermal blood vessels (telangiectasia). The cells have scant cytoplasm, small hyperchromatic nuclei, and a peripheral palisade with clefting from the stroma.
Basal cell carcinoma (TOPNOTCH)Robbins Basic Pathology, 8th ed., p 852
This refers to any benign congenital or acquired neoplasm of melanocytes.
Melanocytic nevus(TOPNOTCH)Robbins Basic Pathology, 8th ed., p 853
These are large nevi and may occur as hundreds of lesions on the body surface. They are flat macules to slightly raised plaques, with a “pebbly” surface. Considered as a marker of melanoma risk.
Dysplastic nevi(TOPNOTCH)Robbins Basic Pathology, 8th ed., p 854
This cancer of the skin may develop from a dysplastic nevus, and results from excessive sun exposure. Malignant cells have large nuclei with irregular contours having chromatin characteristically clumped at the periphery of the nuclear membrane and prominent eosinophilic nucleoli often described as “cherry red”. Has both radial and vertical growth phases.
Melanoma (TOPNOTCH)Robbins Basic Pathology, 8th ed., p 855
This determines the biologic behavior of melanomas.
Nature and extent of the vertical growth phase (TOPNOTCH)Robbins Basic Pathology, 8th ed., p 857
What is the most common type of all autoimmune blistering disordering of the skin (pemphigus)?
Pemphigus Vulgaris(TOPNOTCH)
Histologically, what is the most common denominator in all forms of pemphigus?
Acantholysis (TOPNOTCH)
Morphology: Subepidermal nonacantholytic blisters
Bullous Pemphigoid (TOPNOTCH)
Morphology: Suprabasal acantholytic blister
Pemphigus Vulgaris (TOPNOTCH)
Morphology: Characteristically, fibrin and neutrophils accumulate selectively at the tips of the dermal papillae forming small microabscesses
Dermatitis Herpetiformis (Seen in Celiac Disease) (TOPNOTCH)
Morphology: accumulation of neutrophils beneath the stratum corneum
Impetigo (TOPNOTCH)
Munro microabscesses is classically seen in?
Psoriasis (TOPNOTCH)
Auspitz sign is associated with what condition?
Psoriasis (TOPNOTCH)
Pearly papules often containing prominent, dilated subepidermal blood vessels (telangiectasias)
Basal Cell Carcinoma (TOPNOTCH)
What is the most commonly accepted exogenous cause of squamous cel carcinoma of the skin?
Exposure to UV light (TOPNOTCH)
Cutaneous horns are seen in what condition?
Actinic Keratosis (TOPNOTCH)
Morphology: characterized by loss of melanocytes
Albinism (TOPNOTCH)
In albinism, melanocytes are present but melanin pigment is not produced due to what enzyme deficiency or defect?
Tyrosinase (TOPNOTCH)
Q: + for melanocyte-associated proteins such as tyrosinase or Melan-A or S
Vitiligo (TOPNOTCH)
The early developmental stage in melanocytic nevi is called?
Junctional nevi (TOPNOTCH)
Most junctional nevi grow into the underlying dermis as nests or cords of cells and are calle
Compound nevi (TOPNOTCH)
When all the epidermal nests of compound nevi are lost entirely they form what
intradermal nevi (TOPNOTCH)
Appears to play an important role in the development of skin malignant melanoma
Sunlight (TOPNOTCH)
What are the 5 clinical warning signs of melanoma?
- enlargement of a pre-existing mle2. itching or pain in pre-existing mole3. development of a new pigment lesion during adult life4. irregularity of the borders of a pigment lesion5. variegation of color within a pigmented lesion (TOPNOTCH)
Appears clinically as flesh-colored, dome shaped nodules with central, keratin filled plug, imparting a crater like topography
Keratoacanthoma (TOPNOTCH)
Morphology: Central, keratin filled crater surrounded by proliferating epitheal cells that extend upward in a lip-like fashion over the sides of the crater and downward into the dermis as irregular tongues
keratoacanthoma (TOPNOTCH)
The most important clinical sign of malignant melanoma
change in color, size, or shape in a pigmented lesion (TOPNOTCH)
In Malignant Melanoma, what type of growth indicated the tendency of a melanoma to grow horizontally within the epidermal and superficial dermal layers, often for a prolonged period of time?
Radial growth (TOPNOTCH)
In Malignant Melanoma, what are the determinants of a more favorable prognosis?
- Tumor depth of less than 1.7 mm2. Absence or low numbers of mitoses3. Presence of a brisk TIL response (Tumor Infiltrating Leukocytes)4. Absence of regression 5. Female gender6. Location on extremity skin (TOPNOTCH)
A 20 y/o male, previously known case of peanut allergy inadvertently took biscuits containing peanuts. Within a short time, he developed pink wheals on his extremities and trunk that are pruritic. Histologic findings in his lesion will include:
Sparse superficial perivenular infiltrate of mononuclear cells and eosinophils. (TOPNOTCH) Robbins Pathologic Basis of Disease, 9th ed., p. 1162
Most important cause of cutaneous squamous cell carcoma
DNA damage induced by UV light exposure(TOPNOTCH)Robbins Basic Pathology 9th ed., 122
Usually present as pearly papules contaning prominent dilated subepidermal blood vessles(telangiectasia), which may ulcerate and locally invade bone or facial sinuses; cells at the periphery of tumor cell islands tend to be arranged radially with long axes in parallel alignment(palisading)
Basal cell carcinoma(TOPNOTCH)Robbins Basic Pathology, 9th ed., p. 1157
Actinic keratosis may lead to what type of skin cancer?
Cutaneous squamous cell carcinoma(TOPNOTCH)Robbins Basic Pathology, 9th ed., p. 1157
Histologic hallmark of Cutaneous T-cell Lymphoma
Presence of Sezary-Lutzner cells(TOPNOTCH)Robbins Basic Pathology, 9th ed., p. 1160
Presents with small, pruritic papules to large edematous plaques, which may coalesce to form annular, linear, or arcform configurations. There is usually superficial perivenular infiltrate consisting of mononuclear cells, rare neutrophils, and eosinophils
Urticaria(TOPNOTCH)Robbins Basic Pathology, 9th ed., p. 1162
Febrile form of erythema multiforme associated with extensive involvement of skin, lips and oral mucosa, conjunctiva, urethra, and genital and perianal areas, often seen in children.
Steven-Johnson syndrome(TOPNOTCH)Robbins Basic Pathology, 9th ed., p. 1164
It is characterized by kertinocyte injury mediated by skin-homing CD8+ band cytotoxic T lymphocytes; presenting with diverse array of lesions.
Erythema Multiforme (TOPNOTCH)Robbins Basic Pathology, 9th ed., p. 1164
Process by which local trauma induce psoriatic lesions in susceptible individuals
Koebner phenomenon(TOPNOTCH)Robbins Basic Pathology, 9th ed., p. 1165
Presents with macules and papules on an erythematous-yellow, often greasy base, in association with extensive scaling and crusting. Histologically, mounds of parakeratosis containing neutrophils and serum are present at the ostia of hair follicles(Follicular lipping)
Seborrheic dermatitis(TOPNOTCH)Robbins Basic Pathology, 9th ed., p. 1166
Group of disorders caused by inherited defects in structural proteins that lend mechanical stability to the skin; common feature is a proclivity to form blisters at sites of pressure, rubbing, or trauma, at or soon after birth
Epidermolysis bullosa(TOPNOTCH)Robbins Basic Pathology, 9th ed., p. 1171
Presents with urticaria and vesicles associated with scarring that are exacerbated by exposure to sunlight. The vesicles are subepidermal in location and dermis contains vessels with walls that are thickened by glassy deposits of serum proteins.
Porphyria(TOPNOTCH)Robbins Basic Pathology, 9th ed., p 1172
Presents with stages of flushing, then persistent erythema and telangiectasia, followed by pustules and papules, and lastly by permanent thickening of the nasal skin by confluent erythematous papules and prominent follicles(rhinophyma)
Rosacea(TOPNOTCH)Robbins Basic Pathology, 9th ed., p. 1174
Presents with multiple lesions on the skin and mucus membranes, with predilection for the trunk and anogenital areas. Lesions are firm, often pruritic, pink to skin-colored umbilicated papules, with curd-like material which can be expressed from the central umbilication
Molluscum contagiosum(TOPNOTCH)Robbins Basic Pathology, 9th ed., p. 1176
The pathogenesis of blister formation in this condition is related to bacterial production of a toxin that cleaves desmoglein 1, the protein responsible for cell-to-cell adhesion within the uppermost epidermal layers.
Impetigo(TOPNOTCH)Robbins Basic Pathology, 9th ed., p. 1177
Presents as an erythematous macule and multiple pustules. As pustules break, shallow erosions from, covered with drying serum, giving the characteristic honey-colored crust
Impetigo(TOPNOTCH)Robbins Basic Pathology, 9th ed., p. 1177
It has the characteristic microscopic feature of accumulation of neutrophils beneath the stratum corneum often producing a subcorneal pustule containing serum proteins and inflammatory cells.
Impetigo(TOPNOTCH)Robbins Basic Pathology, 9th ed., p. 1177
A 25 year old male presents with well-demarcated pink plaques on his elbows, scalp, and knees that have a silvery scale. A biopsy showed acanthosis, elongated rete ridges, loss of stratum granulosum with an overlying parakeratotic scale, thinning of the epidermis overlying the dermal papillae, and neutrophil aggregates in the parakeratotic stratum corneum. The dermatologist removes one of the scales, and a pinpoint bleeding is observed. This phenomenon is due to (A) the acanthosis (B) thinning of the epidermis overlying the dermal papillae (C) neutrophil aggregates (D) elongated rete ridges
thinning of the epidermis overlying the dermal papillae (TOPNOTCH)Robbins Basic Pathology, 8th ed., p 841
A 62 year old woman has a coin-like, dark brown plaque on her chest that appears stuck-on. She has it excised, and histopathology showed an orderly proliferation of basaloid cells, with keratin microcysts. Some of the basaloid cells have melanin. Her lesion (A) is a tumor of malignant melanocytes (B) is common in her age group (C) will exhibit a fishnet appearance if subjected to immunofluorescence (D) is a melanocytic nevus
is common in her age group (seborrheic keratosis) (TOPNOTCH)Robbins Basic Pathology, 8th ed., p 845848-849
A 33 year old female has multiple flesh-colored papules on her face, neck, trunk, and limbs. One of the papules is excised, which showed a lobular proliferation of sebocytes, some with vacuolated cytoplasm, others more basaloid in appearance. Her lesions may be a sign of underlying (A) colorectal carcinoma (B) nonHodgkin lymphoma (C) aplastic anemia (D) thalassemia
colorectal carcinoma (sebaceous adenoma and Muir-Torre syndrome) (TOPNOTCH)Robbins Basic Pathology, 8th ed., p 849
A 45 year old male has a pearly papule with prominent vessels on his eyelid. He has it excised, and the lesion showed multiple nodules of basaloid cells with scant cytoplasm and peripheral palisading. The nodules appear separated from the stroma. His lesion (A) frequently metastasizes to distant sites (B) is correlated to sun exposure (C) is associated with HPV infection (D) may arise on mucosal surfaces
is correlated with sun exposure (basal cell carcinoma) (TOPNOTCH)Robbins Basic Pathology, 8th ed., p 852
