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DERM EXAM 2 > Derm Path Handout > Flashcards

Derm Path Handout Flashcards

1
Q

How is vitiligo different from albinsim?

A

Vitligo is an autoimmune destruction of melanocytes whereas albinism involves a loss of (usually) tyrosinase such that melanin cannot be produced.

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1
Q

These tumors present as pearly papules with telangiectasias

A

basal cell CA

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1
Q

What is the possible sequela of GABHS impetigo? Pharyngitis?

A

Impetigo = glomerulonephritis only; pharyngitis = either glomerulonephritis or rheumatic fever

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2
Q

Which metachromatic stains can be used to stain for mast cells?

A

toluidine blue or Giemsa

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2
Q

What are the most common infections to cause erythema multiforme?

A

HSV and mycoplasma

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3
Q

What races are affected by vitiligo?

A

all races just shows up more in dark skinned

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3
Q

When will melasma resolve?

A

After pregnancy

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3
Q

What is the commonality of the Leser-Trelat sign and the malignant form of acanthosis nigricans?

A

Both are associated with an underlying malignancy

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4
Q

What syndrome is associated with multiple trichilemmomas and breast CA?

A

Cowden’s syndrome

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4
Q

What is another name for SCC in situ?

A

Bowen’s disease

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5
Q

What does the nucleus of a Sezary cell look like?

A

Cerebriform (Recall: Seastone said just think that Mr. Sezary is a smart guy)

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6
Q

What 2 stains did he mention can stain for fungi?

A

methenamine silver or PAS

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7
Q

T/F: you can distinguish SLE from Discoid lupus on the basis of skin lesions alone

A

false because many pts with SLE will develop discoid lesions; however, they will also have systemic Sx

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8
Q

How is the appearance of malignant melanoma cells as they invade into the dermis different from what you would find in the melanocytes of a benign melanocytic nevus as its cells went deeper into the dermis?

A

An important feature here is that nevi show maturation as they “invade” deeper but malignant melanoma does not

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9
Q

What is the most aggressive form of basal cell CA?

A

morphea subtype

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10
Q

Which part of the body is usually affected by panniculitis?

A

lower extremities

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11
Q

Actinic keratosis on the lips is called _____

A

Actinic chelitis

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12
Q

What are 3 associated “environmental” hazards that may lead to development of actinic keratosis?

A

Arsenicals, ionizaing rad, and hydrocarbons

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12
Q

What is a rodent ulcer?

A

A description of how SCC can invade nearby structures

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12
Q

T/F: there is acantholysis in PEM-PHI-GUS?

A

TRUE

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12
Q

Name the 3 subtypes of Epidermolysis bullosa

A

Junctional (at lamina lucida); Scarring dystrophic type (beneath lamina densa); simplex type which is loss of the basal layer

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12
Q

What is the most common type of wart?

A

verruca vulgaris

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13
Q

Name the 4 subtypes of epithelial cysts

A

epidermal inclusion cyst, pilar or trichilemmal cyst, dermoid cyst, and steatocystoma multiplex

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13
Q

Main cell in a xanthoma

A

foamy histiocyte

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14
Q

Describe the histology of seborrheic keratosis

A

proliferation of benign basaloid keratinocytes with hyperkeratosis and horn pseudocyst

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14
Q

What are the genetics of basal cell nevus syndrome?

A

autosomal dominant

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15
Q

Which type of epithelial cyst is most likely to undergo dystrophic calcification?

A

Pilar or trichilemmal cyst

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16
Q

How is the histology of acanthosis nigricans different from a benign melanocytic nevus?

A

there is acanthosis of the basal layer of epidermis leading to the hyperpigmentation, there is no melanocytic hyperplasia though as there would be in a nevus (which is characterized by nests of melanocytes)

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16
Q

What are the four types of PEM-PHI-GUS?

A

Those would be PEM-PHI-GUS vulgaris, PEM-PHI-GUS foliaceus, PEM-PHI-GUS vegetans, and PEM-PHI-GUS erythematosus

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17
Q

What is most likely associated with a sudden onset of several seborrheic keratoses? What is this called?

A

usually a GI carcinoma (notes just say underlying malignancy)? This is the Sign of Leser-Trelat

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18
Q

What is it called when eczematous dermatitis develops in response to a tinea?

A

an ID reaction

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19
Q

The dysplastic nevus syndrome shows which form of mendelian inheritance? What chromosome?

A

AD, 1 (short arm)

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20
Q

This is a disorder that involves benign linear melanocyte hyperplasia with benign acanthosis

A

Lentigo

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21
Q

What are betel nuts associated?

A

Chewing on these is associated with SCC

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22
Q

T/F: ocular melanoma occurs in the pigment layer of the retina

A

False. Even though it seems like it should be true. It actually arises in the uvea (iris, ciliary body, and choroid)

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23
Q

What are the white dots and lines on the papules of lichen planus known as?

A

Wickham’s striae

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24
Q

What is the HALLMARK of TEN and Stevens-Johnson syndrome?

A

necrotic keratinocytes in the epidermis

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25
Q

What antibody is present in PEM-PHI-GUS, PEM-PHI-GOID, and dermatitis herpetiformis?

A

PEM-PHI-GUS and PEM-PHI-GOID are IgG, DH is IgA

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26
Q

What is the term for separation of the nail bed from the nail as may occur in psoriasis?

A

onycholysis

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28
Q

What are the 4 tumors of the dermis?

A

Benign fibrous histiocytoma, xanthoma, dermatofibrosarcoma protruberans, and the dermal vascular tumors

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29
Q

Name the 4 general chronic inflammatory dermatoses?

A

Psoriasis vulgaris, Lichen planus, SLE, Acne vulgaris

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30
Q

Describe the 5 Clark’s levels of invasion of malignant melanoma

A

I) tumor in epidermis II) tumor invading into but not filling papillary dermis III) tumor invading/filling papillary dermis IV) tumor invading reticular derms V) tumor in adipose of subcutis

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30
Q

Explain why both malignant melanoma and schwannomas are S-100 positive but glioblastomas are not

A

melanoma and schwannomas are from neural crest which is what S-100 stains for. Astrocytes are from neuroectoderm and GBM’s are astrocytomas thus they are not S-100 positive

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30
Q

What lesion of the integumentary system is characterized bya fibrovascular core covered by epithelium (i.e. epidermis)?

A

skin tag = acrochordon

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31
Q

This is the “mask of pregnancy”

A

melasma

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31
Q

Describe the histology of keratoacanthomas

A

central keratin-filled crater that is surrounded by a benign proliferation of epithelial cells

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31
Q

What are the severe forms of erythema multiforme that are more common in drug reactions?

A

Stevens-Johnson syndrome and Toxic Epidermal Necrolysis

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32
Q

T/F: discoid lupus is associated with systemic Sx

A

false (usually)

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33
Q

In panniculitis what are the two histologic areas that can be inflamed?

A

connective tissue septa between fat lobules or the fat lobules themselves

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34
Q

What will you see on direct immunofluorescence of PEM-PHI-GUS vs. PEM-PHI-GOID?

A

In PEM-PHI-GUS it follows the keratinocytes; in PEM-PHI-GOID it is LINEAR and at the DE jxn

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35
Q

What are the two histologic subtypes of melasma?

A

Epidermal type with increased melanin in basal layer of dermis; Dermal subtype in which MACROPHAGES in the dermis have melanin pigment in the cytoplasm

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35
Q

Which form of acne can result in sinus tract formation?

A

acne congoblata

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36
Q

This is HMB-45 positive

A

malignant melanoma (along with S-100)

38
Q

What causes scabies?

A

Sarcoptes scabiei

39
Q

What is the term for intraepidermal edema?

A

spongiosus

41
Q

What results from excess elastic fibers in the dermis?

A

Solar elastosis–the basis of wrinkles? By the way, if you took the burqa comment as either anti-muslim or sexist, you’re probably not the sharpest tool in the shed.

43
Q

If you were to get ocular malignant melanoma which would you want? Which would you not want?

A

Ocular Spindle Cell malignant melanoma has higher survival rates than ocular epithelioid malignant melanoma

44
Q

What is erythema induratum?

A

A type of panniculitis that occurs secondary to vasculitis supplying fat

44
Q

Enzyme deficient in porphyria cutanea tarda?

A

Uroporphyrinogen deaminase

46
Q

How is a pilar cyst different from an epidermal inclusion cyst?

A

They are lined by the epithelium of the hair follicle but rather than having keratin filling they have eosinophilic material that can undergo dystrophic calcification

47
Q

What is the tick that carries lyme Dz?

A

Ixodes dammini

48
Q

What ist he pathognomonic structure in a MCV infection (not umbilication, but microscopic finding)?

A

MOLLUSCUM BODY, a homogenous red-blue cytoplasmic inclusion

49
Q

T/F: there is acantholysis in PEM-PHI-GOID

A

FALSE acantholysis occurs within the dermis but here the lesion is at DE jxn

51
Q

What is Darier’s sign?

A

localized area of dermal edema and erythema (i.e. a wheal) that occurs when the lesional skin is rubbed

52
Q

Where are the 3 histologic locations for the nests of melanocytes to be located in a benign melanocytic nevus?

A

Junctional (at DE jxn), intradermal, or compound which is in dermis and DE jxn

53
Q

How is angioedema different from urticaria?

A

Angioedema involves the deeper dermis and SubQ fat

54
Q

What are clusters of malignant CD4 positive T cells in the skin called?

A

Pautrier’s microabscesses

55
Q

What is the target lesion of lyme dz called? What about the one by Mycoplasma pneumoniae?

A

Erythema migrans, Erythema multiforme (more commonly HSV)

56
Q

What is the significance of actinic keratosis regarding the outcome for the patient?

A

It is a premalignant lesion for SCC similar to CIN in the cervix

58
Q

What disease are Munro’s microabscesses and spongiform pustules of Kogoj associated with?

A

psoriasis

60
Q

What are the 2 non-inflammatory blistering diseases?

A

Porphyria (cutanea tarda) and epidermolysis bullosa

61
Q

What tumor, similar to a fibrous histiocytoma also has many benign blood vessels and hemosiderin deposits?

A

Sclerosing hemangioma

62
Q

What is Lentigo? What is Vitiligo?

A

Lentigo is a benign proliferation of melanocytes (benign linear melanocyte hyperplasia) typically with benign acanthosis?. Vitiligo involves loss of color due to a loss of melanocytes from autoantibody destruction

63
Q

T/F: nests of melanocytes below the stratum basale can be identified in an ephelis

A

False. An ephelis is a freckle. There is more melanin but there aren’t more melanocytes

65
Q

This is the most common malignant tumor arising on sun-exposed sites in elderly patients

A

SCC

67
Q

What does it mean to say that melanocytic nevus lesions are undergoing “maturation”?

A

They are going deeper and into the dermis

68
Q

Which topical chemotherapeutic is used in actinic keratosis

A

topical 5-FU

69
Q

What is it called when there is inflammatory infiltrate in the subcutis in SLE?

A

lupus profundus (“deep lupus” since it is normally at the DE jxn)

70
Q

What is Cowden’s Syndrome

A

multiple trichilemmomas and breast CA

71
Q

Name the 7 major disorders of pigmentation and melanocytes (no subtypes)

A

1) Vitiligo 2) Melasma 3) Lentigo, 4) Ephelis 5) Benign melanocytic nevus 6) Dysplastic nevus 7) Malignant melanoma

72
Q

Can lichen planus become CA?

A

Yes rarely, oral lichen planus can degenerate to SCC

73
Q

name the 2 types of xanthomas

A

eruptive and tuberous

73
Q

What is a Civatte body?

A

necrotic colloidal epidermis in lichen sclerosis

75
Q

Immunosuppressed patients or those with xeroderma pigmentosum are at risk for ____________

A

SCC (and probably others obviously but SCC and immunosuppression is a pretty big deal!)

76
Q

What is Sezary syndrome?

A

seeding of the blood with malignant T cells from mycosis fungoides that results in diffuse erythema

77
Q

How do you treat the epidermal subtype of melasma?

A

Hydroquinone (a topical bleaching agent)? You may have heard of people bleaching their anus. Don’t know why they do it but this is what they use. Don’t ask me why I know that.

78
Q

T/F: the Koebner phenomenon can occur in both psoriasis and lichen planus

A

TRUE

79
Q

This is a type of panniculitis that occurs secondary to vasculitis of vessels supplying fat tissues

A

Erythema induratum

80
Q

What kind of cells are malignant in mycosis fungoides/sezary syndrome?

A

CD4

81
Q

What describes new lesions of psoriasis at sites of trauma?

A

Koebner phenomenon

83
Q

What is the term for a flat wart? Specifically on the foot?

A

Verruca planis, verruca plantaris (hand = palmaris)

85
Q

What is the sign of Leser-Trelat?

A

A sudden onset (explosive) of several seborrheic keratoses often associated with underlying GI CA

86
Q

Though fibroepithelial polyps are typically benign they have been associated with ________ and __________

A

DM and Intestinal polyposis

87
Q

What is Weber-Christian disease?

A

relapsing febrile nodular panniculitis, a lobular nonvasculitic panniculitis

87
Q

Which form of PEM-PHI-GUS presents with moist verrucous plaques?

A

PEM-PHI-GUS vegetans

89
Q

What is dermatosis papulosa nigra?

A

small seborrheic keratoses on the faces of blacks

90
Q

What is a follicular keratosis?

A

When seborrheic keratosis involves the hair follicles and grows in an endophytic fashion

91
Q

What kind of lymphocytes are present in erythema multiforme?

A

CD8

93
Q

Types of HPV for genital warts. Types for SCC

A

6 and 11; 16 and 18

94
Q

Which disease has blisters that rupture more easily: PEM-PHI-GUS or PEM-PHI-GOID?

A

pemphigus

96
Q

What ages and races are affected by lentigo?

A

all, and the pathogenesis is unknown

97
Q

Where will you see IgG antibodies under direct immunoflouresence in PEM-PHI-GUS (any type)?

A

along the borders of keratinocytes

98
Q

What depth of invasion is associated with a good prognosis in malignant melanoma?

A

0.76 mm

100
Q

Name the 3 major diseases that arise from cellular immigrants to the skin

A

Histiocytosis X, Mycosis fungoides, and Mastocytosis

101
Q

What is lichen planus primarily affecting the hair follicles of the scalp known as?

A

Lichen planopilaris

103
Q

What is xanthelasma?

A

essentially xanthomas on the eyelids

104
Q

Name the 4 general inflammatory dermatoses

A

urticaria, eczematous dermatitis, erythema multiforme, and panniculitis

105
Q

Name the 6 benign epithelial tumors

A

Seborrheic keratosis, Acanthosis nigricans, Fibroepithelial polyp, Keratoacanthoma, Epithelial cyst, Adnexal (appendage) tumors

106
Q

How is lentigo histologically different from a benign melanocytic nevus?

A

lentigo is linear proliferation of melanocytes WITHOUT nesting. A nevus involves nests of melanocytes

107
Q

What ist he most common form of panniculitis?

A

erythema nodosum

107
Q

What accounts for the color of a blackhead?

A

Oxidation of keratin

108
Q

Describe the Auspitz sign

A

the dermal papillae are closer to the epidermis than normal so there will be bleeding if it is peeled off

109
Q

What kind of panniculitis results from injecting foreign substances or self-injury?

A

Factitial panniculitis

110
Q

What is the term for melanin pigment in the macrophages of the dermal subtype of melasma?

A

Melanin incontinence

111
Q

What 2 antigens is malignant melanoma positive for?

A

S-100 and HMB-45

112
Q

This involves the proliferation of benign basaloid keratinocytes with HORN PSEUDOCYSTS

A

seborrheic keratosis

113
Q

Which type of basal cell CA has marked desmoplasia?

A

morphea subtype, worst prognosis

115
Q

What are seborrheic keratoses on the faces of “blacks” called?

A

Dermatosis papulosa nigra

117
Q

What is usually left after lichen planus resolves?

A

A zone of post-inflammatory hyperpigmentation

119
Q

What is the localized cutaneous form of mastocytosis?

A

urticaria pigmentosa

120
Q

Which cutaneous carcinoma is neuroendocrine?

A

Merkel cell CA

121
Q

Name the 4 (no subtypes) premalignant and malignant tumors of epidermis (this does not include melanoma)

A

Actinic keratosis, SCC, Basal cell CA, and Merkel Cell CA

122
Q

What is the term for superinfection of eczematous skin by bacteria to produce a yellow crust

A

impetiginization

123
Q

This skin neoplasm has a rapid onset, mimics SCC, but can go away on its own

A

keratoacanthoma

124
Q

Which 2 subtypes of malignant melanoma involve prolonged radial growth? What does that mean for staging?

A

Lentigo maligna (sun-exposed surfaces on elderly) and Superficial Spreading? This is good for prognosis because staging is by the Breslow thickness, obviously these won’t be very thick

125
Q

Describe the pathogenesis of vitiligo

A

It is autoantibody destruction of melanocytes

126
Q

This tumor has atypical fibroblasts in a storiform pattern

A

Dermatofibrosarcoma protruberans

127
Q

What are 3 ways you get the benign type of acanthosis nigricans?

A

as an AD trait, associated with obesity or endocrine disorder, as part of a number of rare congenital syndromes

129
Q

An epithelial cyst (Wen) develops from the downgrowth of ___________

A

epidermis (downgrowth and cystic expansion)

130
Q

Synonym for fibroepithelial polp

A

acrochordon (also skin tag and squamous papilloma)

131
Q

Where is ocular malignant melanoma most likely to spread?

A

the liver

132
Q

What is hereditary angioneurotic edema?

A

inherted deficiency of C1 activator (C1 esterase inhibitor)

DERM EXAM 2 (7 decks)

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