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33 Cards in this Set

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Patient with demarcarted scaly plaques, affects nails scalp extremities

Micro: parakeratosis, hypogranulosis, psoriasiform epidermal hyperplasia. Polys in stratum corneum, spongiosis
Psoriasis
Patient with a rash

Micro: mounding parakeratosis, variable epidermal hyperplasia and spogiosis, chronic inflammation
Eczematous dermatitis
Buzzwords:
"herald patch"
"christmas tree distribution"

Micro: parakeratosis, spngiosis, papillary dermal microhemorrhage

Small plaques with collarette of scale
Pitiriasis rosea
Irregularly irregular epidermal hyperplasia
Prurigo nodularis "picker's nodule"
Patient with puritic purple, polygonal flat papules, may have lacy white, reticulated hyperkeratosis (Wickham's striae), on the scalp, nails, buccal mucosa

Micro: hyperkeratosis, acanthosis, "saw tooth" elongation of rete, lichenoid infiltrate, colloid bodies

1. what if you see eos? MC cause?

2. what if you see parakeratosis?

3. What if on penis? more nodular areas of inflammation?
Lichen planus

1. Lichenoid drug eruption, caused MC by gold

2. Benign lichenoid keratosis

3. Lichen niditus
younger woman with scaly papules and plaques, follicular plugging, scarring alopecia. Heal with hypopigmentation, especially at sun-exposed sites

Micro: hyperkeratosis, vacular interface dermatitis, superficial AND deep infiltrate

1. percent that develop systemic disease?
Chronic cutaneous lupus erythematosus (Discoid lupus)

1. 5-10%
patient with mucocutaneous eruption, iris and targetoid lesions, bilateral, h/o sulfonimide use

Micro:inflammation at dermal/epidermal junction, vacuolar interface, necrotic keratinocytes, rare eos, later full thickness necrosis and subepidermal bullae

1.what other etiologies?

2. what are other manifestations of this disease?
Erythema multiforme

1.anticonvulsants, herpes infection

2. Toxic epidermal necrosis/ stephens-johnson syndrome
middle aged patient with flacid blisters and erosions with mucus membrane involvement

Micro: suprabasilar acatholysis, intraepidermal bullae, "tombstone row" of basal later, sparse infiltrate

IF- IgG and C3 show "chicken wire" pattern

1.what if patient is elderly and the bullae is formed at the stratum corneum/loss of corneum?

2. What if bullae is subepidermal and contains eos and polys, and is usually intact?

3. what if subepidermal bullae but puritic vescicles on elbows, assc. with gluten-sensitive enteropathy, and bullae are filled with polys that also form microabscesses in the dermis?
Pemphigus vulgaris

1. pemphigus foliaceus

2. bullous pemphigoid (caused by anti-BM antibodies)

3. dermatitis herpetiformis
young patient with dome-shaped pink papule (1cm) on the face or lower extremities

Micro: symmetrical lesion that is well circumscribed with hyperplastic epidermis and kamino bodies, oval melanocytic nests in a "streaming down" pattern. May have focal pagetoid spread, and maturation. Cells are large, spindled and epithelioid with eosinophilic cytoplasm and basophilic nuclei. occasional superficial mitoses are OK. Cleft retraction is classic.
Spitz nevus
30 YO woman with well circumscribed dark papule with recent onset on the thigh

Micro: symmetric lesion with fascicles, horizontally streaming (raining down) growth. Cells are uniform, fusiform. interspersed with pigmented melanophages. Only at dermal/epidermal junction
Pigmented spindle cell nevus
Patient with well circumscribed blue/black papule/nodule, 1-2 cm on the butt or scalp

Micro: biphasic growth, with plexiform growth of dendritic melanocytes in sclerotic stroma and fascicles of fusiform melanocytes, ? no junctional component

IHC: s100, HMB-45 +
Cellular blue nevus
h/o previous nevus, new lesion within 1 year

Micro: atypical junctional component, dermal scar, b9 residual nevus at the base
recurrent nevus
melanoma

1. MC cancer in what age group?
2. what is the ABCD rule?
3.MC genetic abnormalities?
4.how do you measure breslow thickness?
5. prognostic indicators

6. variant with dermal fusiform component/ sarcomatoid looking (or may look low grade with mucin) and lymphocytes
Melanoma

1. 25-29
2. asymmetry, border (irregular), color (varied), diameter (larger than 6mm)
3. del 9p, 10q, gain 7
4. from granular cell later to deepest extension (in mm)
5. Ulceration, mitotic rate, LVS invasion
6. desmoplastic
elderly patient with flat pigmented macule on sun-exposed site that has been slowly growing.

Micro: Confluent dermal/epidermal junction with atypical melanocytes as single units

1. what if microinvasion in the dermis is found?

2. associated with hat other malignant skin lesion?
Lentigo maligna

1. lentigo maligna melanoma

2. desmoplastic melanoma
Basal cell CA

1. variants
basal cell CA

1. sclerosing, morpheaform (retraction, aggresive growth, fibroblastic stroma
patient with flesh colored firm papules on the face around the eyes, after puberty

Micro: small/circumscribed dermal proliferations in "tadpole/ comma" form with central lumen

1. derived form what tissue?
Syringoma

1. eccrine gland duct
patient with flesh-colored pauples on the face around nose, family history

Micro: basaloid tumor islands in the dermis that are interanastimosing "frond-like", with fibroblastic stroma and papilary mesenchymal bodies. may see primitive hair formation

1. variant with horned cysts?
trichoepithelioma

1. desmoplastic trichoepithelioma
patient with flesh colored nodules on the head, neck, and scalp, multiple

Micro: basaloid tumor islands that have a "jigsaw" pattern with dense BM around islands and hyaline droplets within. 2 cell types: outer round cells, inner polygonal cells.
cylindroma
what is the best (most sensitive and specific) immunostain for merkle cell?
CK20- dot like pattern. Yes, also neuroendocrine.
small nodule on neck or head of elderly patient

Micro: lesion c/o pleomorphic population of hyperchromatic stellate to spindled cells, mixed with epithelioid cells. Arrangement is RANDOM. atypical mitoses, background shows solar elastosis

IHC: vimentin, CD68, CD10

DX of exlcusion

1. how is this not MFH/pleomorphic undifferentiated sarcomas?
atypical fibroxanthoma

1. anatomical distinction, AFX ONLY in dermis- no invasion- no subcutis
flesh-brown colored papule on the head and neck of elderly person with hyperkeratosis

Micro: circumscribed, cup-shaped invagination of squamous epithelium, filled with keratin debris. Is ENDOPHYTIC.
Warty diskeratosis
Desmoplastic melanoma

Unique features:

1.
2.
3.

4. why commonly misdiagnosed?
1. Presents like keloid in head/neck- is flesh colored
2. less likely to metastesize
3. more likely to locally recur

4. fusiform spindled cells without atypia- mistaken for dermal scar. Also may be HMB-45 -, should stain for S-100
4mm or greater nevus with a "fuzzy" border

Micro: architectural disorder and cytologic atypia, also dermal fibrosis. However, both are mild, and there is NO pagetoid spread, and NO distruction of rete.
dysplastic melanocytic nevus
older man with stuck-on lesion on the trunk or head/neck


Gross: Exophytic, sharply demarcated, pigmented lesions that protrude above surface of skin, appear to be stuck to skin. Single or multiple, soft, tan-black, “greasy” surface

Micro: Acanthotic – most common, rounded verrucous surface; thick layer of basal cells mixed with horn cysts (contain keratin) and pseudohorn cysts (downgrowth of keratin into tumor mass); no prominent granular layer; some cells contain melanin due to transfer from neighboring melanocytes
Seborrheic karatosis
Skin changes in GVHD

A. Early
1.
2.
B. Late
1.
2.
Skin changes in GVHD

A. Early
1. basal vacuolization
2. chronic inflammation
3. spongiosis and ancatholysis
4. follicular involvement
B. Late
1. acanthosis, hyperkaratosis, hypergranulosis
2. atrophy in chronic stage- like scleroderma
Classic aunt-minnie

peripheral grooved ridge to see classic features
● Keratin-filled epidermal invagination with an angulated, parakeratotic tier (cornoid lamella)
● Epithelium deep to the tier is vacuolated and devoid of a granular cell layer
● Adjacent epithelium towards the center is either atrophic, normal thickness or acanthotic
● Dyskeratotic cells may be seen
porokaratosis
plaque and h/o scratching

Gross: Thick, scaly plaques with erythema, well demarcated from surrounding skin

Micro:
● Marked hyperkeratosis associated with foci of parakeratosis
● Prominent granular cell layer
● The epidermal rete are elongated and irregularly thickened
● Mild spongiosis
● Perivascular and interstitial inflammation with histiocytes, lymphocytes and occasional eosinophils in superficial dermis
Lichen simplex chronicus
Exophytic growth with marked hyperkeratosis, focal parakeratosis, papillomatosis resembling church spires
Prominent granular layer, koilocytosis, dilated vessels within papillary dermis
verruca vulgaris
raised annular lesion associated with morphea, chronic hepatitis C infection, autoimmune thyroiditis, secondary hyperparathyroidism, resolves spontaneously

Micro: Mid dermal necrobiotic collagen center surrounded by palisading histiocytes, as well as fibroblasts and lymphocytes

2. similar in deeper location, associated with adult and juvenile rheumatoid arthritis and rheumatic fever
Granuloma annulare

2. rheumatoid nodule
What is morphea?
Localized scleroderma- thickening of dermal collagen pushing down subcutis, epidermal atrophy
Tan-brown, red or skin colored, circumscribed lesions, sandpaper texture. May have cutaneous horn.

Micro:
Basal cell and squamous layer atypia and disorderly maturation, hyperkeratosis, parakeratosis. Usually no granular layer except at follicular orifices. Elastosis and often chronic inflammation of dermis. Follicular apparatus and intraepidermal sweat duct are spared. May have coexisting melanocytic atypia
Actinic keratosis
Pink to brown, flat or slightly raised plaque or nodule. Peripheral collarette of scale

Micro: Bland, intraepithelial tumor of clear keratinocytes with dermal inflammation and abrupt transition to normal epidermis. May have melanocytic proliferation, psoriasiform acanthosis, parakeratosis
clear cell acanthoma
Child with pink/brown papule on the trunk with a white clearing around it.

Micro:
non-pigmented melanocytic lesion in the dermis. Cells look atypical. Infiltrated by lymphocytes and macs. No fibrosis.
Halo nevus