Pathology(Skin)*

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Marker of visceral malignancy

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Acanthosis Nigricans
-thickened & hyperpigmented areas commonly found in flexural areas

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Extremely pruritic vesicular lesions assoc. w/ celiac dse.

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Dermatitis Herpetiformis
-may respond to a gluten-free diet

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Abnormal proliferation of connective tissue of skin scars that results in large raised tumor-like lesions

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Keloid
-more common in African Americans

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Black-blue papule w/ irregular borders

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Malignant melanoma
-depth of invasion correlates w/ prognosis

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Tumor arising from actinic keratosis

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Squamous Cell Carcinoma

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Antimelanocyte anitbodies assoc. w/ cell loss in discrete areas of skin

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Xanthoma

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Pearly papules w/ superficial telangiectases

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Basal Cell Carcinoma
-almost never metastasizes

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Type IV hypersensitivity rxn. in the skin

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Contact dermatitis
-primary T-cell- & macrophage-mediated immunity

Front 9

Benign neoplasm closely resembling squamous cell carcinoma;regresses spontaneously w/o therapy

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Keratoacanthoma

Front 10

Premalignant epidermal lesion caused by chronic excessive exposure to sunlight; charact. by rough,scaling,poorly demarcated plaques on the face,neck, upper trunk,or extremities

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Actinic Keratosis

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May be a marker of visceral malignancy(stomach,lung,breast,uterus);charact. by acanthosis & hyperpigmentation often involving flexural areas

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Acanthosis Nigricans

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Yellowish papules or nodules composed of focal dermal collections of lipid-laden histiocytes occurring in the eyelids(most common),over tendons or joints;assoc. w/ hypercholesterolemia

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Xanthoma

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Slowly growing,well-differentiated malignant neoplasm histologically resembling dermatofibroma;rarely metastasizes

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Dermatofibrosarcoma Protuberans

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Extremely common benign neoplasm of older persons manifesting as sharp demarcated raised papules or plaques w/ a typical pasted-on appearance occuring on the head,trunk,& extremities;also called senile keratosis

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Seborrheic Keratosis

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Benign neoplasm presenting as a firm nodule(sometimes w/ pigmented acanthosis);charact. by interwinning bundles of collagen & fibroblast;termed fibrous histiocytoma when histiocytes are prominent

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Dermatofibroma

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Pigmented nevi present at birth; charact. by nodular foci of dendritic, highly pigmented melanocytes in the dermis;blue external appearance results from the dermal location

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Blue Nevus

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Contagious viral infxn. transmitted by direct contact affecting mostly children & adolescents;due to a DNA poxvirus;demonstrates umbilicated,dome-shaped papules

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Molluscum Contagiosum

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A benign papilloma caused by certain strains of HPV(distinct from those assoc. w/ gynecologic neoplasms); charact. by vacuolated cells(koilcytes) in the granular cell layer of the epidermis

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Verruca Vulgaris(common wart)

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Extremely common lesion often occurring on the face near the eyelids,neck, trunk,or axilla;consist of a central connective tissue core covered by stratified squamous epithelium

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Acrochordon(fibroepithelial polyp,skin tag)

Front 20

Dome shaped nodule that is filled w/ soft gray white material;lined by stratified squamous epithelium & is filled w/ keratinous material;no assoc. w/ sebaceous glands

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Epidermal Inclusion Cyst

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Atypical,irregular pigmented lesion w/ disorderly proliferation of melanocytes,dermal fibrosis,& subjacent dermal lymphocytic infiltration;may transform into malignant melanoma;may be familial(autosomal dominant inheritance;inc. % for conversion to malignant melanoma)

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Dysplastic Nevus

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A nonfamilial precursor of lentigo maligna melanoma;an irregular macular pigmented lesion on sun-exposed skin; charact. by atypical melanocytes at the epidermal-dermal junction

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Lentigo Maligna(Hutchinson freckle)

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Pigmented macule caused by melanocytic hyperplasia in the epidermis

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Lentigo

Front 24

Pigmented nevi classified as a benign tumor or hamartoma derived from melanocytes w/c occur in clusters or nests;3 types-junctional(confined to epidermal-dermal junct.),compound(epidermal-dermal junct. & dermis), intradermal(w/ in the dermis, nonpigmented)

Back 24

Nevocellular nevus(common mole)

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Pigmented nevi occuring often in children;benign;charact. by spindle-shaped cells;can be confused w/ malignant melanoma

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Spitz Nevus(juvenile melanoma)

Front 26

Melanin synthetic defect involving the eyes,skin,& hair;predisposes to actinic keratosis,basal & squamous cell carcinoma,& malignant melanoma due to sensitivity to sunlight;autosomal recessive

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Oculocutaneous Albinism
-subclassified as:Tyrosinase-neg. albinism(failure of conversion of tyrosine to dihydroxyphenylalanine,DOPA)& Tyrosinase-positive albinism(unknown cause)

Front 27

Acquired loss of melanocytes in discrete areas of skin that appear as depigmented white patches;no relationship to albinism;may be autoimmune in origin or assoc. other autoimmune dse.;may be caused by destruction of melanocytes by toxic intermediates of melanin production or by neurochemical factors

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Vitiligo

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Produced by an increase of melanin pigment w/in basal keratinocytes

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Freckle(ephelis)

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An acantholytic disorder charact. by formation of severe intraepidermal bullae w/c 1st occur in the oral mucosa later spreading~rupture leaving large denuded surfaces(subject to secondary infxn.);autoimmune disorder charact. by IgG autoantibodies directed against the epidermal intercellular cement substance

Back 29

Pemphigus Vulgaris
-charact. by prominent intraepidermal acantholysis & sparing of the basal layer;can be fatal

Front 30

Autoimmune disorder charact. by IgG autoantibodies directed against epidermal basement memb.;resembles pemphigus vulgaris but less severe; subepidermal bullae,w/ charact. inflammatory infiltrate of eosinophils in the surrounding dermis

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Bullous Pemphigoid

Front 31

Recurrent pruritic blistering disorder on the extensor surface of knees & elbows,scalp,upper back,sacral area(blisters occur in groups);assoc.w/ gluten-sensitive enteropathy(celiac dse.);demonstrates IgA deposits & dermal micoabscesses w/ neutrophils & eosinophils @ tip of dermal papillae, w/c become subepidermal blisters

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Dermatitis Herpetiformis

Front 32

Skin disorder w/c presents w/ multiple types of lesions(macules,papules, vesicles);assoc. w/ a "target"lesion resembling an archer's bull's-eye; involves hypersensitivity to coexistent infectious agents,various drugs, concomitant tissue disorder,or assoc. malignancy

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Erythema Multiforme

Front 33

Childhood viral infection charact. by fever & generalized vesicular lesions; immune individuals develop herpes zoster(shingles)w/c are painful skin eruption distributed along the dermatomes corresponding to the affected dorsal root ganglia

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Varicella(chickenpox)
-varicella-zoster virus may remain latent for years in dorsal root ganglia

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Separation of epidermal cells one from the other;cells appear to float w/in extracellular fluid

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Acantholysis

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Accentuation of skin markings caused by scratching

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Lichenification

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Growth phase of Malignant Melanoma

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1)Radial(inital phase)-growth in all directions(mostly lat. w/in the epidermis & papillary zone of the dermis);prominent lymphocytic response; no metastasis;common clinical cure 2)Vertical(later phase)-growth into the reticular dermis or beyond;prognosis varies w/ depth of lesion;lymphatic or hematogenous spread may occur

Front 37

Chronic infl. process charact. by erythematous papules & plaques w/ characteristic silver scaling;sharply demarcated lesions;often involves the extensor surface of elbows,knees,scalp, & sacral area;nonpruritic;epidermal proliferation w/ acanthosis & parakeratosis;assoc. w/ severe destructive rheumatoid arthritis-like lesions(psoriatic arthritis)often affecting fingers;autoimmune in origin

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Psoriasis

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Flat,nonpalpable lesion of a different color than the surrounding skin;less than 1 cm in diameter

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Macule

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Similar to macule;larger than 1cm

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Patch

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Small,palpable,elevated skin lesion less than 1cm in diameter

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Papule

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Similar to papule;larger than 1cm in diameter

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Plaque

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Large fluid-containing blister;0.5cm or more in diameter

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Bulla

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Blister containg pus

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Pustule

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Dried exudate from a vesicle,bulla,or pustule

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Crust

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Increase thickness of the stratum corneum

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Hyperkeratosis

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Hyperkeratosis w/ retention of nuclei of keratinocytes

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Parakeratosis

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Thickening of the epidermis

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Acanthosis

Front 48

Epidermal intercellular edema w/ widening of intercellular spaces

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Spongiosis

Front 49

Common skin tumor charact. by invasion of dermis by sheets & islands of neoplastic epidermal cells,often w/ keratin "pearls"

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Squamous Cell Carcinoma
-<5% metastasis

Front 50

Most common skin tumor involving sun exposed areas(head,neck,upper part of the face);presents as a pearly papule w/ overlying telangiectatic vessels;can be locally aggressive,ulcerate,& bleed; almost never metastasizes;cured by surgical resection

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Basal Cell Carcinoma
-charact. by clusters of darkly staining basaloid cells w/ a typical palisade arrangement of the nuclei of the cells @ the periphery of the tumor clusters

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Malignancy most common in fair-skinned persons w/c arises from melanocytes or nevus cells;often assoc. w/ excessive exposure to sunlight

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Malignant Melanoma
-clinical variants(Lentigo maligna melanoma,Superficial spreading melanoma,Nodular melanoma,Acral-lentiginous melanoma)

Front 52

A vascular pedunculated lesion charact. by numerous capillaries & edematous stroma w/c often develops following trauma;common in skin or mucous memb.

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Granuloma Pyogenicum

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An abn° proliferation of the connective tissue,w/ deranged arrangement of collagen fibers resulting in large, raised,tumor-like scars following trauma to the skin;genetically susceptible;recur after resection; common in African lineage

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Keloid

Front 54

Common skin tumor assoc. w/ excessive exposure to sunlight w/coccurs in sun-exposed areas(face,back of the hands); locally invasive;often originates in pre-existing actinic keratosis;assoc. w/ chemical carcinogens,radiation or X-ray exposure;presents w/ scaling, indurated,ulcerated nodule;excision is usually curative

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Squamous Cell Carcinoma

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Clinical variant of malignant melanoma w/c occurs on sun-exposed skin;radial growth phase predominates;often develops from preexisting lentigo maligna(Hutchinson freckle)

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Lentigo maligna melanoma

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Most common clinical variant of malignant melanoma;lesion is irregularly bordered w/ variegated pigmentation;occurs often in the trunk & ext.;radial growth predominates

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Superficial spreading melanoma

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Clinical variant of malignant melanoma w/ poorest prognosis;begins w/ vertical growth phase

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Nodular melanoma

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Clinical variant of malignant melanoma w/c appears often on the hands & feet of dark-skinned persons

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Acral-lengtiginous melanoma

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Capillary hemangioma(small,bld.-filled capillaries lined w/ a single layer of endothelium)w/c manifest as a purple-red area on the face & neck

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Port-wine stain

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Capillary hemangioma(small,bld.-filled capillaries lined w/ a single layer of endothelium)w/c manifest as bright-red raised lesion

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Strawberry hemangioma

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Capillary hemangioma(small,bld.-filled capillaries lined w/ a single layer of endothelium)w/c manifest as a small, dome-shaped red papule

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Cherry hemangioma

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Port-wine stain of the face,ipsilateral glaucoma,vascular lesions of the ocular choroid tissue,& extensive hemangiomatous involvement of meninges; manifest as convulsions,mental retardation,& retinal detachment

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Sturge-Weber synd.