MIDTERM Flashcards
1
Q
How many days does it take to form EPIDERMIS
A
28 days
2
Q
What two layers form the DERMIS
Where do Meissners and Pacinian Corpuscles belong?
A
Papillary Layer = thin upper (Meissners)
Reticular = THICK lower (Pacinian)
3
Q
Name the three phases of hair growth
A
Anagen = growth phase (2-6yrs)
Catagen = transition (2-3 weeks)
Telogen = resting (3mo)
4
Q
What phae is hair colored in?
A
Anagen Phase = growth phase
5
Q
EUMELANIN=
A
black/brown hair
6
Q
Pheomelanin
A
BLONDE
7
Q
Erythromelanin
A
RED
8
Q
Longitudinal band of brown/black pigment stretching from matrix to nail folds
A
MELANONYCHIA
Hutchinson’s sign
9
Q
small, discrete erythematous scaling papules on the trunk and extremities, some of which coalesce
A
GLUTTATE PSORIASIS
10
Q
irregular and asymmetric hyperpigmented patch with striking variegation of pigmentation
A
MELANOMA
11
Q
Primary Skin Lesions
: flat, < 1 cm
: flat >1 cm
A
Macule: flat, < 1 cm
Patch: flat >1 cm
12
Q
Primary Skin Lesions
: Elevated < 1 cm
: Elevated > 1 cm
A
Papule: Elevated < 1 cm
Plaque: Elevated > 1 cm
13
Q
Primary Skin Lesions
: Large palpable mass > 1 cm
: Fixed large nodule > 2 cm
A
Nodule: Large palpable mass > 1 cm
Tumor: Fixed large nodule > 2 cm
14
Q
Secondary Skin Lesions
Do erosions scar?
A
Loss of epidermis
heals WITHOUT scarring
15
Q
Secondary Skin lesion
Loss of tissue leading to exposure of dermis/ fat
Does it scar?
A
ULCER
heals with scarring
16
Q
red macule due to vasodilation
blanches under pressure ( essentially vasoconstricting
it so redness stops )
A
ERYTHEMA
17
Q
Extravasation of RBCs
* does not blanch under pressure ( RBCs are out so pressing won’t make a difference )
A
PURPURA
18
Q
Dilated vessel i.e. spider angiomas
A
Telangiectasia
19
Q
Thickening of stratum corneum d/t to keratinocyte proliferation
A
Lichenification
20
Q
Yellow Red papule from fat deposition
A
XANTHOMA
21
Q
Itchy, evanescent Hypopigmented papule/plaque d/t edema
from dermis associated with allergies
A
WHEAL
22
Q
What is a good screening tool for susceptibility to skin cancer?
A
Fitzpatrick Skin Types
What happens after 15 min of sun exposure w/o sunscreen
Always -> never
23
Q
Fitzpatrick Skin Types
Type I: Always burn, never tan
Type II: Usually burns, sometimes tans Type III: Sometimes burns
Type IV: Rarely burns
Type V: Very rarely burns
Type VI: Never burns, always tans
A
(Always Burns –> Never Burns)
(Never Tan –> Always Tan)
24
Q
dead, protective layer of epidermis
A
Stratum corneum
25
layer of epidermis present in thick skin dead cells
Stratum lucidum
26
Are there blood vessels in the epidermis?
NO
27
merocrine, tubular glands that help with thermoregulation
SWEAT GLANDS
* Eccrine -- found everywhere
* Apocrine -- found in axila, pubic, perianal area
28
**HOLOCRINE**, associated with hair follices, nerve endings, smooth muscle
SEBACEOUS Glands
29
transepidermal water loss → Ca2+ gradient loss →
**lamellar body** ( lipid-containing) secretion → **cytokine secretion,** inflammation and keratinocyte proliferation
30
What are the two barriers to UV radiation?
Melanin and Protein Lipid Barrier in the stratum corneum
31
defects in lipid metabolism or the protein components of the stratum corneum are accompained by skin barrier defects
ICHTHYOSIS
32
Acute and Chronic eczema result in vesicular lesions that lead to ulcerations and erosions that become easily colonized and infected
Eczema with spongiosis
33
desquamative inflammatory dermatoses make the skin barrier function less effective
34
lymphocytic infiltrate with vasculitis
URTICARIA
35
bacterial infection
ulceration and acute inflammation
IMPETIGO
36
In desquamative, inflammatory dematosis, is the skin barrier intact and fully functional?
NO
37
What dermatological condition demonstrates **HORNCYSTS**?
Seborrheic keratosis
38
What dermatological condition results from **bacterial infection**?
IMPETIGO
39
If **munroe's microabscess** is seen on a pathologiclal specimen slide, what dematological condition is present?
PSORIASIS
40
vitiligo, tinea, moles, freckles, sunspots, lentigenes are examples of
Macules and Patches
41
Acne, boils, candida, chickenpox, impetigo are examples of
PUSTULES
| Small patch of BULGING skin filled with PUS
42
nodule with a central punctum
cheesy, yellow, keratin material
lined by flat epidermal cells, has a granular layer surrounding keratin
Epidermal Inclusion Cysts
43
**rapid build up of epidermal** cells especially over the knees and elbows
**SILVERY** SCALING
Histopath: **Parakeratosis = cell nuclei within stratum corneum**
| **THERE IS NO GRANULAR LAYER**
## Footnote
CD8 is in the DERMIS / CD4 is in EPIDERMIS
PSORIASIS
44
Thick skin, increased keratin (stratum corneum) layer
Plantar (SOLES of Feet)
VITAMIN DEFICIENCIES (E, A, D)
Hyperkeratosis
45
benign neoplasms of melanocytes
grows as nests of melanocytes at the dermal-epidermal junction can extend into dermis
| FLAT macule or RAISED Papule, usually < 6mm
NEVI
46
Dysplastic nevus is a precursor
MELANOMA
47
Antibodies against **desmogelin 3** is seen in what bullous disease?
Pemphigus Vulgaris
48
Antibodies against **hemidesmosmes** is seen in which bullous disease?
Bullous phemphigod
49
If Nikolsky's sign is positive, what bulloys disease?
Pemphigus Vulgaris
50
Pemphigus Vulgaris vs Bullous Phemphigoid **Immunofluorescence appearance**
Pemphigus Vulgaris -- **FISH NET**
Bullous Phemigoid -- **LINEAR** PATTERN
51
**Autoimmune bullous disease of IgA** at the tips of dermal papillae
Consists of: **pruritic vesicles and bullae** grouped together bullae-> filled with watery fluid, PMN’s, and eosinophils
Dermatitis Herpetiformis
52
What skin disease is associated with celiac disease and resolves with a gluten free diet?
| Immunofluorescence: granular deposits w/in the dermal papillae
Dermatis Herpetiformis
53
**multisystem blood vessel diseaes**
* Affects: mostly men in the 4th and 5th decade of life
* Associated with Hep B in some patients
* Skin: may show gangrene, nodules purpura, rashes, ulcers, livedo reticularis
| Most often on legs
Polyarteritis Nodosa Vasculitis
54
Hypersensitivity reaction of dermal blood vessels
* Characterized by: **targeted rash and bullae of skin** and mucous membranes
* Associated with herpes simplex, penicillin, SLE, steven johnson syndrome
| vascular interface dermatitis w lymphocytes along dermo epiderm junction
Erythema Multiforme
55
What are Nevi, can they extend into the dermis?
Benign neoplasms of melanocytes
YES
56
What is acantholysis?
Seen in pemphigus vulgaris, s**eperation of the stratum spinosum keratinocytes**. BM is connected, Nikolsky's sign happen on skin and oral mucosae
57
What is the antibody formed in bullous pemphigod?
In celiac disease, what is the immunoglobulin?
It is also used diagnostic immunofloruensce
Anti-hemidesmosomes
IgA
58
Which has a histopathology that demonstrates vaculoar interface dermatitis with lymphocytes along the dermo epidermal junction?
erythema multiforme
59
What vasculitis shows rashes, ulcers, subQ nodules and livido reticularis?
It is likely in a 40 yo male with Heb B
PAN
Polyarteritis Nodosa
60
Patient presents with **oral lesions and blisters that easily rupture**. Immunofluorescence depicted with image on left. What does this patient most likely have?
Pemphigus vulgaris
| immunofluorescence = FISH NET
61
A 45 year old patient presents with **red lesions on the lower legs** shown in picture. He also has a **fever** and endorses **night sweats.** What is this condition associated with in some patients?
HEP B
| Polyartertis Nodosa Vasculitis
62
What **Fitzpatrick Skin Type** is the following person: **usually burns, sometimes tans**?
Type II
63
What are the four infection sites of Strep pyogenes and what do we see
Corneum -- IMPETIGO
Epidermis -- Ecthyma
Dermis -- Erysipelas
Cellulitis -- FAT
64
Patient comes in with painless, **prurutic vesicular rash**. When the fluid dries it forms a **honey colored thick crust**. What do you suspect?
IMPETIGO
65
What protein **inhibits osponization and phagocytosis** seen in **strep impetigo**?
M PROTEIN
66
Patient presents with "**fiery red patch" rash** you suspect **ERYSIPELAS**. What is a **predisposing** factor to this?
LYMPH OBSTRUCTION
67
Bacterial cause of **cellulitis**, infects skin abrasions upon contact with **contaminated raw meat** and fish
Erysipelothrix rhusiopathiae
68
What **Induces** **pro-inflammatory cytokine** production and **Activates endothelia** (rash and inflammation)
Streptococcal Pyrogenic **Exotoxin** B (SpeB)
69
What **toxins** damage mammalian cells, resulting in **cell lysis** and release of lysosomal enzymes
Streptolysin O and S
70
Two mechanisms involved in Necrotizing Fasciitis
Streptodornases and Hyaluronidase
71
Newborn presents as febrile, erythematous **lesions** around mouth, nose and neck. **+ Nikolsky sign**
Staph Scalded Skin Syndrome
72
What toxin is involved in **Staph Scalded Skin Syndrome**
Exfoliative Toxin A and B
73
What staphylococcus virulence factors are responsible for folliculitis, furnucles and carbuncles?
Adhesins/Teichoic Acid
Capsules and Protein A
Toxins
74
Another major cause of **folliculitis**: grows in adequately chlorinated warm water (**hot tubs**)
Pseudomonas Aeruginosa
75
Another major cause of **folliculitis**: **itchy acne-like eruption** on the upper back, upper arms, chest, neck, chin and face
Malassezia furfur
76
How does VZV infect the skin epithelia when it is in the Lymph node?
VIREMIA to liver ans spleen via T cells and monocytes --> skin --> local nerve
77
What virulence factor is responsible for viral dissemintation of varicella zoster virus?
VZV glycoprotein C
**binds to chemokine** and then to chemokine receptor triggering enhanced recruitment and migratory action of **monocytes, dendritic
cells, and T cells**
78
# Name the VIRUS
ssDNA naked virus
Transmission = inhalation of contaminated resp dropplets
Patients no longer contagious once the rash has appeared -- due to immune response
PARVOVIRUS B19
79
Child presents to urgent care with cold like sympotoms, fever, headache and **facial rash**
Rash develops a **lacy, reticular pattern**
FIFTH DISEASE
erythema infectiosum
80
Which type of hypersensitivity reaction is seen in Fifth disease?
| Parvovirus B19
Type 3
81
# What virus and what disease?
Patient presents with **blister-like painful lesions in the mouth (herpangina) & skin rash**
Oral and pharyngeal ulcers and vesicular rash of **palms of hands + soles of feet**
Coxsackievirus
Hand Foot Mouth Disease
82
Patient presents with fever, cough, coryza, conjunctivitis, **koplik spots**, rash, diffuse **blotchy erythematous maculopapular rash**
**Leukopenia** and Serum Vit. A is DEC
| Vaccine: MMR
MEASLES (RUBEOLA)
| complication = subacute sclerosing panencephalitis
83
Patient presents with Postauricular/occipital lymphadenopathy ( usually before rash)
Forschheimer spots on mucosa (pinpoint, red/purpule macules on uvula)
| If congenital -- Blueberry Muffin Rash + sensorineural deafness/cataract
Rubella GERMAN MEASLES
84
patient presents with vesicles that look like **dew drops on a rose petal**
Vesicular rash in crops
**Giant cells on Tzanck Smear**
Varicella (Chickenpox)
| reactivation as shingles
85
Patient has a high fever for 3-5 days and then **rash breaks out once fever subsides**
non-pruritic blanching erythematous maculopapular rash starts on trunk --> spreads to out to face and extremities
Roseola Infantum
HHV 6
| Little 6 yo Rosy has a Rash
complication - seizures
86
Patient presents with skin colored **pearly papules with central umbilication**
**Molluscum bodies** (keratinocytes + eosinophilic cytoplasmic inclusion bodies)
Molluscum contagiousm
87
# Kissing Disease
Fatigue * distinct in children* , exudative pharyngitis, lymphadenopathy ( posterior cervical ) , hepatosplenomegaly,
Infectious Mononucleosis
EBV (HHV4)
88
Patient presents with clustered vesicles on an erythematous base and eroded bullae that can leave scars
"**Cold sore"/"Fever blister**"
| ** Multinucleated Giant cells on Tzanck smear**
HSV
89
**Vesicular/ulcerative rash** around the **mouth**
Could also present with **herpetic whitlow** ( vesicular lesions )
Herpetic Gingivostomatitis
90
Round papules with rough edges ( **warts** ) that can occur anywhere, *often **hands***
| HPV 2 and 4
Verruca Vulgaris
| Condyloma Acuminata (HPV 6/11) -- genital warts
91
This infection is seen in **contact lens** wearers -- dont wash with tap water
**Chronic Granulomatous Dermatitis**
Acanthamoeba Infection
92
Infection caused by **sandfly** bite
Visceral:
Mucocutaneous
DERMAL: hypopigmented macules --> diffuse nodular lesions
Leishmaniasis
93
infection due to skin penetration by **freshwater snails** causing dematitis
**Swimmer's Itch**
**Katayama Fever,** Pruritic Rash
Schistosmiasis
94
Infection die to larvae from soil penetrates human skin --> **serpiginous tunnel**
Ground Itch
Ancylostomiasis
95
**Mosquito** vector transmits tiny larvae with bite in human
**Adult worm** may form in subcutaneous nodules and **subconjunctival** nodules
Dirofilariasis
96
infection due to drinking **contaminated water (water flea = cyclops)**
Worm migrates to skin -- blisters on legs and feet
Dracunculosis
97
infection due to bite of **black fly (simulium**) on subcutaneous tissue forming **painless skin nodules affecting eyes**
| Dermatitis and Keratoconjunctivitis -- **river blindness**
Onchocerciasis
98
infection via bite from **Mango Fly (Chrysops)** --> eye --> **subconjunctivia**
| **Calabar Swelling of eye**
Loiasis
Loa Loa = filarial nematode
99
infection due to ingestion of **undercooked pork** -- enters mucosa of intestines (**striated muscle, heart, brain**)
Myalgia
| Tx: Albendazole
Trichinellosis
100
Human Lice infestation
Pediculosis
| Pediculosis ciliaris ->conjunctivitis -keratitis
Complication - impetigo
101
skin infection caused by **fly larvae (maggots**) of **dermatobia hominis (human bot fly**)
| **Furnucular** , Wound and Migratory depending on species
MYIASIS
102
**Chiggers -- Scrub itch**
agent = **harvest mite** -- bite thin areas of skin
severly prutitic papules or vesicles
Trombidiosis
103
# What is the causative agent?
Patient presents with a **visibly lumpy jaw**; oral/fascial abscesses that that drain through sinus tracts with **yellow sulfur granules**
Ac+inomyces israelli
| Bacterial Infection
104
# What is the causative agent
Pt. said they were **scratched by a cat** and now presents with **bacillary angiomatosis**
| Tx: Erythromycin or Doxyclcline
BartoNellosis
105
# What is the causative agent?
Pt. is a **butcher** recently handling **contaminated raw fish and meat.** Presents with violaceous lesions with raised margins b.w fingers and spares
| TX: Penicillin
ERYSIPELOID
(Erysipelothrix rhusiopathiae)
106
# What disease?
Patient was recently in contact with **infected horses**, now has **ulcerated nodule** with **regional lymphadenopathy**
GLANDERS
107
# What disease?
Child comes in **petechiae** on his extremities, which is progressing to **ecchymotic**
| Tx: ICV penicillin or ceftriaxone
Meningococcemia
108
# What disease?
Pt. presents with **1-3 mm pits on plantar surface of feet**
| Tx: Topical erythromycin, clindamycin, or benozyl peroxide
Pitted Keratolysis
| Kytococus Sedentarius
109
# What disease?
Patient presents with **erythematous macules or papules and fever**. Was possibliy in contact wiith **rats** and or contaminated food.
Rat bite Fever (Haverhill fever)
| Streptobacillus moniliformis
110
# What disease
Patient presents with **hypertrophic plaques on nares**
| Histopath shows MIKULICZ cells
Rhinoscleroma
(Klebsiella pneumoniae)
111
**S. aureus** produces what?-- which can produce **bullous** or **exfoilative skin lesions**?
| TSS, Staph. scaled skin syndrome, bullous impetigo, scarlet fever
EXOTOXINS
112
Enanthem vs. Exathem
Enanthem = rash **INSIDE** body : **strawberry tongue/exudative pharynigitis**
Exanthem = **diffuse** erythematous rash with **sandpaper texture** that starts on head and neck.spreads, circumoral pallow and pastiass lines
113
# What disease
Patient has **yellowish brown concretions on axillary hair shafts**
Trichomycosis Axillaris
(Corynebacterium tenuis)
114
Patient presents with **solitary lesion** and has **no sensory loss**
Leprosy
(Mycobacterium leprae)
115
Pt. comes in with **bright pink, painful nodules on UE/LE and face**
Type 2 Erythema Nodosum leprosum
| Tx = Thalomide
116
Hematogenous **spread of mycobacteria from fulminant tuberculosis** of the lung or meninges
| **exposure to contaminated surgical instruments**
Miliary tuberculosis of the skin
117
# Swimming pool
Begins as a **small papule at the site of inoculation** and **evolves into a nodule** or granulomatous plaque
| Tx: Minocycline
**Pool**/Aquarium Granuloma
118
# Exposure to humidity, moisture, warmth, and **increased CO2 tension**
sharply demarcated **hyper/hypopigmented macules** with slight scaling on neck, shoulders, chest, back, and abdomen
| Histo: spaghetti/meatball → turns into hyphae and spore ), + Woods lamp
Pityriasis/tinea versicolor
(Malassezia)
119
**black** ,firm, **adherent** concretions
**white**, soft, **nonadherent** small concretion.
Both found on scalp, beard, moustache, and beard areas.
Tinea piedras
120
**arthroconidia** **invade interior of hair shaft**
**black dots are remnants of brittle hair broken** at the surface of the scalp
Endothrix - Black Dot Ringworm
121
**chronic infection of the scalp** - begins during childhood
**Yellowish cup shaped crusts** made up of hyphae and keratinous debris
FAVUS (t. schoenleinii)
122
dermatophyte infection of the nails
* AIDS Marker *
Onychomycosis
Tinea Ungium
123
How do you treat tinea?
With antifungals only NOT systemic steroids
124
# Gardening, farming, being **florist** ( organism lives in soil )
fixed cutaneous = lesion without lymphatic spread, occurs with prior exposure vs. lymphocutaneous = subcutaneous macules and papules that follow the shape/flow of lymph vessels, ulceration with lymphatic spread usually on hand, forearm, and leg
| “Cigar bodies/ asteroid bodies
Sporotrichosis ( from sporothrix schenckii
125
# found in Tropic of Cancer
Penetrating wound in the foot
Presents as : Subcutaneous abscesses
Mycetoma/ madura foot
126
# from soil saprophytes, decaying vegetation / Found in tropics/subtropics
**Cauliflower-like tumors** that can conjoin, irregular verrucous plaques, annular nodules with central clearing
| Histo:“**Copper** pennies
Chromoblastomycosis/ Verrucous dermatitis
127
# associated with **bottlenose dolphins**
** Painless keloids**, nodules, ulcers, and verrucous lesions on face and UE
| Biopsy: “Chain of coins”/ “brass knuckles”
Lacaziosis/Keloid Blastomycosis/Lobo’s Disease
128
**Exposure to soil with bat, bird, and/or chicken droppings**
Cutaneous manifestations in AIDS = general macules, papules, nodules, ulcers, that are **molluscum-like**
| Primary cutaneous ( rare )= chancre with lymphadenopathy
Histoplasmosis/Cave Disease
129
Symptoms: Acts like virus causing resp disease/ cough/ fever & causes chronic pulmonary symptoms that mimic pneumonia
**Gilchrist’s Disease**: primary cutaneous manifestation
Blastomycosis ( from Blastomyces dermatitidis
130
# **found in Southern California, Arizona, New Mexico, SW Texas**
Asymptomatic, self-limited resp infection or pulmonary manifestation with flu-like symptoms
Cutaneous ( rare )= chancre-like lesion with lymphadenitis
Disseminated cocci ( rare ) = papules, pustules, nodules on face, scalp, neck
Coccidioidomycosis/ San Joaquin Valley Fever
from Coccidioides immitis
131
# found in **Brazil**
Skin symptoms: Papules, vesicles, crusty granulomatous lesions
Biopsy: “**Mariner’s Wheel**” ( large thick round cells with buddings attached to mother
Paracoccidioidomycosis ( from Paracoccidioides brasiliensis
132
# found in SE Asia
Skin symptoms:** Molloscum-like**, mucocutaneous lesions Biopsy: Intra/extracellular oval/round yeast shaped
Penicilliosis ( from Penicillium marneffei)
133
# **encapsulated and found in pigeon droppings**
Primary cutaneous = sentinel of disseminated disease ( to the CNS, bone, skin, lungs )
Cutaneous symptoms ( 10-15% of HIV patients )= nodules, papules ulcers, cellulitis, molluscum-like on head, neck ,mouth, and nose
Cryptococcosis ( Cryptococcus neoformans, gatti )
134
# MOST COMMON FUNGAL OPPORTUNISTIC INFECTION
increased risk if impaired epithelial cell barrier, systemic illnesses, catheters, heat, and humidity *
Skin symptoms: Thrush ( tongue ),perleche, vulvovaginitis/balanitis, folliculitis, onychomycosis
Cutaneous: papulonecrotic eschars and purpura
| Biopsy: budding yeast with pseudohyphae
Candidiasis ( from Candida albicans
135
# 2nd MC cause of opportunistic infection, found in leaves, grain soil
Starts in lungs usually
Cutaneous manifestations = Usually due to trauma; erythematous macules, papules, and plaques → turn into hemorrhagic bullae and ulcerations with central necrotic eschar
Aspergillosis
136
# **caused by acholoric algae in stagnant water**
Skin symptoms: Papules, plaques, vesicles, cellulitis, eczematoid dermatitis, verrucous nodules. 1⁄3 of cases also causes olecranon bursitis
Protothecosis ( from prototheca wickerhamii )
137
3 Pathogenesis of ACNE
1. Keratinocyte proliferation
2. Excessive sebum production
3. Cutibacterium acnes
138
gram positive non motile rod found deep within the sebaceous follicle
CUTIBACTERIUM ACNES
139
this acne treatment:
**normalization of follicular keratinization and corneocyte cohesion** which aids in the expulsion and existing comedones and prevents formation of new ones
Have **anti-inflammatory** properties
RETINOIDS
140
# acne treatment
potent bacteriocidal agent that reduces P. acnes within the follicle
Benzoyl Peroxide
141
**naturally occurring dicarboxylic acid** that inhibits protein synthesis of P. acne
- Also aids in reversing the hyperkeratosis or the hair follicles, thus decreasing microcomedo formation
AZELAIC ACID
142
bacteriostatic agent that **inhibits folic acid synthesis** by competing with para-aminobenzoic acid
Dapsone
143
What drug can cause blue pigmentation of teeth and nails?
MINOCYCLINE
144
**analog of Vitamin A**; **oral therapy effective to induce long-term remission of acne;** dosing = 0.5-2 mg BID; should get 120-150 mg/kg over their treatment course
| Can cause teratogenicity and toxicity:
Isotretinoin
145
tumors contains **FXIIIa positive** dermal dendritic cells
| appear at **firm tan brown papiles -- often flat**
Benign Fibrous Histiocytoma = Dermatofibroma
| hyperplasia and tendency of fibroblasts to surround collagen bundles
146
# Pathogenesis: Molecular Hallmark
* Translocation: gene encoding for **collagen 1A1 (COL1A1)** and platelet-derived growth factor-beta (PDGFB)
* Resulting Rearrangement: Juxtaposition of COL1A1 promoter sequences and the **coding region of PDGFB**
* Overexpression and increased secretion of PDGFB: drives tumor cell growth through autocrine loop
Dermatofibrosarcoma protuberans
147
Tumor consists of flesh-colored fibrotic nodule on sectioning. Lesions often infiltrates the subcutis in a manner reminiscent of “**swiss chess**” to adicionades. Characteristic **storiform (swirling) alignment** of the spindled cells is apparent
Dermatofibrosarcoma protuberans
148
Intracellular **accumulation of cholesterol** within macrophages
**Foamy cell clusters**: subepithelial connective tissue of skin; tendons
| Depositions of yellowish cholesterol rich material
Xanthomas
| Associated condition: **cholestasis**
149
**local dilation** of a structure vs **permanent dilation** of preexisting small vessels
**Ectasis** v. **Telangiectasia**
| spider telan. = arrays of dilated subcut. arteries- **blanch w press**
150
**Mutation: TGF-beta signaling pathway genes**
--> **dilated capilaries and veins** - present at birth
Hereditary Hemorrhagic Telangiectasia = **Osler-Weber-Rendu disease**
151
common tumors
**Increased number of normal and abnormal vessels filled with blood**
| 3 types: capillary, juvenile, cavernous
**Hemangiomas**
152
Most common type of hemangioma
* made up of thin-walled capillaries with **scant stroma**
* occur in skin, subcut. tissue, mucous membranes
CAPILLARY Hemangioma
153
**Strawberry type hemangiomas** of the newborn
Fade by 1-3 years of age and **completely regress by age 7** in most cases
Juvenile Hemangioma
154
# What type of hemangioma
- Rapidly growing red lesion of skin, gingiva, and/or oral mucosa
- **Bleed easily and ulcerate**
- **Develop after trauma**
Cavernous Hemangioma -- **Pyogenic Granulomas**
155
Two types of **angiosarcomas**
associated with **carcinogenic exposure**
| Malignant Tumor
Organ associated and cutaneous form
156
This type of angiosarcoma begins as **multiple deceptively small nodules that become
asymptomatic red papules**
- Color: fleshy masses of **red-tan to gray-white tissue**
- Margins blur surrounding structures
- Central areas of necrosis and hemorrhage
Cutaneous Angiosarcomas
157
T cell lymphoma that presents in skin → Lymphoma - Characteristics:
- Erythematous plaques early in disease
- Appear on trunk, extremities, face, and scalp - Size of nodules correlates with spread
Mycosis Fungoides/Sezary Syndrome
158
Pathology of what disease has **Pautrier's Microabscess**
Sezary Syndrome
159
a group of idiopathic disorders:
Letterer-Siwe disease
Hand Schuller Christian Syndrome
Localized Eosinophilic Granuloma
**Langerhans Cell Histiocytosis**
160
this disease occurs before age 2/ocasionally adults
* Cutaneous lesions resembling a seborrheic eruption - infiltrates of LCs; front/back of the trunk, scalp - Hepatosplenomegaly
* Lymphadenopathy
* Pulmonary lesions
Letterer-Siwe disease
(Multifocal Multisystem)
| Langerhans Cell Histiocytosis
161
**2nd MC tumor of sun-exposed sites in older people**
- Higher incidence in M > F
- Premalignant condition: **Actinic keratosis**
- Invasive/metastasize
| Path: **UV induced DNA damage to squamous cells** defect in p53/RAS
Squamous Cell Carcinoma
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Most common invasive cancer in human
- rarely metastasizes
- Incidence: increase in immunosuppression, increase in **xeroderma pigmentosum**
| Present as pearly papules
Basal Cell Carcinoma
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Do basal cell carcinomas occur on mucosal surfaces?
NO -- arise from the **epidermis or follicular epithelium**
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pathogenesis of **basal cell carcinomas** is due to **mutations** in what?
mutations in p53
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What is the **morphological progression of melanocytic nevi** ?
Junctional --> Compound --> Intradermal
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What's unique about Intradermal Nevi
Undergo maturation = **NEUROTIZATION**
- **Fusiform cells**
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# What type of NEVUS?
* non-nesting/dermal infiltration/fibrosis
* heavily pigmented
| CLINCALLY CONFUSED WITH MELANOMA
BLUE NEVUS
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# What type of NEVUS?
* fascicular growth pattern
* plump and fusiform cells with pink-blue cytoplasm
| **clinically confused with hemangiomas**
SPITZ NEVUS
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# MRA Drug
**MEK inhibitor** indicated for melanoma with **BRAF** mutations
TRAMETINIB
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# MRA Drug
BRAF protein kinase inhibitor
Dabrafenib
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# What type of basal cell carcinoma presentation?
flush with skin, erythematous , scaly +/- shallow ulcer or crusting
Superficial Basal Cell Carcinoma
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# What type of basal cell carcinoma presentation?
“**enlarging scar**”, white/yellow plaque with poorly defined borders *more aggressive growth* , induration ( thickening/hardening of skin )
Morpheaform Basal Cell Carcinoma
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Surgical excision of what size lesion margins have shown 5 year cure rates exceeding 95%
4-5mm margins
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When is it most appropriate to use **electrodesiccation and curettage**?
low risk superficial or nodular BCCs on the trunk or extremities
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tumor suppressor gene on chrom 9
PTCH1
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**Merkel Cell Cancer** is linked to what virus?
| more aggresive than melanoma
Polyomavirus
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# Merkel cell Carcinoma -- 90% involve 3 factors
AEIOU
Asymoptomatic
Expanding rapidly
immunosuppresive
older patients > 70 yo
UV exposure
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# appearance of sqamous cell carcinoma
actinic keratosis =
scaly plaque
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squamous cell carcinoma mainly affects what areas?
ears, lips, temples, upper face and dorsum of hands
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# clinical presentation of SCC
Variant that grows rapidly ( 4-6 weeks ) and then spontaneously resolves =
KERATOACANTHOMA
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# clinical presentation of SCC
Ulcerating variant of SCC predisposed by chronic unstable burns/scars & draining osteomyelitis. Can metastasize rapidly after resection.
Marjolin's Ulcer
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# TNM Staging
T1 < 1mm
T2 = 1.01-2 mm
T3= 2.01-4 mm
T4 > 4 mm
a= no ulcerations b= ulcerations
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# TNM staging
N0= no lymphatic metastases
N1= 1 lymph node involved
a= micrometastases
b= macrometastases N2
a= 2 lymph nodes involved
b= 3 lymph nodes involved N3= 4+ positive nodes
M= Distant metastases
M0= no distant metastases
M1=
a= metastases to distant skin, subcutaneous, and LN sites with normal LDH (LDH= sign of tissue damage ) b= lung metastases with normal LDH
c= metastases to other visceral sites with normal LDH or any metastases with
elevated LDH
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# TNM staging
N0= no lymphatic metastases
N1= 1 lymph node involved
a= micrometastases
b= macrometastases N2
a= 2 lymph nodes involved
b= 3 lymph nodes involved N3= 4+ positive nodes
M= Distant metastases
M0= no distant metastases
M1=
a= metastases to distant skin, subcutaneous, and LN sites with normal LDH (LDH= sign of tissue damage ) b= lung metastases with normal LDH
c= metastases to other visceral sites with normal LDH or any metastases with
elevated LDH
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"itching condition"
T-cell mediated inflammatory disease
main issue = proliferation of keratinocytes
PSORIASIS
Keratinocyte injury/infection → increase of proinflammatory cells ( i.e. APCs ) that activate
T cells → T-cell mediated: CD4+ Th17 and Th1 cells & CD8+ T cells secrete growth
factors that cause keratinocyte hyperproliferation → leads to the formation of lesions
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# Histopath of Papulosquamous Rash:
**Acanthosis** = epidermal thickening
Increased epidermal cell degeneration ( leading to decreased epidermal thickening) above areas
of elongated dermal papillae
- Neutrophil aggregation in superficial epidermis
PSORAIAS
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Auspitz's sign
| Clinical feature of psoriasis
pinpoint bleeding when scale is removed
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# 6P's describe this skin disorder
Pruritic, purple, polygonal, planar papules, and plaques
Lichen Planus
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# Pathology of what skin disorder?
autoimmune disorder results from **CD8+ T cell mediated cytotoxic triggered** against antigens in the basal keratinocyte cells and the dermo-epidermal junction --:> INFLAMMATION and necrosis
LICHEN PLANUS
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# Clincal presentation of which skin disorder?
**Wickham Striae** = papules have whites dots or lines
Melanin from damaged keratinocytes gives the lesions black color
Lymphocytes infiltrate dermoepidermal junction
**Zigzag Contour**
**Civatte bodies/Colloid bodies** = annucleate, necrotic basal cells seen in inflammed paillary dermis
Lichen Planus
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known as **balanitis xerotica obliterans** (BXO) when it affects the penis
lichen sclerosis
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Erythematous, scaly plaques with hyperpigmentation. Can lead to scarring, dyspigmentation, and alopecia if scalp is involved
Etilology = sun exposure, smoking, MHC-II/HLA-8, DR3, DR2 genetic associations
Histopath = epidermal atrophy, effacement of rete ridges, hyperparakeratosis, follicular kertoti plugging and basement membrane thickening with vacuolar interface change
Discoid Lupus erythematous (DLE)
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**Oval shaped erythematous**, very pruritic, plaques/lesions with **well-defined borders** that occur on **upper and lower extremities **(drying of skins → causes lesions to recur at previously involved sites ) with scaling, oozing, and crusting
Nunmular Eczema = coin shaped eczema
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exanthematas skin disease characterized by diffuse, scaling papules in T-shirt distribution after a viral prodrome
seen in young pateitns esp. women
Etiology = drug induced reactions
Pityriasis rosea
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skin disorder primarily affects areas with sebaceous glands
- craddle cap in infants
- caused by a rxn to pityrosporum yeast on the skin
Seborrheic dermatitisi
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ruffled sock appearance
loose anagen (cuticle folded back)
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trichotillosis
habitual pulling and plucking of hairs
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minoxidil and finasteride can be used in treatment of what?>
Alopecia
