Derm Path Handout Flashcards
(132 cards)
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.
1
Q
These tumors present as pearly papules with telangiectasias
A
basal cell CA
1
Q
What is the possible sequela of GABHS impetigo? Pharyngitis?
A
Impetigo = glomerulonephritis only; pharyngitis = either glomerulonephritis or rheumatic fever
2
Q
Which metachromatic stains can be used to stain for mast cells?
A
toluidine blue or Giemsa
2
Q
What are the most common infections to cause erythema multiforme?
A
HSV and mycoplasma
3
Q
What races are affected by vitiligo?
A
all races just shows up more in dark skinned
3
Q
When will melasma resolve?
A
After pregnancy
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
4
Q
What syndrome is associated with multiple trichilemmomas and breast CA?
A
Cowden’s syndrome
4
Q
What is another name for SCC in situ?
A
Bowen’s disease
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)
6
Q
What 2 stains did he mention can stain for fungi?
A
methenamine silver or PAS
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
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
9
Q
What is the most aggressive form of basal cell CA?
A
morphea subtype
10
Q
Which part of the body is usually affected by panniculitis?
A
lower extremities
11
Q
Actinic keratosis on the lips is called _____
A
Actinic chelitis
12
Q
What are 3 associated “environmental” hazards that may lead to development of actinic keratosis?
A
Arsenicals, ionizaing rad, and hydrocarbons
12
Q
What is a rodent ulcer?
A
A description of how SCC can invade nearby structures
12
Q
T/F: there is acantholysis in PEM-PHI-GUS?
A
TRUE
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
12
Q
What is the most common type of wart?
A
verruca vulgaris
13
Q
Name the 4 subtypes of epithelial cysts
A
epidermal inclusion cyst, pilar or trichilemmal cyst, dermoid cyst, and steatocystoma multiplex
13
Q
Main cell in a xanthoma
A
foamy histiocyte
14
Describe the histology of seborrheic keratosis
proliferation of benign basaloid keratinocytes with hyperkeratosis and horn pseudocyst
14
What are the genetics of basal cell nevus syndrome?
autosomal dominant
15
Which type of epithelial cyst is most likely to undergo dystrophic calcification?
Pilar or trichilemmal cyst
16
How is the histology of acanthosis nigricans different from a benign melanocytic nevus?
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)
16
What are the four types of PEM-PHI-GUS?
Those would be PEM-PHI-GUS vulgaris, PEM-PHI-GUS foliaceus, PEM-PHI-GUS vegetans, and PEM-PHI-GUS erythematosus
17
What is most likely associated with a sudden onset of several seborrheic keratoses? What is this called?
usually a GI carcinoma (notes just say underlying malignancy)? This is the Sign of Leser-Trelat
18
What is it called when eczematous dermatitis develops in response to a tinea?
an ID reaction
19
The dysplastic nevus syndrome shows which form of mendelian inheritance? What chromosome?
AD, 1 (short arm)
20
This is a disorder that involves benign linear melanocyte hyperplasia with benign acanthosis
Lentigo
21
What are betel nuts associated?
Chewing on these is associated with SCC
22
T/F: ocular melanoma occurs in the pigment layer of the retina
False. Even though it seems like it should be true. It actually arises in the uvea (iris, ciliary body, and choroid)
23
What are the white dots and lines on the papules of lichen planus known as?
Wickham's striae
24
What is the HALLMARK of TEN and Stevens-Johnson syndrome?
necrotic keratinocytes in the epidermis
25
What antibody is present in PEM-PHI-GUS, PEM-PHI-GOID, and dermatitis herpetiformis?
PEM-PHI-GUS and PEM-PHI-GOID are IgG, DH is IgA
26
What is the term for separation of the nail bed from the nail as may occur in psoriasis?
onycholysis
28
What are the 4 tumors of the dermis?
Benign fibrous histiocytoma, xanthoma, dermatofibrosarcoma protruberans, and the dermal vascular tumors
29
Name the 4 general chronic inflammatory dermatoses?
Psoriasis vulgaris, Lichen planus, SLE, Acne vulgaris
30
Describe the 5 Clark's levels of invasion of malignant melanoma
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
30
Explain why both malignant melanoma and schwannomas are S-100 positive but glioblastomas are not
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
30
What lesion of the integumentary system is characterized bya fibrovascular core covered by epithelium (i.e. epidermis)?
skin tag = acrochordon
31
This is the "mask of pregnancy"
melasma
31
Describe the histology of keratoacanthomas
central keratin-filled crater that is surrounded by a benign proliferation of epithelial cells
31
What are the severe forms of erythema multiforme that are more common in drug reactions?
Stevens-Johnson syndrome and Toxic Epidermal Necrolysis
32
T/F: discoid lupus is associated with systemic Sx
false (usually)
33
In panniculitis what are the two histologic areas that can be inflamed?
connective tissue septa between fat lobules or the fat lobules themselves
34
What will you see on direct immunofluorescence of PEM-PHI-GUS vs. PEM-PHI-GOID?
In PEM-PHI-GUS it follows the keratinocytes; in PEM-PHI-GOID it is LINEAR and at the DE jxn
35
What are the two histologic subtypes of melasma?
Epidermal type with increased melanin in basal layer of dermis; Dermal subtype in which MACROPHAGES in the dermis have melanin pigment in the cytoplasm
35
Which form of acne can result in sinus tract formation?
acne congoblata
36
This is HMB-45 positive
malignant melanoma (along with S-100)
38
What causes scabies?
Sarcoptes scabiei
39
What is the term for intraepidermal edema?
spongiosus
41
What results from excess elastic fibers in the dermis?
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
If you were to get ocular malignant melanoma which would you want? Which would you not want?
Ocular Spindle Cell malignant melanoma has higher survival rates than ocular epithelioid malignant melanoma
44
What is erythema induratum?
A type of panniculitis that occurs secondary to vasculitis supplying fat
44
Enzyme deficient in porphyria cutanea tarda?
Uroporphyrinogen deaminase
46
How is a pilar cyst different from an epidermal inclusion cyst?
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
What is the tick that carries lyme Dz?
Ixodes dammini
48
What ist he pathognomonic structure in a MCV infection (not umbilication, but microscopic finding)?
MOLLUSCUM BODY, a homogenous red-blue cytoplasmic inclusion
49
T/F: there is acantholysis in PEM-PHI-GOID
FALSE acantholysis occurs within the dermis but here the lesion is at DE jxn
51
What is Darier's sign?
localized area of dermal edema and erythema (i.e. a wheal) that occurs when the lesional skin is rubbed
52
Where are the 3 histologic locations for the nests of melanocytes to be located in a benign melanocytic nevus?
Junctional (at DE jxn), intradermal, or compound which is in dermis and DE jxn
53
How is angioedema different from urticaria?
Angioedema involves the deeper dermis and SubQ fat
54
What are clusters of malignant CD4 positive T cells in the skin called?
Pautrier's microabscesses
55
What is the target lesion of lyme dz called? What about the one by Mycoplasma pneumoniae?
Erythema migrans, Erythema multiforme (more commonly HSV)
56
What is the significance of actinic keratosis regarding the outcome for the patient?
It is a premalignant lesion for SCC similar to CIN in the cervix
58
What disease are Munro's microabscesses and spongiform pustules of Kogoj associated with?
psoriasis
60
What are the 2 non-inflammatory blistering diseases?
Porphyria (cutanea tarda) and epidermolysis bullosa
61
What tumor, similar to a fibrous histiocytoma also has many benign blood vessels and hemosiderin deposits?
Sclerosing hemangioma
62
What is Lentigo? What is Vitiligo?
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
T/F: nests of melanocytes below the stratum basale can be identified in an ephelis
False. An ephelis is a freckle. There is more melanin but there aren't more melanocytes
65
This is the most common malignant tumor arising on sun-exposed sites in elderly patients
SCC
67
What does it mean to say that melanocytic nevus lesions are undergoing "maturation"?
They are going deeper and into the dermis
68
Which topical chemotherapeutic is used in actinic keratosis
topical 5-FU
69
What is it called when there is inflammatory infiltrate in the subcutis in SLE?
lupus profundus ("deep lupus" since it is normally at the DE jxn)
70
What is Cowden's Syndrome
multiple trichilemmomas and breast CA
71
Name the 7 major disorders of pigmentation and melanocytes (no subtypes)
1) Vitiligo 2) Melasma 3) Lentigo, 4) Ephelis 5) Benign melanocytic nevus 6) Dysplastic nevus 7) Malignant melanoma
72
Can lichen planus become CA?
Yes rarely, oral lichen planus can degenerate to SCC
73
name the 2 types of xanthomas
eruptive and tuberous
73
What is a Civatte body?
necrotic colloidal epidermis in lichen sclerosis
75
Immunosuppressed patients or those with xeroderma pigmentosum are at risk for \_\_\_\_\_\_\_\_\_\_\_\_
SCC (and probably others obviously but SCC and immunosuppression is a pretty big deal!)
76
What is Sezary syndrome?
seeding of the blood with malignant T cells from mycosis fungoides that results in diffuse erythema
77
How do you treat the epidermal subtype of melasma?
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
T/F: the Koebner phenomenon can occur in both psoriasis and lichen planus
TRUE
79
This is a type of panniculitis that occurs secondary to vasculitis of vessels supplying fat tissues
Erythema induratum
80
What kind of cells are malignant in mycosis fungoides/sezary syndrome?
CD4
81
What describes new lesions of psoriasis at sites of trauma?
Koebner phenomenon
83
What is the term for a flat wart? Specifically on the foot?
Verruca planis, verruca plantaris (hand = palmaris)
85
What is the sign of Leser-Trelat?
A sudden onset (explosive) of several seborrheic keratoses often associated with underlying GI CA
86
Though fibroepithelial polyps are typically benign they have been associated with ________ and \_\_\_\_\_\_\_\_\_\_
DM and Intestinal polyposis
87
What is Weber-Christian disease?
relapsing febrile nodular panniculitis, a lobular nonvasculitic panniculitis
87
Which form of PEM-PHI-GUS presents with moist verrucous plaques?
PEM-PHI-GUS vegetans
89
What is dermatosis papulosa nigra?
small seborrheic keratoses on the faces of blacks
90
What is a follicular keratosis?
When seborrheic keratosis involves the hair follicles and grows in an endophytic fashion
91
What kind of lymphocytes are present in erythema multiforme?
CD8
93
Types of HPV for genital warts. Types for SCC
6 and 11; 16 and 18
94
Which disease has blisters that rupture more easily: PEM-PHI-GUS or PEM-PHI-GOID?
pemphigus
96
What ages and races are affected by lentigo?
all, and the pathogenesis is unknown
97
Where will you see IgG antibodies under direct immunoflouresence in PEM-PHI-GUS (any type)?
along the borders of keratinocytes
98
What depth of invasion is associated with a good prognosis in malignant melanoma?
0.76 mm
100
Name the 3 major diseases that arise from cellular immigrants to the skin
Histiocytosis X, Mycosis fungoides, and Mastocytosis
101
What is lichen planus primarily affecting the hair follicles of the scalp known as?
Lichen planopilaris
103
What is xanthelasma?
essentially xanthomas on the eyelids
104
Name the 4 general inflammatory dermatoses
urticaria, eczematous dermatitis, erythema multiforme, and panniculitis
105
Name the 6 benign epithelial tumors
Seborrheic keratosis, Acanthosis nigricans, Fibroepithelial polyp, Keratoacanthoma, Epithelial cyst, Adnexal (appendage) tumors
106
How is lentigo histologically different from a benign melanocytic nevus?
lentigo is linear proliferation of melanocytes WITHOUT nesting. A nevus involves nests of melanocytes
107
What ist he most common form of panniculitis?
erythema nodosum
107
What accounts for the color of a blackhead?
Oxidation of keratin
108
Describe the Auspitz sign
the dermal papillae are closer to the epidermis than normal so there will be bleeding if it is peeled off
109
What kind of panniculitis results from injecting foreign substances or self-injury?
Factitial panniculitis
110
What is the term for melanin pigment in the macrophages of the dermal subtype of melasma?
Melanin incontinence
111
What 2 antigens is malignant melanoma positive for?
S-100 and HMB-45
112
This involves the proliferation of benign basaloid keratinocytes with HORN PSEUDOCYSTS
seborrheic keratosis
113
Which type of basal cell CA has marked desmoplasia?
morphea subtype, worst prognosis
115
What are seborrheic keratoses on the faces of "blacks" called?
Dermatosis papulosa nigra
117
What is usually left after lichen planus resolves?
A zone of post-inflammatory hyperpigmentation
119
What is the localized cutaneous form of mastocytosis?
urticaria pigmentosa
120
Which cutaneous carcinoma is neuroendocrine?
Merkel cell CA
121
Name the 4 (no subtypes) premalignant and malignant tumors of epidermis (this does not include melanoma)
Actinic keratosis, SCC, Basal cell CA, and Merkel Cell CA
122
What is the term for superinfection of eczematous skin by bacteria to produce a yellow crust
impetiginization
123
This skin neoplasm has a rapid onset, mimics SCC, but can go away on its own
keratoacanthoma
124
Which 2 subtypes of malignant melanoma involve prolonged radial growth? What does that mean for staging?
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
Describe the pathogenesis of vitiligo
It is autoantibody destruction of melanocytes
126
This tumor has atypical fibroblasts in a storiform pattern
Dermatofibrosarcoma protruberans
127
What are 3 ways you get the benign type of acanthosis nigricans?
as an AD trait, associated with obesity or endocrine disorder, as part of a number of rare congenital syndromes
129
An epithelial cyst (Wen) develops from the downgrowth of \_\_\_\_\_\_\_\_\_\_\_
epidermis (downgrowth and cystic expansion)
130
Synonym for fibroepithelial polp
acrochordon (also skin tag and squamous papilloma)
131
Where is ocular malignant melanoma most likely to spread?
the liver
132
What is hereditary angioneurotic edema?
inherted deficiency of C1 activator (C1 esterase inhibitor)
