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YR5 Histopathology > Skin > Flashcards

Skin Flashcards

1
Q

Describe the normal layers of the epidermis from top to bottom

A

Stratum CORNEUM
Stratum LUCIDUM
Stratum GRANULOSUM
Stratum SPINOSUM
Stratum BASALE

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2
Q

What nmeumonic can be used to remember the layers of the epidermis in order?

A

Come
Lets
Get
Some
Beers

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3
Q

What lies at the bottom and below the epithelium?

A

Basement membrane
Dermis
Subcutaneous tissue: connective tissue, fat, vessels

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4
Q

What happens to the epidermis and collagen in the subcutaneous tissue with age?

A

Epidermis: thins
Collagen + elastic fibres: weaken

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5
Q

What lies within the dermis?

A

Blood vessels
Sweat glands
Hair follicles
Sebaceous glands
Nerve fibres

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6
Q

Give examples of why location of skin is important

A

Face: more sebaceous glands
Palmar-plantar: no sebaceous glands, very thick corneal layer

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7
Q

What 4 patterns of inflammation can occur in the epidermis?

A

Spongiotic
Lichenoid
Psoriasiform
Vesiculobullous

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8
Q

What 2 patterns of inflammation can occur in the dermis?

A

Vasculitic
Granulomatous e.g. Sarcoid

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9
Q

What pattern of inflammation can occur in the sub cutis?

A

Panniculitis e.g. erythema nodosum

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10
Q

Define hyperkeratosis

A

Thickening of stratum CORNEUM

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11
Q

Define parakeratosis

A

Abnormal retention of keratinocyte nuclei in stratum corneum

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12
Q

Define Acanthosis

A

Thickening of stratum SPINOSUM

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13
Q

Define Acantholysis

A

Separation of keratinocytes in epidermis due to loss of adhesion between them

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14
Q

Define Spongiosis

A

Widening of INTERcellular spaces between keratinocytes due to INTERcellular oedema

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15
Q

Define Lentiginous

A

Linear pattern of melanocyte proliferation within epidermal basal cell layer
Reactive or neoplastic

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16
Q

Define Lichenoid

A

Sheeny plaque appearance on surface of skin

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17
Q

Define Psoriaform

A

Thickened skin

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18
Q

Give an example of a spongiotic reaction

A

Eczema

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19
Q

List 6 types of eczema

A

Atopic dermatitis: IgE mediated
Contact dermatitis: Type IV hypersensitivity
Dyshidrotic eczema
Nummular eczema
Seborrheic dermatitis
Statis dermatitis

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20
Q

What histological features characterise eczema?

A

Spongiosis: fluid collection in dermis
Eosinophil infiltrate in dermis
Dilated dermal capillaries

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21
Q

What is eczema/. dermatitis?

A

Interchangeable terms to describe disorders with same histology with inflamed, dry, itchy rashes

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22
Q

Give an example of Lichenoid inflammation

A

Lichen Planus

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23
Q

Describe the pathophysiology of Lichen Planus

A

T lymphocytes destroy basement membrane
Creates band-like inflammation
Cannot see where dermis finishes + epidermis starts

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24
Q

Give 2 signs of Lichen Planus

A

Shiny, purple, itchy papules + plaques on wrists + arms
White lacy lines in mouth= Wickham striae

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25
Q

What are the 6ps of lichen planus?

A

Purple
Polygonal
Plaques
Papules
Pruritic
Planar

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26
Q

In which group of diseases is there a slightly lichenoid pattern of inflammation?

A

Erythema multiforme
Steven Johnson’s syndrome
Toxic epidermal necrolysis

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27
Q

Describe the presentation of erythema multiforme

A

Annular target lesions classically on extensor surface of hands + feet
Pleomorphic lesions; combination of macules, papules, urticarial wheals, vesicles, bullae + petechiae

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28
Q

Name 2 infectious causes of erythema multiforme

A

HSV
Mycoplasma

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29
Q

Name 5 drugs that can cause erythema multiforme. What mnemonic can be used to remember these?

A

SNAPP
Sulphonamides
NSAIDs
Allopurinol
Penicillin
Phenytoin

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30
Q

What occurs in SJS/TEN?

A

Derm emergency
Sheets of skin detachment
Nikolsky sign +ve: slight rubbing causes shearing of skin
Mucosal involvement prominent

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31
Q

Give an example of a psoriaform reaction

A

Psoriasis

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32
Q

Describe the pathophysiology of plaque psoriasis

A

Rapid turnover: thicker epidermis
Layer of PARAKERATOSIS forms at top
Stratum granulosum disappears as not enough time to form it + dilated vessels form
MUNRO’s MICROABSCESSES form, from recruitment of neutrophils

33
Q

What is psoriasis?

A

Chronic inflammatory dermatosis with erythematous, well-dermarcated scaly plaques
Bi-modal distribution 15-25 + 50-60

34
Q

Describe the pathophysiology of psoriasis

A
  1. Type IV T cell hypersensitivity reaction in epidermis
  2. Further T cell recruitment
  3. Release of pro-inflammatory cytokines
  4. Keratinocyte hyper proliferation
  5. Epidermal thickening
35
Q

List the 5 types of psoriasis

A

Chronic plaque
Flexural
Guttate
Erthrodermic/ pustular
Koebner phenomenon

36
Q

Describe chronic plaque psoriasis

A

Salmon pink plaques + silver scales
Affects extensor aspects of knees, elbows + scalp

37
Q

Psoriasis is associated with which 3 nail changes?

A

POSH
Pitting
Onycholysis
Subungual Hyperkeratosis

38
Q

Psoriasis is associated with which 4 forms of arthritis?

A

DIP disease
Arthritis mutilans “telescoping”
Spondylopathy
Symmetrical polyarthritis

39
Q

Name 3 AI vesiculobollous patterns of inflammation

A

Bullous pemphigoid
Pemphigoid vulgaris
Pemphigoid folliaceus

40
Q

Give 4 facts about presentation of bullous pemphigoid

A

Large tense bullae on erythematous base
Often flexural surfaces
ELDERLY
Bullae don’t rupture as easily as pemphigus

41
Q

Describe the pathophysiology of bullous pemphigoid

A
  1. IgG + C3 bind to hemidesmosomes of basement membrane
  2. Eosinophils recruited to release elastase
  3. Epidermis lifts off + fluid accumulates in space
42
Q

What bullae are seen in bullous pemphigoid and pemphigus vulgaris?

A

BP: SUBepidermial bulla
PV: INTRAepidermal bulla

43
Q

Give 3 facts about presentation of pemphigus vulgaris

A

Flaccid blisters, rupture easily- raw red surface
Found on skin + mucosal membranes
Nikolsky’s sign +ve

44
Q

Describe the pathophysiology of pemphigus vulgaris

A

IgG bind to desmoglein 1+3 BETWEEN keratinocytes in stratum Spinosum- loss of intracellular connections- Acantholysis

45
Q

What is seen on immunofluorescence in bullous pemphigoid and pemphigus vagaries?

A

BP: Linear deposit of IgG at dermal-epidermal junction
PV: Intercellular deposits of IgG “Chicken wire” pattern

46
Q

How does pemphigus foliaceus differ to pemphigus vulgaris?

A

PF: Superficial
PV: Deeper in epidermis

47
Q

Aetiology of seborrhoeic keratoses

A

Skin ageing

48
Q

5 features of seborrhoeic keratoses

A
  1. Flat/ raised papule/plaque. “Stuck on”
  2. mm-cm’s diameter
  3. Skin coloured, yellow, grey, brown, black or mixed
  4. Smooth, waxy or warty surface
  5. Solitary or grouped
49
Q

Describe the histology of seborrhoeic keratoses

A

Keratin horns in epidermis
Ordered benign proliferation

50
Q

What is this?

A

Sebhorrhoeic keratosis

51
Q

What is the correct term for sebaceous cyst?

A

Epidermoid cyst
(originate from epidermis, don’t contain sebum)

52
Q

Give 4 features of epidermoid cysts

A
  1. Firm, fleshy/ yellowish papule/ nodule fixed to skin surface but typically mobile over deeper layers
  2. Diameter 1–3 cm
  3. A central punctum
  4. Foul-smelling cheesy debris can be expressed from central punctum.
53
Q

What is this?

A

Epidermoid cyst

54
Q

Most common skin cancer

A

BCC

55
Q

3 characteristics of BCC

A

Slow growing
Locally invasive
Rarely metastasise

56
Q

4 characteristics of appearance of BCC

A

Pearly white/ pink papule-nodule or firm plaque
Rolled edge
Shiny
Associated telangiectasias

57
Q

What are BCCs also known as?

A

“Rodent ulcers”
Locally destructive

58
Q

Describe the histology of BCCs

A

Mass of basal cells pushing down into dermis
Palisading (nuclei align in outermost layer)

59
Q

What is this?

A

Basal cell carcinoma

60
Q

Cells involved in BCC

A

Cells in epidermis + follicular epithelium

61
Q

Cells involved in SCC

A

Keratinocytes

62
Q

2nd most common skin cancer

A

SCC

63
Q

List 4 characteristics of SCC

A
  1. Non-healing ulcerated lesion with hard, raised edges.
  2. Slow-growing ulcer or reddish skin plaque.
  3. May bleed
  4. Metastatic potential
64
Q

Growth rate of SCC and BCC

A

SCC develop + grow over 3-6 months
BCC are slower

65
Q

Describe the histology in SCCs

A

Atypia/dysplasia throughout epidermis
Nuclear crowding + spreading through basement membrane into dermis

66
Q

What are Actinic Keratoses?

A

Dry, rough, adherent scaly lesions
Pink/ skin coloured/ red
Non-malignant (low risk transformation to SCC)
AKA Solar keratoses

67
Q

Describe the histology of Actinic Keratosis

A

SPAIN
Solar elastosis
Parakeratosis
Atypical cells
Inflammation
Not full thickness

68
Q

What is Bowens disease?

A

Red scaly patches
Intraepidermal (in situ SCC)
Arises in outer layers of epidermis
Pre-cancerous: 3% risk of progression to invasive SCC

69
Q

Describe the histology in Bowens disease

A

Full thickness atypia/ dysplasia
Basement membrane intact: i.e. not invading the dermis

70
Q

HPV is a risk factor for which skin carcinoma

A

SCC

71
Q

Name a benign lesion originating from melanocytes

A

Melanocytic naevi (moles)
Junctional, compound or intradermal

72
Q

What is this?

A

SCC

73
Q

Describe the 3 types of benign naevus

A

Junctional: melanocytes in epidermis. Flat + coloured
Compound: melanocytes in epidermis + dermis. Raised + surrounded by flat patch
Intradermal: melaoncytes in dermis. Raised with pedunculated/ smooth surface.

74
Q

5 signs of malignant melanoma

A

A; asymmetrical
B; irregular border
C; >1 colour
D; diameter >6mm
E; Evolving/ elevating

75
Q

3 further signs from ABCDE that indicate nodular melanoma

A

Elevated
Firm to touch
Growing

76
Q

Describe the histology in malignant melanomas

A
  1. Atypical melanocytes with mitotic figures; initially grow horizontally in epidermis
  2. Melanocytes migrate into upper epidermis (pagetoid spread) + are scattered among epithelial cells in a “buckshot” manner
  3. Vertical growth downwards, penetrate dermal-epidermal junction = invasive
77
Q

6 risk factors for malignant melanoma

A

MMRISK
Moles- atypical >5
Moles- common >50
Red hair
Inability to tan
Sunburn
Kindred

78
Q

What is used to stage Melanoma?

A

Breslow thickness (most important prognostic factor, based on depth)
(+Clark Scale)
TNM

79
Q

What are 4 types of melanoma?

A

Superficial (60%): irregular borders, variation in colour
Nodular (>50s): most aggressive
Lentigo maligna (Elderly)
Acral lentiginous malignant (dark skinned): rare

YR5 Histopathology (27 decks)

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