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124 Cards in this Set
- Front
- Back
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Define a macule.
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A spot you can see, but cannot feel. Circumscribed and any size.
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Define a papule.
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Small elevated bump. <5mm.
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Define a nodule.
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Elevated bump >5mm
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Define a plaque.
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A nodule with a flat surface. >5mm
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Define a vesicle.
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Small fluid filled, raised area <5mm
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Define a bulla
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Fluid filled raised area >5mm
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Define a pustule.
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Discrete pus-filled raised area
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Grossly, what does parakeratosis look like?
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scaling.
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What is lichenification?
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Thickening of the skin.
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What is too much keratin called?
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Hyperkeratosis
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What is parakeratosis?
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Increased keratin with nuclei retained in the corneum.
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Where is parakeratosis normal?
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In the mucous membranes
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What are the layers of the skin from external to internal?
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Corneum
Lucideum Granulosum Spinosum Basale DEJ Papillary dermis Reticular dermis |
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What is thickening of the spinosum called?
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Acanthosis
Can refer to any epidermal hyperplasia |
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What is keratinization close to the basement membrane called?
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dyskeratosis
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What term refers to the loss of intercellular connections resulting in loss of cohesion between keratinocytes?
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Acantholysis
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What is hyperplasia of the papillary dermis with elongation and widening of the dermal papillae look like grossly? What is it called?
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Called papillomatosis.
Looks like the surface of a wart. Spiky, velvety surface. |
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What term refers to the linear pattern of melanocyte proliferation?
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Lentiginous
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Where do melanocytes proliferate?
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basal cell layer of the epidermis
(Basale) |
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What is spongiosis?
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Edema in the spinosum
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What is the characteristic urticaria lesion? How would you describe it medically?
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The wheal
edematous plaque |
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What reaction, pathogenically, causes urticaria?
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hypersensitivity type I: Mast cell degranulation by allergens or drugs.
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What drugs can cause urticaria? How?
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Opiates and antibiotics by causing direct degranulation of mast cells. This is IgE independent.
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What disorder is morphologically defined with: dermal edema, superficial chronic perivasculitis, with occasional eosinophils?
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Urticaria
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What causes the edema in urticaria?
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histamine
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Where is urticaria most serious?
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Larynx and respiratory pathway
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What layer of the skin shows pathology with urticaria?
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Deep dermis layers show edema. You can see the collagen fibers pushed apart. Everything else looks normal.
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What causes the skin to appear red?
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Dilation of the vasculature and increased vessel permeability.
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What is the common name for spongiotic dermatitis?
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eczema
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What is the characteristic finding associated with eczema?
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Spongiosis
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What are the five common causes of eczema?
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Allergic contact
Atopic Drug-related Photo Primary irritant |
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What is the gross appearance of eczema?
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red, papulovesicular lesion with oozing, wet, crusted appearance acutely. Scaling plaques if chronic.
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When will eczema show eosinophils?
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When drug-induced
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What is the key difference between urticaria and eczema?
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Urticaria shows pathology in the deep dermis
Eczema is spongiosis: edema in the spinosum causing separation of the intercellular connections forming vesicles. |
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What is the general definition of erythema multiforme?
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Hypersensitivity reaction to drugs or infections.
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What is the characteristic lesion of erythema multiforme (EM)?
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the target lesion
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What is the typical infection that causes EM?
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mycoplasma
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What does biopsy of the target lesion show?
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Central area will show degeneration of the basal layer with epidermal necrosis.
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In EM, what is the characteristic finding regarding lymphocytes?
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Margination of the DEJ, causing the degeneration of the basal layer.
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What is vacuolar degeneration?
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Degeneration of kerotinocytes. Causes vacuoles to form.
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What is the unique histologic finding in EM?
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Normal corneum
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What causes pigment drop out?
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Destruction of the basal layer causes pigment to drop into the dermis where it is picked up by macrophages.
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What condition will have vacuolar degeneration of basal cells with necrotic keratinocytes? What key finding will confirm this?
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Erythema Multiforme
Confirmed if corneum is intact. |
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What causes the basal layer destruction in EM?
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CD8 margination at the DEJ
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How many are affect by psoriasis?
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1-2%
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What areas can be effected by psoriasis?
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Extensor areas
Elbows, knees, scalp, lumbosacral region, intergluteal cleft, glans of the penis. |
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What percent of psoriasis patients experience nail changes? What happens?
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30%
Brown discoloration and onycholysis |
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What does psoriasis look like grossly?
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Pruritic pink plaques and sliver scales.
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What is Auspitz sign? What disease has it?
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Found in psoriasis.
Bleeding when thinned epidermis is peeled back exposing vessels. |
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What key microscopic findings are evident with psoriasis?
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Acanthosis (Regular): each rete peg is the same size and club shaped.
Parakeratosis Thin or absent granulosum Thinned epidermal layer over papillary dermis. This causes Auspitz sign. |
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Why is there parakeratosis with very little granulosum in psoriasis?
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Cell turnover is way too fast.
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What are the four microscopic findings specifically associated with psoriasis?
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1. Spongiform pustule
2. Munro microabscess 3. Spongiosis 4. Mitoses above basal layer |
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What is spongiform pustules?
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Neutrophils in the spinosum
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What is Munro microabscess?
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Neutrophils in parakeratotic corneum
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Other than psoriasis, what must be ruled out if you find neurtophils in the epidermis, acanthosis, and spongiosis?
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Fungal infections. Do a PAS or silver stain.
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What are the pathogenic factors associated with psoriasis?
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Genetic factors
Environmental factors HLA type T-cell activity |
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What will acanthosis look like in psoriasis?
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Regular, straight line.
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Where are lichen planus normally located?
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Flexor surfaces
symmetrically located on extremities: wrists, elbows, glans of the penis and also in the mouth |
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What is the gross appearance of lichen planus?
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In the mouth it is white and lacey. On the skin it is red-purple pruritic papules.
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What are the key morphologic findings associated with lichen planus?
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Interface dermatitis: Band-like lymphocytic infiltrate at DEJ
Sawtooth acanthosis |
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Does lichen planus exhibit parakeratosis?
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No.
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What disease has wedge-shaped hypergranulosis, sawtooth acanthosis and band-like lymphocytic infiltrate at the DEJ? Does the corneum show nuclei?
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Lichen planus
No parakeratosis, except in the mucous membrane. |
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What are the bullous diseases?
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Pemphigus vulgaris
Bullous pemphigoid Dermatitis herpeticus |
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What bullous disease is an autoimmune mediated loss of intercellular attachments in the epidermis and mucosa?
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Pemphigus vulgaris
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What type of reaction is pemphigus vulgaris?
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Hypersensitivity type II with IgG
Antibodies to intercellular cement (desmogleins). |
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What cell layer is effected in pemphigus vulgaris?
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IgG target intercellular proteins in the spinosum
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What term is used to describe the loss of connectivity between cells in the epidermis?
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Acantholysis
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How would you treat a biopsy of pemphigus vulgaris?
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Treat with anti-IgG tagged with fluorescence.
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What is Nikolsky's sign?
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Skin so fragile that it breaks with gentle contact. Typical with acantholysis.
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What is the difference between Auspitz sign and Nikolsky's sign?
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Auspitz has bleeding with pulling away of the epidermal layer. (Psoriasis).
Nikolsky's: epidermis peels away with gentle contact (pemphigus vulgaris, staph infections, etc) |
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Where is the blister located in pemphigus vulgaris?
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suprabasal
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What is the key feature of pemphigus vulgaris?
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Acantholysis
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What disease has iconic tombstones lying on the basement membrane? What are they?
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Pemphigus vulgaris
It is the basal layer still attached to the basement membrane |
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What is the difference between bullous pemphigoid and pemphigus vulgaris?
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Position of the blister. In PV the blister forms above the basement membrane, making the bullae very fragile. In BP, the blister is below the basement membrane, forming a tense bullae.
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What is the pathogenesis of bullous pemphigoid?
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Type II hypersensitivity to lamina lucida layer, just below the basal layer.
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What will the biopsy of bullous pemphigoid look like?
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Linear band outlining the subepidermal basement membrane.
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Is the basal layer attached to the basement membrane in bullous pemphigoid or pemphigus vulgaris?
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Attached in PV forming tombstones. Not attached in BP.
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Who typically develops dermatitis herpetiformis?
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Males between 20-40.
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Where do dermatitis herpetiformis lesions develop?
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Bilateral and symmetical on extensor surfaces: elbows, knees, upper back, and ass
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What disease is associated with dermatitis herpetiformis?
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celiac
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Describe the age distribution of bullous lesions.
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Young: herpetiformis
Old: pemphigus or pemphigoid |
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What type of reaction is herpetiformis?
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IgA mediated Type II hypersensitivity
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Why do celiac and herpetiformis co-occur?
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Antibodies to gliadin can cross react with reticulin which is part of the anchoring fibrils that connect the epidermal basement membrane to the dermis.
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What is the role of reticulin?
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Tethers basement membrane to dermis.
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If a patient comes in with a vesicular grouped rash and a history of GI problems, what are you considering?
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Celiac with cross reaction dermatitis herpetiformis
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Is the blister formation of DH supra or sub epidermal?
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Subepidermal. The antibodies attack the attachment of the basement membrane to the dermis.
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What should you suspect if you see neutrophils in the epidermis?
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Psoriasis or fungal infection.
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What should you suspect if you see neutrophils just below the epidermis?
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Herpetiformis
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If biopsy of a bullous shows fluorescence with anti-IgA, what are you considering? Where will the fluor show?
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Herpetiformis
Fluorescence present at the tip of dermal papillae. |
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What is a seborrheic keratosis? what is the characteristic feature?
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"stuck on" benign hyperkeratotic lesion with horn cysts that is usually pigmented.
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Who gets seborrheic keratosis?
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old people
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What is a keratoacanthoma? What is the characteristic feature?
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Dome shaped nodule of squamous cells with central keratin plug. Occurs in sun exposed areas and heals spontaneously.
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What does a keratoacanthoma look like? How should it be treated?
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Squamous cell carcinoma
If it looks like a cancer, just be safe and take it off. |
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What is a verrucae? What causes it? What is the characteristic cell type?
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HPV caused wart
Koilocytes |
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What are the classifications of verrucae?
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vulgaris
plana palmaris plantaris venereal |
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Which HPV strains can cause venereal warts? Whats the other name?
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6, 8, 11, 18
condyloma accuminata |
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What is keratohyaline?
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granules of viral particles
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What is the morphologic difference between verrucae and squamous papillomas?
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curved outer border means verrucae
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Actininc keratosis is a precursor to what disease?
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squamous cell carcinoma
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Where does actinic keratosis occur?
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sun exposed areas
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What percent of actinic keratoses complicate to cancer?
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5%
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What is the characteristic features of actinic keratosis?
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red or tan appearing lesion with partial thickness dysplasia with abnormal keratinization.
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What are the malignant epidermoid tumors?
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squamous and basal cell carcinomas
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What percent of squamous cell ca met?
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2-5%
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Which squamous cell lesions are more significant?
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Those caused by burns and chronic irritation as they are more likely to met. Dont worry too much about sun exposure ones.
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What is the difference between actinic keratosis and squamous cell ca?
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thickness of the lesion
squamous cell lesions are full thickness AK is only partial thickness |
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Which is the more common epidermoid tumor?
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basal cell tumors
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What is the characteristic feature of basal cell carcinoma?
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basaloid cells with palisading borders and lots of mitosis
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You are looking at a slide that that shows a lesion retracting from the stroma. What do you suspect and why?
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basal cell carcinoma
retraction if a formulin-fixing artifact |
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What are the tumors of melanocytes called?
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Benign and dysplastic nevi
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A mole can be one of two things. What?
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A nevus or seborrheic keratosis
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How can you distinguish a nevus from a melanoma?
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Asymmetry
Border Color Diameter Evolution Nevus should have no mitosis and no atypia. |
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What are the three types of nevi?
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Junctional
Compound Dermal |
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In a benign nevus, what should the melanocytes do as you go deeper?
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Should get smaller and less pigmented, because they get bigger as they mature.
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What are the gross features of a dysplastic nevus?
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Big pebbly mole with irregular borders and pigmentations
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What are the microscopic features of a dysplastic nevus?
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Lentiginous hyperplasia
Atypical melanocytes Linear dermal fibrosis with nests of abnormal cells |
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Why would you get paler areas with melanoma?
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due to regression from immune system response
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What are some warning signs of a melanoma?
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Enlargement
Itching/pain/bleeding New lesions with poor borders and colors |
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Why would you have itching or pain with a melanoma?
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growth into a nerve
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What is characteristic of the radial growth phase of melanoma?
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First phase, cells grow parallel to the surface to form a flat lesion
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What is characteristic of the vertical growth phase of melanoma?
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Penetration of cells into deeper dermis forming a nodule with no signs of maturation.
Risk of metastases proportional to the depth of growth |
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What depth of invasion is bad for melanoma?
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>2 mm
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Where does melanoma met?
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LNs
Hematogenous to liver, lung and brain |
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What stains are used to identify a malignancy?
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immunoperoxidase stains
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