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73 Cards in this Set

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This could show what infections?

This could show what infections?

Herpes zoster/Varicella
Herpes simplex
60-yo man c/o pruritic popular eruption involving chest and back.  Best dx is?
60-yo man c/o pruritic popular eruption involving chest and back. Best dx is?
Grover's disease (focal acantholytic disease)
Often associated w/ heat, sweating, sunlight exposure.
Grover's disease (focal acantholytic disease)
Often associated w/ heat, sweating, sunlight exposure.
Skin bx showing papillary dermal edema and dense interstitial infiltrate of neutrophils involving the upper half of the reticular dermis.  Best dx?
Often associated w/ what malignancy?
Skin bx showing papillary dermal edema and dense interstitial infiltrate of neutrophils involving the upper half of the reticular dermis. Best dx?
Often associated w/ what malignancy?
Sweet's syndrome
Abrupt onset of tender or painful erythematous plaques and nodules on the face and extremities and less commonly on the trunk, in association with fever (usually), malaise and a neutrophil leukocytosis.
AML Acute myeloid leukemia
Sweet's syndrome
Abrupt onset of tender or painful erythematous plaques and nodules on the face and extremities and less commonly on the trunk, in association with fever (usually), malaise and a neutrophil leukocytosis.
AML Acute myeloid leukemia
Bx specimen showing discontinuity of parakeratosis sparing adnexal structures, dense dermal elastosis.
Bx specimen showing discontinuity of parakeratosis sparing adnexal structures, dense dermal elastosis.
Actinic keratosis/Solar keratosis
Actinic keratosis/Solar keratosis
Basal cell carcinoma.  What is this subtype?
Basal cell carcinoma. What is this subtype?
Fibroepithelioma of Pinkus type
2 cm white "scar-like" plaque on left side of nose extending onto the cheek.  No hx of prior injury or previous surgical procedure at site.  Best interpretration?
2 cm white "scar-like" plaque on left side of nose extending onto the cheek. No hx of prior injury or previous surgical procedure at site. Best interpretration?
Sclerosing or morpheaform BC
Sclerosing or morpheaform BCC
45-yo woman c/o painful subcutaneous nodules on both legs of 4 wks duration.  Lesions are not ulcerated.  Image shows inflammation within septae between fat lobules.  Dx?
45-yo woman c/o painful subcutaneous nodules on both legs of 4 wks duration. Lesions are not ulcerated. Image shows inflammation within septae between fat lobules. Dx?
erythema nodosum
May be associated with streptococcus infexn, TB, sarcoidosis, coccidioidomycosis, UC, Behcet’s disease, drug rxns or idiopathic; also Hodgkin lymphoma, RCC and carcinomas of colon, pancreas and uterine cervix
erythema nodosum
May be associated with streptococcus infexn, TB, sarcoidosis, coccidioidomycosis, UC, Behcet’s disease, drug rxns or idiopathic; also Hodgkin lymphoma, RCC and carcinomas of colon, pancreas and uterine cervix
83-yo man c/o generalized rash characterized by oval erythematous asxmatic patches over entire torso.  eruption had waxed and waned over 10 yrs.  Best dx?
83-yo man c/o generalized rash characterized by oval erythematous asxmatic patches over entire torso. Eruption had waxed and waned over 10 yrs. Best dx?
Cutaneous T-cell lymphoma (mycosis fungoides)
Most common primary cutaneous T cell lymphoma.
By definition, are negative for HIV1, HIV2, HTLV.
Aytpical lymphocytes w/ cerebriform nuclei, Pautrier's microabscesses
Cutaneous T-cell lymphoma (mycosis fungoides)
Most common primary cutaneous T cell lymphoma.
By definition, are negative for HIV1, HIV2, HTLV.
Aytpical lymphocytes w/ cerebriform nuclei, Pautrier's microabscesses
46-yo diabetic developed multiple papulonodules of the arms and legs that clinically were thought to be mulluscum contagiosum.  Bx demonstrated invagination of epidermal lined by epithelium w/ strands of eosinophilic material w/in epithelium.  Dx?
46-yo diabetic developed multiple papulonodules of the arms and legs that clinically were thought to be molluscum contagiosum. Bx demonstrated invagination of epidermal lined by epithelium w/ strands of eosinophilic material w/in epithelium. Dx?
Reactive perforating collagenosis
Occurs in setting of diabetes and chronic renal disease especially in patients on dialysis.
Reactive perforating collagenosis
Occurs in setting of diabetes and chronic renal disease especially in patients on dialysis.
6-yo boy presented w/ 0.8 cm red nodule of forearm that had appeared 4 months ago.  Dx?
6-yo boy presented w/ 0.8 cm red nodule of forearm that had appeared 4 months ago. Dx?
Spitz nevus
Symmetric  well-circumscribed melanocytic proliferation arising in the epidermis and extending into dermis.  Maturation present.
Spitz nevus
Symmetric well-circumscribed melanocytic proliferation arising in the epidermis and extending into dermis. Maturation present.
What is this called?
What is this called?
Lentigo maligna (in situ melanoma w/ solar elastosis)
Lentigo maligna (in situ melanoma w/ solar elastosis)
What is this? 
What is it seen in?
What is this?
What is it seen in?
Spongiosis 
Seen in eczematous dermatoses:  contact dermatitis, nummular dermatitis, photoallergic dermatitis, atopic dermatitis
Spongiosis
Seen in eczematous dermatoses: contact dermatitis, nummular dermatitis, photoallergic dermatitis, atopic dermatitis
15-yo boy p/w asxmatic papulonodules on the dorsum of the hands, histologically characterized by foci of mucin deposition surrounded by a palisading arrangement of histiocytes.  dx?
15-yo boy p/w asxmatic papulonodules on the dorsum of the hands, histologically characterized by foci of mucin deposition surrounded by a palisading arrangement of histiocytes. dx?
Granuloma annulare
Associated with morphea, chronic HCV infection, autoimmune thyroiditis, 2ndary hyperparathyroidism, Plummer’s dx, MDS metastatic carcinoma.
Granuloma annulare
Associated with morphea, chronic HCV infection, autoimmune thyroiditis, 2ndary hyperparathyroidism, Plummer’s dx, MDS metastatic carcinoma.
25-yo male p/w generalized eruption clinically resembling a drug eruption of 1 week's duration.  It was asxmatic.  Bx shows lymphocytes and plasma cells.  dx?
25-yo male p/w generalized eruption clinically resembling a drug eruption of 1 week's duration. It was asxmatic. Bx shows lymphocytes and plasma cells. dx?
2ndary syphilis 
Characterized by plasma cells in the inflammatory infiltrate.
2ndary syphilis
Characterized by plasma cells in the inflammatory infiltrate.
Rough, slightly tender lesion of the forehead present for months.  dx?
Rough, slightly tender lesion of the forehead present for months. dx?
Seborrheic keratosis
Epidermal proliferation, horn pseudocysts (called "pseudo" b/c they connect to surface and represent papillomatosis), sharp demarcation "string sign" of base of epidermal proliferation.
Seborrheic keratosis
Epidermal proliferation, horn pseudocysts (called "pseudo" b/c they connect to surface and represent papillomatosis), sharp demarcation "string sign" of base of epidermal proliferation.
57 year old Japanese man with facial plaque slowly enlarging for at least 5 years.  Dx?
57 year old Japanese man with facial plaque slowly enlarging for at least 5 years. Dx?
Microcystic adnexal carcinoma
Hyalinized stroma, basaloid strands.
Perineural invasion common.
Microcystic adnexal carcinoma
Hyalinized stroma, basaloid strands.
Perineural invasion common.
72-yo woman w/ enlarging brown macule on left first toe.  Dx?
72-yo woman w/ enlarging brown macule on left first toe. Dx?
Acral lentiginous melanoma
Acral lentiginous melanoma
60-yo man noted sudden appearance of a 1-cm nodule on the back of the neck that was friable and bled easily.  Dx?
60-yo man noted sudden appearance of a 1-cm nodule on the back of the neck that was friable and bled easily. Dx?
Pyogenic granuloma
Pyogenic granuloma
35-yo HIV+ man p/w 1 cm non-tender asxmatic brown intracutaneous nodule on the calf.  What is the dx?
35-yo HIV+ man p/w 1 cm non-tender asxmatic brown intracutaneous nodule on the calf. What is the dx?
Dermatofibroma
Limited infiltration into subcutaneous tissues. 
Collagen trapping, Grenz zone in superficial dermis. 
F13A+
CD163+
CD68+ (early lesions)
CD34- (differentiates it from DFSP F13A-, CD34+)
CD34 may be + in cellular type
Dermatofibroma
Limited infiltration into subcutaneous tissues.
Collagen trapping, Grenz zone in superficial dermis.
F13A+
CD163+
CD68+ (early lesions)
CD34- (differentiates it from DFSP F13A-, CD34+)
CD34 may be + in cellular type
30-yo woman had a "mole removed from her chest.  Surgical site healed with a flat white mark in the center of which was a blue-black macule.  The site was re-excised and the specimen shown.  Dx?
30-yo woman had a "mole removed from her chest. Surgical site healed with a flat white mark in the center of which was a blue-black macule. The site was re-excised and the specimen shown. Dx?
Recurrent (persistent) nevus
45-yo man w/ slowly enlarging nodule of skin of the right thigh.  Lesion was raised above surface and measured 3 cm in diameter.  What immunostain is most likely +?
45-yo man w/ slowly enlarging nodule of skin of the right thigh. Lesion was raised above surface and measured 3 cm in diameter. What immunostain is most likely +?
CD34+ for Dermatofibrosarcom Protuberans DSFP
Residual fat cells are in linear arrangement resembling a string of pearls, 
 which is characteristic of DFSP but not benign fibrous histiocytoma.
CD34+ for Dermatofibrosarcoma Protuberans DSFP
Residual fat cells are in linear arrangement resembling a string of pearls,
which is characteristic of DFSP but not benign fibrous histiocytoma.
Storiform pattern
30-yo man developed a raised firm to rubbery nodule of the perianal-buttock area.  Lesion measured 1.5 cm in diameter.  Dx?
30-yo man developed a raised firm to rubbery nodule of the perianal-buttock area. Lesion measured 1.5 cm in diameter. Dx?
Granular cell tumor
Granular cell tumor
45-yo man with painful ulcerated lesion of the pinna of right ear.  Dx?
45-yo man with painful ulcerated lesion of the pinna of right ear. Dx?
Chondrodermatitis nodularis chronica helicis
Hyperplasia of epidermis often w/ focal ulceration. Granulation tissue, fibrosis, solar elastosis, and mixed inflammatory infiltrate (lymphs, neuts, plasma cells) between ulcer and underlying cartilage...
Chondrodermatitis nodularis chronica helicis
Hyperplasia of epidermis often w/ focal ulceration. Granulation tissue, fibrosis, solar elastosis, and mixed inflammatory infiltrate (lymphs, neuts, plasma cells) between ulcer and underlying cartilage.
Degeneration of cartilage.
45-yo man w/ multiple nodules of forehead and scalp that appeared at puberty and have been asxmatic.  Dx? 
Syndrome?
Genetics?
45-yo man w/ multiple nodules of forehead and scalp that appeared at puberty and have been asxmatic. Dx?
Syndrome?
Genetics?
Cylindroma
Hyalinized cylinders surrounding lobules of cells.  Hyalinized droplets w/in the tumor.
turban tumor syndrome, Brooke-Spiegler syndrome
AD, mutations in CYLD gene at chromosome 16q12-13
Cylindroma
Hyalinized cylinders surrounding lobules of cells. Hyalinized droplets w/in the tumor.
turban tumor syndrome, Brooke-Spiegler syndrome
AD, mutations in CYLD gene at chromosome 16q12-13
2-yo boy p/w well-circumscribed yellow nodule of the scalp which was itchy but otherwise asxmatic.  Dx?
2-yo boy p/w well-circumscribed yellow nodule of the scalp which was itchy but otherwise asxmatic. Dx?
Juvenile xanthogranuloma
monotonous CD68+ histiocytic cells
Juvenile xanthogranuloma
monotonous CD68+ histiocytic cells
6-yo boy w/ nodular lesion of the left cheek.  Bx was described as showing aggregates of basaloid cells in association w/ granulomatous inflammation.  Dx?
6-yo boy w/ nodular lesion of the left cheek. Bx was described as showing aggregates of basaloid cells in association w/ granulomatous inflammation. Dx?
Pilomatricoma
● Solid nests of basaloid cells undergoing abrupt trichilemmal-type keratinization
 ● Ghost cells, often foreign body reaction, calcification or ossification with extramedullary hematopoiesis
Pilomatricoma
● Solid nests of basaloid cells undergoing abrupt trichilemmal-type keratinization
● Ghost cells, often foreign body reaction, calcification or ossification with extramedullary hematopoiesis
40-yo woman presented w/ 5 mm flesh-colored papule of the right nasolabial fold.
40-yo woman presented w/ 5 mm flesh-colored papule of the right nasolabial fold.
Trichoepithelioma
No artifactual retraction between tumor and stroma as in BCC.  Can look similar to trichilemmoma as well.  Trichilemmoma is characterized by downward proliferation of pale-staining (glycogen-containing) keratinocytes.
Trichoepithelioma
No artifactual retraction between tumor and stroma as in BCC. Can look similar to trichilemmoma as well. Trichilemmoma is characterized by downward proliferation of pale-staining (glycogen-containing) keratinocytes.
Papillary mesenchymal bodies seen in this lesion.
The dx of erythema chronicum migrans (cutaneous manifestation of Lyme dz is made by ?
Clinical features, serologic studies, and a cutaneous bx excluding other conditions.
Name the 2 most important prognostic histologic findings in a bx specimen of melanoma.

Tumor thickness (Breslow measurement)
Presence or absence of ulceration

In what conditions can you see necrotic keratinocytes?

In what conditions can you see necrotic keratinocytes?

Erythema multiforme (picture on other side)
Fixed drug reaction
Phototoxic reaction
Graft vs. host disease (pictured above)

Erythema multiforme (picture on other side)
Fixed drug reaction
Phototoxic reaction
Graft vs. host disease (pictured above)

Subepidermal blister with neutrophils.  What is on the differential?
Subepidermal blister with neutrophils. What is on the differential?
Bullous lupus erythematosus
Dermatitis herpetiformis
Bullous pemphigoid
IgA bullous dermatosis
Patient w/ photodermatitis on hands and face.
Patient w/ photodermatitis on hands and face.
Porphyria cutanea tarda
most common type of porphyria:  uroporphyrin decarboxylase deficieny
Porphyria cutanea tarda
most common type of porphyria: uroporphyrin decarboxylase deficieny
Describe 3 histologic features of the lesion shown.
Describe 3 histologic features of the lesion shown.
psoriasis vulgaris
Parakeratosis
Neutrophils in parakeratotic layer (Munro's microabscesses)
Loss of granular layer
Psoriasis vulgaris
Confluent parakeratosis
Neutrophils in parakeratotic layer (Munro's microabscesses)
Loss of granular layer
What histologic features are associated w/ lichen planus?
Compact hyperorthokeratosis (usually no parakeratosis)
Hypergranulosis
Liquefaction degeneration (necrotic keratinocytes in the basal layer)
Saw-tooth rete ridges
Lichenoid lymphocytic infiltrate

Compact orthokeratosis (usually no parakeratosis)
Hypergranulosis
Liquefaction degeneration
Civatte bodies: Necrotic keratinocytes in the basal layer
Saw-tooth rete ridges
Lichenoid lymphocytic infiltrate

1.  Affected target antigen in this lesion is?
2.  What malignancies can be associated w/ these lesions?
1. Affected target antigen in this lesion is?
2. What malignancies can be associated w/ these lesions?
1.  Desmoglein 3 - Pemphigus vulgaris
IgG autoantibody
DIF:  chicken-wire pattern of IgG and C3 in intercellular spaces
2.  Paraneoplastic pemphigus: lymphoma, thymoma, SCC, carcinoma of bronchus, pancreas and breast

1. Desmoglein 3 - Pemphigus vulgaris
IgG autoantibody
DIF: chicken-wire pattern of IgG and C3 in intercellular spaces
2. Paraneoplastic pemphigus: lymphoma, thymoma, SCC, carcinoma of bronchus, pancreas and breast

What is this disease? 
What does DIF show?
What is this disease?
What does DIF show?
Hailey-Hailey disease (Benign familial pemphigus)
AD, deficiency of desmoplakin and plakoglobin
"dilapidated brick wall"
DIF is negative
Hailey-Hailey disease (Benign familial pemphigus)
AD, deficiency of desmoplakin and plakoglobin
"dilapidated brick wall"
DIF is negative
Leukocytoclastic vasculitis presents clinically as?
Painful, palpable purpura
Vasculitis w/ neutrophils, eos, lymphocytes, or histiocytes. 
Nuclear dust
Extravasated RBCs
Thrombi sometimes
Painful, palpable purpura
Vasculitis w/ neutrophils, eos, lymphocytes, or histiocytes.
Nuclear dust
Extravasated RBCs
Thrombi sometimes
The following neoplasm is positive for P63 & CD10 and negative for wide spectrum cytokeratin, CK 5/6, SMA and S100.
Spindle cell carcinoma
Also called metaplastic carcinoma
● Tumor is contiguous with basal layer of epidermis
● Usually at least focal SCC
Tend to lose epithelial markers; thus, include at least two epithelial markers (P63 and CK 5/6). Also, these tumors as any other cutaneous malignant spindle tumors may express CD10.
The pictured neoplasm can present in eruptive fashion in which genetic condition?
The pictured neoplasm can present in eruptive fashion in which genetic condition?
Down Syndrome
Syringoma
Proliferation of eccrine ductal structures in the dermis. "Tadpole-shaped" when sectioned at angle.
What immunostain has distinctive staining?
What immunostain has distinctive staining?
CK20 perinuclear dot-like staining
Merkel cell tumor
EMA+
NSE+ 
CD56+
CK20 perinuclear dot-like staining
Merkel cell tumor
EMA+
NSE+
CD56+
A 65-year-old woman presents with a large multinodular lesion on her scalp.
A 65-year-old woman presents with a large multinodular lesion on her scalp.
Proliferating trichilemmal cyst
Lobular intradermal proliferation of squamous cells, which may simulate a SCC, but has individual lobules with a characteristically sharply defined and regular non-infiltrative border.
The pictured neoplasm was biopsied out of clinical suspicion for non-melanoma skin cancer. Dx?
The pictured neoplasm was biopsied out of clinical suspicion for non-melanoma skin cancer. Dx?
Clear cell acanthoma
Zone of irregular psoriasiform epidermal hyperplasia, composed of cells with pale cytoplasm, with a very sharp demarcation from the normal epidermis
A 56-year-old man presents with a lesion on his forehead.
A 56-year-old man presents with a lesion on his forehead.
Desmoplastic trichilemmoma
Rare variant of trichilemmoma arising from the outer root sheath or infundibular epithelium. Shows typical areas of conventional trichilemmoma, especially at the periphery of the lesion. In the center of the lesion, there are narrow irregular cords of smaller epithelial cells admixed with a dense hyalinized hypocellular stroma.
This 36-year-old man has pruritic papules and vesicles of the elbows and shoulders.  Punch biopsy is performed (see image) and direct immunofluorescence (DIF) reveals granular deposition of IgA along the epidermal basement membrane.  The other fin...
This 36-year-old man has pruritic papules and vesicles of the elbows and shoulders. Punch biopsy is performed (see image) and direct immunofluorescence (DIF) reveals granular deposition of IgA in the papillary dermal tips. The other finding most likely to be present in this patient is
gluten sensitivity
Dermatitis herpetiformis
HLA-B8
HLA-DR3
HLA-DQw2
Common diagnostic feature of ?
Common diagnostic feature of ?
Cryoglobulinemia types 2 and 3
Leukocytoclastic vasculitis associated w/ drugs, infections or rheumatologic d/o
What is this tumor?  What syndrome can it be associated w/?
What is this tumor? What syndrome can it be associated w/?
sclerotic fibroma (storiform collagenoma, plywood fibroma)
Can present in Cowden's syndrome.
Tumor is well-circumscribed & unencapsulated hypocellular dermal nodule. Composed of thickened & hyalinized collagen bundles arranged in a laminated fashion with intervening clefts (focal storiform pattern may be present).
What is pseudoxanthoma elasticum?
What is pseudoxanthoma elasticum?
Pseudoxanthoma elasticum is an inherited elastic tissue disorder due gene defect on chrom 16 w/ grouped, pseudoxanthomatous yellowish papules in flexural areas.   
Calcification of elastic fibers occurs, leading to laxity of the skin and vessel w...
Pseudoxanthoma elasticum is an inherited elastic tissue disorder due gene defect on chrom 16 w/ grouped, pseudoxanthomatous yellowish papules in flexural areas.
Calcification of elastic fibers occurs, leading to laxity of the skin and vessel wall changes that lead to HTN, cerebrovascular accidents, and GI hemorrhage.
A 22-year-old man presents with a subcutaneous nodule on the dorsal aspect of the distal arm.  A punch biopsy is performed, which shows a deep lesion composed of EMA positive spindled to epithelioid cells arranged in palisaded configuration around...
A 22-year-old man presents with a subcutaneous nodule on the dorsal aspect of the distal arm. A punch biopsy is performed, which shows a deep lesion composed of EMA positive spindled to epithelioid cells arranged in palisaded configuration around central zones of necrotic material. What stain would be most diagnostically specific?
Loss of INI1 indicating epithelioid sarcoma
Differential includes epithelioid sarcoma, infectious granuloma, granuloma annulare, or rheumatoid nodule.
A 59-year-old woman presents to the dermatology clinic complaining of extensive tender purpuric lesions on thighs and buttocks.  What is this?  What is it associated w/?
A 59-year-old woman presents to the dermatology clinic complaining of extensive tender purpuric lesions on thighs and buttocks. What is this? What is it associated w/?
Calciphylaxis
Rare dermatosis associated w/ calcification of small- & medium-sized vessels resulting in ischemic necrosis of the skin. Characterized by exquisitely tender purpuric lesions, most often on medial thighs or buttocks. Calciphylaxis most often affects pts w/ end-stage renal disease (ESRD) undergoing hemodialysis or peritoneal dialysis & patients with kidney transplantation. Histologically, there is calcification of small vessels in deep dermis and subcutaneous tissue.
A 17-year-old man presents with an isolated pustular lesion on his arm. The biopsy shows a subepidermal blister with many eosinophils. What is the most likely dx?
Bullous arthropod bite reaction
A 35-year-old woman presents to the clinic with multiple ulcerated papules on the trunk and limbs, some of which have regressed per the patient.  A biopsy was taken and shows a wedge-shaped mixed cellular dermal infiltrate which includes a variabl...
A 35-year-old woman presents to the clinic with multiple ulcerated papules on the trunk and limbs, some of which have regressed per the patient. A biopsy was taken and shows a wedge-shaped mixed cellular dermal infiltrate which includes a variable number of large atypical lymphocytes admixed with eosinophils, histiocytes and rare plasma cells. What marker is + in the atypical lymphocytes?
CD30
Lymphomatoid papulomatosis
Indolent clinical course, although 10% are associated with or evolve to anaplastic large cell lymphoma
A localized tumor of the skin is biopsied.  The tumor depicted in the image is positive for CD20, BCL-2, BCL-6, MUM-1 and negative for CD3 and CD5 and BCl-1.  What is the classic clinical setting of the neoplasm represented in this question?
A localized tumor of the skin is biopsied. The tumor depicted in the image is positive for CD20, BCL-2, BCL-6, MUM-1 and negative for CD3 and CD5 and BCl-1. What is the classic clinical setting of the neoplasm represented in this question?
Older women on the leg
Primary cutaneous diffuse large B-cell lymphoma, leg-type (PCDLBCL-LT).
PCDLBCL-LT is characterized by a predilection for the leg (72%), for women, an advanced age at onset (mean age 76 years), frequent relapses and extracutaneous dissemination.
Any PCDLBL-LT with bcl-2+ and MUM-1+ is designated as such regardless of anatomic location
How should mitoses in melanoma be reported?
Dermal mitoses/square mm
In a patient with multiple cutaneous lesions, similar to that depicted in the image, and confirmed deletion mutations in DNA mismatch repair protein MSH2, what is the most important clinical follow-up in addition to a complete clinical dermatology...
In a patient with multiple cutaneous lesions, similar to that depicted in the image, and confirmed deletion mutations in DNA mismatch repair protein MSH2, what is the most important clinical follow-up in addition to a complete clinical dermatology exam?
GI endoscopy
Muir-Torre syndrome
Clinical variant of Lynch syndrome
● Rare AD d/o with < 100 adenomas, usually in proximal colon
● Multiple colorectal tumors associated w/ multiple sebaceous tumors (mostly cystic tumors, including carcinomas), keratoacanthomas and BCC
● Rare case reports of HCC in non-cirrhotic background
● 15% of women develop endometrial cancer
Bx was taken from the lip of a 46-year-old man.  In which syndrome can you see similar lesions?
Bx was taken from the lip of a 46-year-old man. In which syndrome can you see similar lesions?
Verruciform Xanthoma.  
Can be seen in CHILD (congenital hemidysplasia with ichthyosiform erythroderma and limb defects) syndrome.
Verruciform Xanthoma.
Can be seen in CHILD (congenital hemidysplasia with ichthyosiform erythroderma and limb defects) syndrome.
The following lesion is found in a patient with tuberous sclerosis.
The following lesion is found in a patient with tuberous sclerosis.
Angiofibroma/adenoma sebaceum
Angiofibroma/adenoma sebaceum
Associated w/ vacuolar to lichenoid interface pattern
Lupus erythematosus
Dermatomyositis
Acute GVHD
Erythema multiforme
Paraneoplastic pemphigus does not exhibit this histologic reaction pattern.
Psoriasis-like
Desmoplastic melanoma is most commonly associated w/?
What is the most reliable immunstain for desmoplastic melanoma?
lentigo maligna
S100
Kamino bodies are seen most commonly in what lesions?
Spindle and epithelioid cell nevus
Patient w/ large tense blisters on flexor surfaces, trunk, intertriginous regions and mucosa.  DIF staining with IgG (and C3) as above. dx? 
Target for antibodies?
Patient w/ large tense blisters on flexor surfaces, trunk, intertriginous regions and mucosa. DIF staining with IgG (and C3) as above. dx?
Target for antibodies?
Bullous pemphigoid
Chronic autoimmune blistering disease. 
BP-Ag1:  230 kD protein, Desmoplakin I/II
BP-Ag2:  180 kD polypeptide transmembranous glycoprotein, type XVII collagen
Bullous pemphigoid
Chronic autoimmune blistering disease.
BP-Ag1: 230 kD protein, Desmoplakin I/II
BP-Ag2: 180 kD polypeptide transmembranous glycoprotein, type XVII collagen
Differentiate between EIC and trichilemmal cyst (pilar cyst)
Epidermal inclusion cyst has a granular layer and
"dry" keratin.
Trichilemmal cyst has no granular layer and "wet" or compact keratin.
Patient w/ clinically indurated skin

Patient w/ clinically indurated skin

Scleroderma (morphea)


Dermal collagen markedly thickened and tightly packed, epithelial adnexa obliterated, mucin absent, superficial and deep lymphoplasmacytic perivascular infiltrate

This condition results from?

This condition results from?

Chronic trauma. Lichen simplex chronicus


Thickened epidermis and papillary dermis, pruritus frequently present. Irregular acanthosis, hyperkeratosis w/ focal parakeratosis and hypergranulosis, vertically oriented collagen bundles, superficial lymphocytic infiltrate

The age of this patient is most likely?

The age of this patient is most likely?

Under 10


Bullous urticarial pigmentosa (mastocytosis)


rare subepidermal vesiculobullous dz

What is this?

What is this?

Promontory sign of Kaposi's sarcoma: adnexal structures and preexisting vessels protruding into newly-formed vessels


flat monomorphous cells lining vascular spaces, hyaline globules

Patient who developed verrucous nodule on foot after wading through an irrigation canal. Dx?

Atypical Mycobacterium marinum


swimming pool granuloma

Coccidioidomycosis

Erythema multiforme


vacuolar alteration, keratinocyte necrosis, sparse lymphocytic infiltrate

eruptive xanthoma


associated w/ hypertriglyceridemia

HIV patient w/ widespread subcorneal pustules.  Cx identified?

HIV patient w/ widespread subcorneal pustules. Cx identified?

Staphylococci or streptococci


Bullous impetigo

Keratoacanthoma: may be multiple, characterized by striking nuclear atypia, usually regress w/ fibrosis and rarely metastasize.

Congenital melanocytic nevus


Hamartoma involving other tissue types