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60 Cards in this Set
- Front
- Back
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Normal epidermal strata
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•Stratum corneum •Stratum granulosum •Stratum spinosum
• Basal cell layer •Basement membrane/basal lamina |
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Acantholysis
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SEPARATION of individual cells of the STRATUM SPINOSUM due to a loss of cohesion between the cells. This change commonly leads to formation of vesicles or bullae.
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Acanthosis
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THICKENING of the epithelial layer as a result of hyperplasia of the BASAL CELL LAYER and/or STRATUM SPINOSUM
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Bulla(e)
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Elevated lesion containing fluid & measuring over 5mm in diameter
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Carcinoma-in-situ
(Intraepithelial carcinoma) |
Anaplastic cellular changes of the epithelium in the absence of obvious invasion
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Dysplasia
(dyskeraosis, atypia) |
Reversibel alteration in cellular proliferation characterized histologically by variation in cell size, shap & organization
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Excoriation
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self-produced region of ulceration as occurs following intense scratching
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Hyperkeratosis
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thickening of the STRATUM CORNEUM
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Inflammatory Hyperplasia
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increase in quantity of tissue in ass. with chronic inflammation
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Macule
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circumscribed, non-elevated discoloration, as an aphelis (freckle)
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palisading
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lining up of cells & nuclei in a "picket fence" pattern
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papule
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circumscribed elevation up to 5mm in diameter
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parakeratosis
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retention of nuclei in STRATUM CORNEUM
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Pseudoepitheliomatous hyperplasia
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marked hyperplasia (acanthosis) of the epithelium
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Spongiosis
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intercellular and/or intracellular accumulation of fluid in the epithelium to produce a microscopic sponge effect
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Telangiectasia
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Localized dilation of vessels producing a "spider web" effect
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Vesicle
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Elevated fluid-containing lesion up to 5mm in diameter
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Vesiculobullous diseases
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heterogenous group of disorders characterized by BLISTERS, ULCERS or EROSIONS of SKIN, MUCOSA or BOTH
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Impetigo
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•acute, superficial bacterial infection usually of the face and hands of children. •Autoinoculable and contagious.
•Most common in: ◦children with poor hygeine, ◦crowded living conditions, ◦hot and humid climates. •Often arise in areas of trauma. •Early vesicles become crusts and abscesses. •Multiple vesicles that rupture, leaving a honey-colored crust •Etiology usually STAPH AUREUS or STREP PYOGENES. •Treated with topical or systemic antibiotics. |
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Miliaria
"heat rash, diaper rash" |
due to occlusion & subsequent rupture of ECCRINE SWEAT GLAND DUCTS
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Lichen Planus
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•skin disease with fairly common ORAL manifestations- may be easily confused with speckled luekoplakia
•unknown pathogenesis- exacerbated by ANXIETY; IMMUNOLOGIC MECHANISM •Degenerative process: histologic DEGENERATION of BASAL LAYER & superficial CONNECTIVE TISSUE •FLEXOR surfaces of wrists, forearms, knees & thighs •Orally: reticular & erosive- most common on BUCCAL MUCOSA & TONGUE; most often BILATERAL •affects ADULTS; more common in FEMALES; Caucasians •patient often complains of THICKENINS or "BURNING SENSATION" |
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RETICULAR Oral Lichen Planus
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•interlacing white lines, BUCCAL MUCOSA
•retiform arrangement with lacey patches, rings & links •NO TXT |
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EROSIVE Oral Lichen Planus
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•Ulcers with erythema & white streaks
•txt: topical corticosteroids (Diprolene Gel or Temovate Gel) |
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Wickham's Striae
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Skin lesions of Lichen Planus with a VIOLET hue & small pruitic (itching) papules covered in fine lines
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Histomorphology of Lichen Planus
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•hyperparakeratosis or hyperorthokeratosis: "SAW TOOTH" appearance of rete pegs
• "BAND-LIKE" infiltrate of LYMPHOCYTES & occasional PLASMA CELLS into most superficial layer of the connective tissue; infiltrate obliterates epithelial connective tissue jxn •dirct immunoflurescence is non specific; SHAGGY deposition of FIBRINOGEN along basement membrane zone • |
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Lichen Planus Prognosis
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SKIN lesions- often self-limiting, may even regress
ORAL lesions- persist & typically respond to topical costeroid therapy •unlikely to progress to cancer •25% have superimposed CANDIDIASIS so antifungal txt. may be necessary |
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Psoriasis
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•chronic skin disease; unknown etiology- GENETIC/ENVIRONMENTAL
•increase in PROLIFERATIVE activity of KERATINOCYTES •SILVER SCALES on erythematous base- removal of scale results in bleeding point (AUSPITZ'S SIGN) •EXTENSOR surfeces of knees, elbows; scalp & face •lesions wax & wane- improve in summer •ass. with crippling ARTHRITIS •rarely within oral cavity •no txt required for mild cases •topical corticosteroids, UV light, PUVA or systemic corticosteroid therapy for more severe cases; may persist for years |
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Psoriasis Histology
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Psoriasiform mucositis
•marked acanthosis with elongation of dermal papillae •"test tube" rete pegs & parakeratosis •perivascular inflammation & MUNRO ABSCESSES |
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Munro abscesses
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seen in PSORIASIS
•microscopic collection of polymorphonuclear leukocytes found in the stratum corneum in psoriasis |
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Pemphigus
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•potentially fatal
•PEMPHIGUS VULGARIS (4x most common); other types: vegetans, foliaceous, erythematous •AUTOIMMUNE- Abs against eptihelial DESMOSOME complex •usually affects ages 40-70 but also a childhood type •RAGGED ORAL EROSIONS precede skin manifestations •FLACCID BULLAE •rarely oral blisters •histologically- SUPRABASAL CLEAVAGE •NIKOLSKY'S SIGN •Direct & Indirect immunofluroescence demostrate IGs vs. DESMOSOMES (intercellular) •txt: systemic corticosteroids & immunosuppressants. often AZATHIOPRINE •corticosteroid therapry has decreased mortality from 50-90% to 5-10% |
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Cicatricial Pemphigoid
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•AUTOIMMUNE- Abs against BASEMENT MEMBRANE
•clinically resembles pemphigus, but less serious & 2x more common •vesicles & bulla are SUB-BASAL or SUBEPITHELIAL •linear deposition of immunoreactants @ BMZ •direct immunofluorescence •F>m, avg age=60 •DESQUAMATIVE GINGIVITIS •OCULAR involvement = SYMPLEPHARON •txt: topical corticosteroids or DAPSONE; systemic corticosteroids with ocular involvement •prognosis- rarely fatal, but blindness can result from ocular involvement |
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Desquamative Gingivitis
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associated with Cicatricial Pemphigoid
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Symplepharon
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Ocular involvement of CICATRICIAL PEMPHIGOID- scarring of conjunctival mucosa
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Epidermolysis Bullosa
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•Heterogenous group of inherited blistering Mucocutaneous disorders
•types: 1. simplex 2. junctional 3. dystrophic •Autosomal Dominant, Recessive & Acquired •no txt: magagement of deformities & infections •FLUORIDE & non-cariogenic diet to prevent TOOTH DECAY •increased risk of CUTANEOUS SQUAMOUS CELL CARCINOMA |
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DOMINANT DYSTROPHIC Epidermolysis Bullosa
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•vesicles/bullae that become ulcers & erosions that heal with scarring
•GINGIVAL ERYTHEMA, RECESSION & reduction in VETIBULAR DEPTH |
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RECESSIVE DYSTROPHIC Epidermolysis Bullosa
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•characterized by bullae formation following minor pressure of TRAUMA to epidermis or mucous membranes
•much more SERIOUS •Secondary infection •MITTEN DEFORMITY •MICROSTOMIA "small mouth" |
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Erythema Multiforme
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•acute, usually self-limiting vesicobullous disease; commonly affects LIPS & ORAL CAVITY
•a type of MUCOCUTANEOUS-OCULAR SYNDROME •drug hypersensitivity (25%); microorganisms (Herpes- 25%), other allergens/unknown (50%) •young adult MALES •fall or spring •"TARGET" LESION- rings of necrosis, congestion & erythema •ragged ulcerations •lips - HEMORRHAGIC CRUSTING •3 types: minor, major, TEN •histology: destruction of KERATINOCYTES & SUBEPITHELIAL EDEMA •mixed Inflammatory infiltrate with perivascular arrangement •Immunopathology useful only in ruling out other vesiculobulluos diseases |
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Erythema Multiforme Minor
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skin or mucosa only
•txt: topical coritcosteroids |
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Erythema Multiforma Major
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STEVENS-JOHNSON SYNDROME
•at least two mucosal sites + skin involvement •shock, renal failure, broncho-pneumonia may result •sever form of EM- young males; 2~10% mortality •txt: systemic cortocosteroids |
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Toxic Epidermal Necrosis
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LYELL'S DISEASE
•F>M •older pts.- typically ass. with ingestion of a drug •diffuse sloughing of skin •pts. are treated in burn units •34% mortality |
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Reiter's Syndrome
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mimics GONORRHEA
•arthritis •conjunctivitis •urethritis •mucocutanous lesions including ALPHA-LIKE ORAL ULCERS •young adult MALES; much less mortality & morbidity that Stevens-Johnson |
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Behcet's Syndrome
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•similar to Reiter's;
•consists of APTHA-like oral & genital ulcers •ocular inflammation manifests as: recurrent uveitis, conjuntivitis or retinitis |
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Actinic (senile, solar) Keratosis
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•common PRE-malignant lesion; usually on skin exposed to UV light
•scaly lesions on an erythematous base on sun-exposed skin of middle aged or elderly > 40 yrs •face, dorsum of hands, scalp •rough "sandpaper feel" •hyperkeratosis with varying degrees of cellular hyperplasia & dysplasia •may progress to SQUAMOUS CELL CARCINOMA (13-25%); lesions should be excised •SOLAR ELASTOSIS- microscopic degenerative change in dermal connective tissue •ACTINIC CHELITIS- lip involvement •txt: curettage, cryotherapy, topical 5-FLUOROURACIL |
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Leukoplakia
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*MOST COMMON PREMALIGNANT LESION OF THE ORAL CAVITY!!!*
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Bowen's Disease
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•skin lesions which posess more sever dysplastic alterations than actinic keratosis
•associated with a predisposition to CANCER in INTERNAL ORGANS •1/3 of pts. with Bowen's disease will develop VISCERAL CANCER in 6-10 yrs. |
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Malignant lesions of the skin
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most common cancer in humans
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Malignant Melanoma
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tumor of ANAPLASTIC MELANOCYTES (MALIGNANT NEOPLASM)
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Cutaneous Melanoma
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•arise from pre-existing beningn melanocytic lesions or history of ACUTE SOLAR DAMAGE
•2% of skin cancers (3rd most common, but the #1 cause of death) •uncommon in mouth •white adults (50-55 yrs.) •typically appears as an enlarging, blue-black flattened area of pigmentation with satellite lesions, ulceration, itching and/or bleeding; also may occur as an amelanocytic lesion |
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4 types of cutaneous melanoma
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1. Lentigo maligna
2. Superficial Spreading (most common) 3. Nodular 4. Acral lentiginous (most oral melanoma) |
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ABCDS of Melanoma
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Asymmetry
Borders (Irregular) Color variegation Diameter (greater than 6mm) Symptoms |
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Melanoma Prognosis
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Breslow's Depth of invasion = the deeper the invasion, the worse the prognosis
•surgical incision with 3-5cm margins •FEMALES & people UNDER 50 have better prognoses |
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Intraoral melanomas
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Almost always occur after age 30
•usually involve MAXILLARY ALVEOLAR RIDGE or PALATE •rapidly growing pigmented lesions; usually ulcerated •increased focal pigmentation frequently precedes caner by months or yrs.- view these areas closely |
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Radial vs. Vertical growth of Melanomas
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•atypical melanocytes along basal epithelial layer (Lateral growth phase)
•Vertical growth begins as these cells invade the connective tissue |
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Pagetoid Spread
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•Melanocytic distribution throughout the epithelium
(Melanomas) |
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Basal Cell Carcinoma
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Rodent Ulcer
•MOST COMMON OF ALL CANCERS •slowly growing, LOW GRADE, non-metastatic malignancy ass. with long exposure to UV light •fair complected, middle-aged men (>40) who have spent most of their lives outdoors •tumor cells arise from BASAL CELL LAYER •may be associated with NEVOID BASAL CELL CARCINOMA •most common type = NODULO-ULCERATIVE TYPE (appears as an ulcer which, heals, breaks down, then enlarges) •other types: pigmented, sclerosing & superficial •MIDDLE THIRD of the face- eyebrows to lower lip •Microscopically: nests of basal cells with a PALISADED PERIPHERAL COLUMNAR CELL & STROMAL RETRACTION •theoretically easily curable, but may produce deformity of death from extension to vital structures •5 yr. survival is approximately 98% |
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Squamous Cell Carcinoma
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•similar predisposing factors as for BCC.
•SECOND MOST COMMON type of SKIN CANCER •may metastasize •may follow or be assoicated with actinic keratosis, leukoplakia, radiodermatitis, arsenical keratosis or severe burn scars •EXCELLENT prognosis due to late metastasis |
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Keratosis follicularis
(Darier's Disease) |
•an AUTOSOMAL DOMINANT GENODERMATOSIS
•lack of cohesion among the surface cells •associated GENE MUTATION affects the integrity of the DESMOSOMAL COMPLEX •erythematous, pruritic papules of the skin; pits & keratoses of the palms & soles; nails that feature longitudinal lines, ridges & splits •oral lesions- PALATAL or ALVEOLAR MUCOSA; present as multiple flat-topped papules •Suprabasilar acantholysis, "test tube" rete ridges, central keratin plugging •dyskeratoic cells- "CORPS RONDS" & "GRAINS" |
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Systemic Lupus Erythematosus (SLE)
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•AUTOIMMUNE disease affecting vessels & connective tissue in kidney, lung, joints & other tissues- variable clinical pattern
**FIBRIOD NECROSIS** •young adult FEMALES (8:1 ratio) •BUTTERFLY facial rash, joint pain, shortness of breath, renal failure, immune complex disease, etc.. •Oral plaque-like lesions with central ulceration & a rim of keratinization •LE test: nuclear chromatin phagocytosed by neutrophil is almost pathognomic, but false positives do occur •ANTINUCLEAR ANTIBODIES* (& also antinucleolar Abs are often present) •controlled with corticosteroids |
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Chronic Cutaneous Lupus Erythematosus (CCLE) -
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DISCOID LUPUS (DLE)
•skin & oral lesions are more prominent than with SLE •hyperkeratosis and/or hyperorthokeratosis alternating with atrophic foci, diffuse inflammatory infiltrate & thickening of basement membrane •rarely DLE converts to SLE |
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Scleroderma
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SYSTEMIC SCLEROSIS
•progressive deposition of COLLAGEN within subcutaneous & submucosal tissues- leading to scarring, unduration & fixation •MASK-LIKE FACE & CLAW-LIKE HANDS (SCLERODACTYLY) •oral findings: WIDENEND PDL & atrophy of MANDIBULAR RAMUS •F>M •death due to involvement of esophagus, lungs, other viscera |
