XXII - The Skin

Question 2

This term is the accumulation of edema fluid within the epidermis. Characterizes all forms of eczamatous dermatitis.

Answer 2

Spongiosis(TOPNOTCH)Robbins Basic Pathology, 8th ed., p 839

Question 3

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.

Answer 3

Erythema Multiforme (TOPNOTCH)Robbins Basic Pathology, 8th ed., p 840

Question 4

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.

Answer 4

Psoriasis(TOPNOTCH)Robbins Basic Pathology, 8th ed., p 841

Question 5

This sign is described as bleeding upon removal of scales from the lesions of psoriasis.

Answer 5

Auspitz sign(TOPNOTCH)Robbins Basic Pathology, 8th ed., p 841

Question 6

Small aggregates of neutrophils within the parakeratotic stratum corneum in psoriasis.

Answer 6

Munro microabscesses(TOPNOTCH)Robbins Basic Pathology, 8th ed., p 841

Question 7

Small aggregates of neutrophils within the spongiotic superficial epidermis in psoriasis.

Answer 7

Pustules of Kogoj(TOPNOTCH)Robbins Basic Pathology, 8th ed., p 841

Question 8

Layer of the skin which is affected in psoriasis.

Answer 8

S. granulosum(TOPNOTCH)Robbins Basic Pathology, 8th ed., p 841

Question 9

“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.

Answer 9

Lichen Planus (TOPNOTCH)Robbins Basic Pathology, 8th ed., p 841

Question 10

Anucleate, necrotic basal cells seen in the inflamed papillary dermis of patients with lichen planus are called?

Answer 10

Colloid bodies or Civatte bodies(TOPNOTCH)Robbins Basic Pathology, 8th ed., p 841

Question 11

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.

Answer 11

Lichen Simplex Chronicus (TOPNOTCH)Robbins Basic Pathology, 8th ed., p 842

Question 12

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).

Answer 12

Verrucae (warts)(TOPNOTCH)Robbins Basic Pathology, 8th ed., p 843

Question 13

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.

Answer 13

Verruca vulgaris(TOPNOTCH)Robbins Basic Pathology, 8th ed., p 844

Question 14

These warts are common on the face or dorsal surfaces of the hands. These warts are flat, smooth, tan macules.

Answer 14

Verruca plana/flat wart(TOPNOTCH)Robbins Basic Pathology, 8th ed., p 844

Question 15

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.

Answer 15

Verruca plantaris and verruca palmaris(TOPNOTCH)Robbins Basic Pathology, 8th ed., p 844

Question 16

These warts occurs on the penis, female genitalia, urethra, and perianal areas.

Answer 16

Condyloma acuminatum (venereal wart) (TOPNOTCH)Robbins Basic Pathology, 8th ed., p 844

Question 17

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

Answer 17

Pemphigus (TOPNOTCH)Robbins Basic Pathology, 8th ed., p 845

Question 18

Common histologic denominator in all forms of pemphigus, described as the lysis of the intercellular adhesion sites.

Answer 18

Acantholysis (TOPNOTCH)Robbins Basic Pathology, 8th ed., p 845

Question 19

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.

Answer 19

Pemphigus vulgaris(TOPNOTCH)Robbins Basic Pathology, 8th ed., p 845

Question 20

In this variant of pemphigus, acantholysis selectively involves the superficial epidermis at the level of the stratum granulosum.

Answer 20

Pemphigus foliaceus(TOPNOTCH)Robbins Basic Pathology, 8th ed., p 845

Question 21

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.

Answer 21

Bullous pemphigoid (TOPNOTCH)Robbins Basic Pathology, 8th ed., p 846

Question 22

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.

Answer 22

Dermatitis herpetiformis (TOPNOTCH)Robbins Basic Pathology, 8th ed., p 846

Question 23

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.

Answer 23

Seborrheic keratosis(TOPNOTCH)Robbins Basic Pathology, 8th ed., p 849

Question 24

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.

Answer 24

Sebaceous Adenoma (TOPNOTCH)Robbins Basic Pathology, 8th ed., p 849

Question 25

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.

Answer 25

Actinic keratoses(TOPNOTCH)Robbins Basic Pathology, 8th ed., p 850

Question 26

Acronym for remembering the histologic features of actinic keratoses.

Answer 26

“Sunny” SPAINS - solar elastoses (dermal sun damage)P - parakeratosisA - atypia (keratinocytic)I - inflammationN - not full thickness atypia(TOPNOTCH)Robbins Basic Pathology, 8th ed., p 850

Question 27

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).

Answer 27

Squamous cell carcinoma (TOPNOTCH)Robbins Basic Pathology, 8th ed., p 851

Question 28

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

Answer 28

Basal cell carcinoma (TOPNOTCH)Robbins Basic Pathology, 8th ed., p 852

Question 29

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.

Answer 29

Basal cell carcinoma (TOPNOTCH)Robbins Basic Pathology, 8th ed., p 852

Question 30

This refers to any benign congenital or acquired neoplasm of melanocytes.

Answer 30

Melanocytic nevus(TOPNOTCH)Robbins Basic Pathology, 8th ed., p 853

Question 31

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.

Answer 31

Dysplastic nevi(TOPNOTCH)Robbins Basic Pathology, 8th ed., p 854

Question 32

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.

Answer 32

Melanoma (TOPNOTCH)Robbins Basic Pathology, 8th ed., p 855

Question 33

This determines the biologic behavior of melanomas.

Answer 33

Nature and extent of the vertical growth phase (TOPNOTCH)Robbins Basic Pathology, 8th ed., p 857

Question 34

What is the most common type of all autoimmune blistering disordering of the skin (pemphigus)?

Answer 34

Pemphigus Vulgaris(TOPNOTCH)

Question 35

Histologically, what is the most common denominator in all forms of pemphigus?

Answer 35

Acantholysis (TOPNOTCH)

Question 36

Morphology: Subepidermal nonacantholytic blisters

Answer 36

Bullous Pemphigoid (TOPNOTCH)

Question 37

Morphology: Suprabasal acantholytic blister

Answer 37

Pemphigus Vulgaris (TOPNOTCH)

Question 38

Morphology: Characteristically, fibrin and neutrophils accumulate selectively at the tips of the dermal papillae forming small microabscesses

Answer 38

Dermatitis Herpetiformis (Seen in Celiac Disease) (TOPNOTCH)

Question 39

Morphology: accumulation of neutrophils beneath the stratum corneum

Answer 39

Impetigo (TOPNOTCH)

Question 40

Munro microabscesses is classically seen in?

Answer 40

Psoriasis (TOPNOTCH)

Question 41

Auspitz sign is associated with what condition?

Answer 41

Psoriasis (TOPNOTCH)

Question 42

Pearly papules often containing prominent, dilated subepidermal blood vessels (telangiectasias)

Answer 42

Basal Cell Carcinoma (TOPNOTCH)

Question 43

What is the most commonly accepted exogenous cause of squamous cel carcinoma of the skin?

Answer 43

Exposure to UV light (TOPNOTCH)

Question 44

Cutaneous horns are seen in what condition?

Answer 44

Actinic Keratosis (TOPNOTCH)

Question 45

What factor is the most important in the determining the biological behavior of malignant melanoma? Vertical or Radial growth?

Answer 45

Vertical growth (TOPNOTCH)

Question 46

Morphology: characterized by loss of melanocytes

Answer 46

Albinism (TOPNOTCH)

Question 47

In albinism, melanocytes are present but melanin pigment is not produced due to what enzyme deficiency or defect?

Answer 47

Tyrosinase (TOPNOTCH)

Question 48

Q: + for melanocyte-associated proteins such as tyrosinase or Melan-A or S

Answer 48

Vitiligo (TOPNOTCH)

Question 49

The early developmental stage in melanocytic nevi is called?

Answer 49

Junctional nevi (TOPNOTCH)

Question 50

Most junctional nevi grow into the underlying dermis as nests or cords of cells and are calle

Answer 50

compound nevi (TOPNOTCH)

Question 51

When all the epidermal nests of compound nevi are lost entirely they form what

Answer 51

intradermal nevi (TOPNOTCH)

Question 52

Appears to play an important role in the development of skin malignant melanoma

Answer 52

Sunlight (TOPNOTCH)

Question 53

What are the 5 clinical warning signs of melanoma?

Answer 53

1. 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)

Question 54

Morphology: proliferations of basaloid cells with formation of prominent keratin filled “horn” cysts

Answer 54

Seborrheic keratosis (TOPNOTCH)

Question 55

Appears clinically as flesh-colored, dome shaped nodules with central, keratin filled plug, imparting a crater like topography

Answer 55

Keratoacanthoma (TOPNOTCH)

Question 56

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

Answer 56

keratoacanthoma (TOPNOTCH)

Question 57

The most important clinical sign of malignant melanoma

Answer 57

change in color, size, or shape in a pigmented lesion (TOPNOTCH)

Question 58

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?

Answer 58

Radial growth (TOPNOTCH)

Question 59

In Malignant Melanoma, what are the determinants of a more favorable prognosis?

Answer 59

1. 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)