Skin Flashcards
(80 cards)
1
Q
Benign epithelial tumors
A
Seborrheic ketatosis
acanthosis nigricans
epidermal cyst
2
Q
Seborrheic ketatosis
A
loos like melanoma
older indiv
light brow/flat - pale brown w/ pink tones to dark brown/black
velvety or waxy to finely verrucous surface
looks stuck on, Crumbles with scraping
Leser trelat - eruptive, multiple assoc w/ internal malignancy
Subtype in African americans: dermatosis papulosa nigra
Histo:
- exophytic
- basaloid cells
- pigmented
- exuberant keratin production
- HORN CYSTS (keratin filled)**
- loose lamellar “shredded-wheat” or “onion-skin” keratin
3
Q
Dermatosis papulosa nigra
A
-
4
Q
acnathosis nigricans
Benign vs malignant
A
- hyperpigmentation
- hyperplasia - spinosum layer – thick and velvety
- folds - neck axilla groin
Benign - childhood/puberty - endocrine abnormality (DM)
Malignant - middle-age/older - visceral malignancy (cancer)
indication of underlying disorder
5
Q
Epidermal cyst
A
-
6
Q
Melanoma
A
Superficial spreading Lentigo maligna Nodular Acral Amelanotic
7
Q
Superficial spreading
A
a
8
Q
Lentigo maligna
A
a
9
Q
Nodular
A
a
10
Q
Acral
A
a
11
Q
Amelanotic
A
a
12
Q
Disorders of pigmentation and melanocytes
A
Hypopigmentation
Hyperpigmentation
13
Q
Hypopigmentation
A
a
14
Q
Vitiligo
A
a
15
Q
Hyperpigmentation
A
Freckle Lentigo Melanocytic nevi spitz nevus Dysplastic melanocytic nevus melanoma
16
Q
Freckle
A
a
17
Q
Lentigo
A
a
18
Q
Melanocytic nevi
A
a
19
Q
spitz nevus
A
a
20
Q
Dysplastic melanocytic nevus
A
large, oval, multiple
irregular pigment
Fading border “fried egg” - central papule with surrounding macule
Histo: compound, concentric papillary dermal fibrosis
Horizontally oriented nests w/ bridging of adj rete
nests are at tips/sides of rete
cytologic atypia: hyperchromatic, enlarged nuclei
potential precursor for melanoma
21
Q
Premalignant and malignant epidermal tumors
A
Actinitic keratosis
nonmelanoma skin cancer
22
Q
Actinic keratosis
A
Premalignant lesion assoc w/ sun exposure
earliest identifiable lesion that can develop into SCC (60%) - patient will follow up in 2-3 mo with ulcerated/thickened lesion
palpation key to diagnosis
Rough or “gritty” skin, discrete, scaly, feels like “broken glass” - surface lesion
found on sun exposed areas - face, scalp, ears, posterior neck, forearms, legs
Histo:
- parakeratosis in corneum
- hyperplasia and cytologic atypia of basal layer
- solar elastosis in superficial dermis
must BIOPSY to distinguish between AK and SCC
23
Q
Nonmelanoma skin cancer
A
Squamous cell carcinoma
Keratoacanthoma
Basal cell carcinoma
24
Q
Squamous cell carcinoma
A
Oral
Verrucous
25
Keratoacanthoma
benign epithelial tumor
looks like SCC
sudden on actinically-damaged skin
rapid growth
spontaneosly regresses in few months
Red to flesh colored, dome-shaped papule w/ central crater filled w/ keratin plug
Histo
- large, red, glassy squamoid cells
- neutrophil microabscess common
- eosinophils and lymphocytes in surrounding infiltrate
cant transform into SCC
Mohs micrographic surgery - remove tumor and thin rim of normal appearing skin around the diefect -- sectioned and labeled, frozen so examine while patient is in the office. Best long- term cure rate of any treatment modality
26
Basal cell carcinoma
Nodular
Superficial
Morpheaform
Most common malignancy
```
pluripotent cells in basal layer or follicular structures
slow growing. rarely metastasize
local destruction if neglected
excellent prognosis
non-healing lesion that bleeds
```
UV radiation imp risk factor
Histo:
- nests of basaloid cells that palisade at the border of the nest
- nests in fibromyxoid stroma
- nodules attach to undersurface of the epiderpis
- STROMA SEPERATES FROM TUMOR NODULES
27
Nodular BCC
MC - 60%
Face
```
Waxy w/ central depression
Pearly
erosion, ulceration, or crusting
bleeding w/ minor trauma
rolled border
translucency
Telangiectasia
```
28
Superficial BCC
Trunk
scaly
light red color
atrophic center with fine translucent micropapules on rim
29
Tumors of the dermis
Dermatofibroma
| Dermatofibrosarcoma protuberans
30
Dermatofibroma aka
Benign fibrous hisiticytoma
Very common
lower legs
slow growing
flesh colored-pigmented
"Dimple-sign"
pruritic
past trauma
Fibroblasts with collagen , hyperkeratosis and hyperpigmentation - reddish brown color
dermatofibrosarcoma protuberans
- primary fibrosarcoma of skin
- locally aggressive but rarely metastasize
- Hypercellular
- thinned epidermis
- into subcut fat "honeycomb" pattern
- fibroblasts in pinwheel pattern
31
Tumors of cellular migrants to the skin
Mycosis fungoides
| Mastocytosis
32
Mycosis fungoides
T-cell lymphoma
trunk
3 stages
3rd - nodule - tumor w/ systemic spread. deep into dermis
Histo:
sezary-lutzner cells - bands in superficial DERMIS (cd4+)
Pautrier microabscess - single/small cluster of invading cells in epidermis
33
Mastocytosis
Urticaria pigmentosa
Systemic mastocytosis
- Darier sign: wheal when lesion is rubbed
- Dermatographism: hive when normal skin is stroked
Sx - due to release of histamine, heparin, other mast cell contents
Mastocytoma: histo-
- metachromatic granules w/in dendritic mast cells
- monomorphous dermal infiltrate
- NO epidermotropism
- "Fried egg cells"
- Giemsa stain: purplish mast cells in dermis - the granules are purple
34
Urticaria pigmentosa
Children usually
>50% of mastocytosis
- multiple mastocytoma - round to oval, red-brown papules and plaques, pruritic, blister. shortly after birth
35
systemic mastocytosis
Adults usually
only abt 10% of of mastocytosis
similar to urticaria pigmentosa PLUS multi-organ mast cell infiltration: BM, liver, spleen, LN
Pruritis and flushing due to certain foods, drugs, EtOH, temp changes
36
Disorders of epidermal maturation
Icthyosis
37
Ictyosis
impair epidermal maturation
thick corneum w/ loss of basket weave
thick granular layer
except with icthyosis vulgaris - no granular layer
Congenital
Acquired
38
Congenital icthyosis
a
39
Acquired icthyosis
a
40
Acute inflammatory dermatoses
Urticaria
Acute eczematous dermatitis (aka spongiotic dermatitis)
Erythema multiforme (SJ, TEN, pitryiasis rosea)
Stasis dermatitis
41
Urticaria
Histo
- perivenular infiltrate - neuts then mononuclear cells
- Collagen bundles more widely spaced bc of edema fluid
- Dilated lymphatics
- no epidermal changes
42
Spongiotic dermatitis
Contact dermatitis
- irritant: direct toxic effect. not immunogenic. crust
- allergic: cell mediated. Type IV. produce urushiol. nickel. papule and scale
Atopic dermatitis - worse in winter. Very itchy. dry with oozing. diaper area, face. CHRONIC - lichenification - epidermal thickening and skin lines
begins at 1st yr of life. babies, children, adults - just different areas
Nummular dermatitis
- coin shaped, red plaques, young adults
Asteatotic dermatitis
- "winter itch"
- older people in winter. dry and cracked, itchy
Histo:
- spongiosis - intERcellular edema
- Exocytosis of lymphocytes in epidermis
43
Erythema multiforme
CD8+ attack
early -
superficial perivascular lymph infiltrate
dermal edema
lymphocytes at dermo-epi junction w/ degenerating and necrotic keratinocyte
later-
lymph migrate into epidermis, necrosis of epi and blister forms
target lesions
44
Stevens johnson
involves mucous membrane, mouth and conjunctiva
children > adults
fever, renal failure, sepsis, difficulty eating
sulfa, anticonvulsant
45
TEN
necrotic epidermis lifts off dermis - supepidermal bulla
macules
w/ or w.o target lesions
46
Pitryiasis rosea
HHV-7
herald patch - resembles ringworm
christmas tree pattern
patient feels well
not on face
trunk,upperarms, thigh
ithcy
spongiosis w/ erythrocyte extravasation
spontaneously remits - 6wks
47
Stasis dermatitis
- venous incompetence
inc hydrostatic pressure and extravasation of rbc
middle aged, older
incomp valves in lower legs
hyperpigmentation, edema, itchy, scaly, infl
ulceration above medial malleolus
Histo:
- chronic intercellular epidermal edema
- rbc extrav -- hemosiderin to collect --> thickened rough brown appearance
48
Chronic inflammatory dermatoses
Psoriasis
Seborrheic dermatitis
Lichen planus
SLE
49
Psoriasis
Auspitz sign - pinpoint bleeding
symmetrical
Koebner phenomenon-trauma and stress cause exacerbation
thin granulosum layer and parakeratosis in corneum
- nail involvement. oil spotting - brown, onycholysis - distal separation. also pitting and subungual hyperkeratosis
- arthritis
pencil in cup
50
Seborrheic dermatitis
cradle cap
dandruff
yellow, scaly, greasy patch w. erythema
common in parkinsons, hiv
parakeratosis near follicles
51
Lichen planus
5 Ps: pruritic PURPLE polygonal planar papules plaques
wrists/ankles/mucous membrane
Wickham's striae: fine, reticulated white lines
Koebner phenomenon
Hep C assoc
Histo:
- interface dermatitis - dense infiltrate of lymphocytes along dermoepidermal junction. the junction is more angulated zigzag (saw toothing)
- degeneration/necrosis of basal keratinocytes (Civatte bodies - incorporation into inflamed papillary dermis)
Self-limited.
mucous mem inv - longer course
52
SLE
african americans
females
30-40
sun, weightloss, cns, arthralgia
Malar rash - "butterfly" - macular eruptions w/ clear borders
multi sys involvmnt
SPARES nasolabial folds
immune complex deposit
False pos - RPR and VDRL
lichenoid interface dermatitis,
epidermal atrophy with thickened basal membrane
53
Blistering disease
Inflammatory
| Non inflammatory
54
Inflammatory blistering disease
Pemphigus vulgaris
Bullous Pemphigoid
Dermatitis herpetiformis
55
Pemphigus vulgaris
IgG
56
Bullous pemphigoid
IgG
57
Dermatitis herpetiformis
IgA
58
Noninflammatory blistering disease
Epidermolysis bullosa
| Porphyria cutanea tarda
59
Epidermolysis bullosa
a
60
Porphyria cutanea tarda
a
61
Disorders of epidermal appendages
Acne vulgaris
| Acne rosacea
62
Acne vulgaris
a
63
Acne rosacea
a
64
Panniculitis
Erythema nodosum
65
Erythema nodosum
a
66
Infection
Verrucae
Molluscum contagiosum:
self-limited, spontaneously remits in a few months. skin-skin, h. contagious. flesh colored/translucent. Cheesy core. anywhere in kids/genitals sexually active adults. Histo: cup-shaped, verrucous acanthosis - epidermal hyperplasia, molluscum bodies in corneum and granulosum - ovoid, homogenous, cytoplasmic inclusion bodies
Impetigo
Scabies
67
Verrucae
Vulgaris
plana
plantaris
condyloma acuminatum
68
Verruca vulgaris
a
69
Verruca plana
a
70
Verruca plantaris
a
71
Condyloma acuminatum
anogenital wart
72
Xanthelasma
a
73
Mongolian spot
a
74
Chediak-higashi syndrome
a
75
Cherry angioma
a
76
Hemangioma of infancy
a
77
Wiskott-Aldrich syndrome
a
78
Alopecia
a
79
Albinism
a
80
Xeroderma pigmentosum
a
