Path: Skin

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created 6 years ago by jgaversa5
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updated 6 years ago by jgaversa5
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1

where do basal cell carcinomas come from

stratum basale

2

what does the stratum spinosum have

prickle cells/acanthocytes

3

what are the majority of the cells in the stratified sqamous epithelium

stratum spinosum

4

what is stratum lucidum prominent in

thick skin (clear zone)

5

should the stratum corneum have nuclei

no just layers of keratin

6

what are the keratinocyte layers in order

basale
spinosum
granulosum
lucidum
corneum

7

what are the cells of the epidermis not the keratinocytes

melanocytes
langerhans cells
merkel cells

8

what are the appendages in the epidermis

hair follicles
sebaceous gland
eccrine
apocrine

9

what are the dermis' areas

papillary
reticular

10

what are the APCs of the skin

langerhans cells

11

what are the merkel cells of the skin

neuroendocrine cells

12

what is another name for the hair follicle

pilosebaceous apparatus

13

what part of the dermis inter-reticulates wit the epidermis

papillary dermis

14

what does the reticular dermis have a lot of

reticular fibers

15

what is vitilligo

lack of pigmentatino

16

what do xanthomas relate to

hypercholesterolemia and hyperlipidemia

17
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what are all the areas here

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there you go

18

are epithelial layers named by the bottom layer or top laeyr

top (stratified squamous instead of stratified columnar)

19

what connects stratum spinosum to one another

tonofibrils

20

where does keratin begin in the skin

granulosum

21

what is true of stratum corneum in thick skin

it is thicker than the rest of the layers

22
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where is the langerhans cell

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boom

23

where are there eccrine sweat glands

everywhere

24

where are apocrine sweat glands

axilla and groin

25

what type of things are included in apocrine sweat

protein

26

what is a macule and what is a papule

flat lesion
bumpy lesion

27

what is a macule

circumscribed lesion of <5mm in diameter characterized by flatness and usually disoclored

28

what is a patch

circumscribed lesion of >5mm in diameter characterized by flatness and usually disoclored

29

what is a papule

elevated dome shaped or flat topped lesion <5mm acrooss

30

what is a nodule

elevated lesion with spherical contour >5mm across

31

what is a plaque

elevated flat topped lssion, usually >5mm across

32

what is a vesicle

fluid filled raised lesion <5mm across

33

what is a bulla

fluid filled raised lesion >5mm across

34

what is blister

common term used for vesicle or bulla

35

what is a pustule

discrete, pus-filled, raised lesion

36

what is a wheal

itchy, transiet, elevated lesion with variable blanching and erythema formed as a result of dermal edema

37

what is a scale

dry, horny, plate-like excrescence usually the result of imperfect cornification

38

what is lichenification

thickened and rough skin characterized by prominent skin markings, usually the result of repeated rubbing in susceptible persons

39

what is excoriation

traumatic lesion characterized by breakage of the epidermins causing a raw linear area

40

what is onycholyssi

separation of nail plate from nail bed

41

what is hyperkeratosis

thickening of stratum corneum, often associated with a qualitative abnormality of the keratin

42

what is parakeratosis

modes of keratinization characterized by the retention of the nuclei in the stratum corneum; on mucus membranes, parakeratosis is normal

43

what is hypergranulosis

hyperplasia of the stratum granulosum, often due to intense rubbing

44

what is acanthossi

diffuse epidermal hyperplasia

45

what is papillomatosis

surface elevation caused by hyperplasia and enlargement of contiguous dermal papillae

46

what is dyskeratosis

abnormal keratinization occuring prematurely within individual cells or groups of cells below the stratum granulosum, generally the same as dysplasia

47

what is acantholysis

loss of intercellular connection resulting in loss of choesion between keratinocytes

48

what is spongiosis

intercellular edema of epidermis

49

what is hydropic swelling (ballooning)

intercellular edema of keratinocytes

50

what is exocytosis

infiltration of the epidermis by inflammatory or circulating blood cells

51

what is erosion

discontinuity of the skin exchibiting incomplete loss of epidermis

52

what is ulceration

discontinuity of the skin exhibiting complete loss of the epidermis and often of portion of the dermis and even subcutaneous fat

53

what is vacuolization

formation of vacuoles within or adjacent to cells; often refers to basal cell basement membrane zone area

54

what is lentiginous

referrring to a linear pattern of melanocyte proliferation within the epidermal basal cell layer; lentiginous melaocytic hyperplasia can occur as a reactive change or as part of a neoplasm of melanocytes

55

what is the skin defined as

keratinized stratified squamous epithelium with skin appendages

56

what other places in the body have stratified squamous epithelium

esophagus and cervix

57

what other part of the body also has keratinized stratified squamous epithelium

hard palate

58

what are some pigemtnation disordres

vitiligo
freckles (ephelis)
melasma
lentigo
nevus
dystplastic nevus
malignant melanoma

59
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what is this

vitiligo

60

what would also behave like vitiligo but would clear up

post=inflammatory hypopigmentation

61
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what is going on here

melasma

62

what is another name for melasma

mask of pregnancy

63

what is lentigo

brown pigmented spont on the skin, a benign hyperplasia of melanocytes taht is linear in its spread

64
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what is this

lentigo

65

would lentigo be palpable

no

66
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what is this

lentigo

67

will lentigo be palpable

no

68

what are the main things to differentiate nevi from melanomas

junctional (more pigmented, more closely associated with melanoma

intra dermal

compound

69

do nevi have to be hyperpigmented

no

70
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what is this

intradermal nevus

71
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what is this

intradermal nevus

note the lack of "junctional activity"

72

why is the above nevus not pigmented

mostly by the epidermal/dermal jucntion

73
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what is this

junctional nevus

74
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what is this

junctional nevus

75

what would a compound nevus be

both junctional and intradermal

76

what are most of the things that are confused with malignant melanoma

junctional nevi

77

what is malignant melanoma related to

sun

78

what is the only primary skin cancer that can kill you (except rare merkel cell tumor)

malignant melanoma

79

what growth phases exist in malignant melanoma

both vertical and horizontal

80

what is prognosis of malignant melanoma related to

vertical growth, breslow staging, TNW

81

is it difficult to differentiate malignant melanomas from nevi clincally and microscopically

yes

82

what are malignant melanoms a proliferation of

melanocytes

83
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what is this

malignant melanoma

84

what is teh ABCDEFG principle of malignant melanoma

asymmetry
borders (irregular)
color (variegated)
diameter (greater than 6 mm)
evolving over time

NODULAR MELANOMA
elevated above the skin surface
firm to the touch
gorwing

85
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what is this

malignancy: ipgment is MELANIN

86

what are the benign epidermal tumors

seborrheic keratosis
acanthosis nigricans
fibroepithelial polyp (skin tag
epidermal cyst
adnexal tumors: eccrine, apocrine
keratoacanthoma

87
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what is this

saborrheic keratosis

88
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what is this

seborrheic keratosis

89
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what is this and what are the circles

seborrheic keratosis

horn cysts

90
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what is this

acanthosis nigricans

91
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what is this

acanthosis nigricans

92

what is acanthosis nigricans associated with

diabetes mellitus

93

where are the skin folds in acaanthosis nigricans

axilla, neck

94
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what is this

fibroepithelial polyp/skin tag

95
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what is this

fibroepithelial polyp

CT with dermis covered by skin that pops up

96
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what is this

epidermal inclusion cyst

97
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what is this

epidermal inclusion cyst

98

what are adnexal tumors

hair follicles
sebaceous glands
sweat glands (eccrine, apocrine)

99

are adnexal tumors malignant

no, almost all benign

100

what is the main lesion to differentiate from SCC

keratoacanthoma

101
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what is this

keratoacanthoma

102
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what is ithis

keratoacanthoma

103
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what is this

keratoacanthoma

104

what is a collarette

classical feature which differentiates KAs from SCCs

looks like a volcanic crater

105

what is included in the premalignant/malignant skin cancers

actinic keratosis
SCC
BCC
merkel cell carcinoma

106

what is the precursor to SCC

actinic keratosis

107

which skin cancer shows "pearls"

SCC, also shows intercellular bridges

108

what are the most common premalignant/malignant skin cancers

BCC

109

what skin cancer is associated with BCC

blue palisading nests

110

what does merkel cell carcinoma look like

small cell carcinoma of the lung

111

what is "farmer's ear"

BCC

112

are BCCs and SCCs releated to the sun

yes

113

what is SCC related to

As, carcinogens, chaw, betel nut, HPV

114

what type of damage do both SCC and BCC do

local damage, rarely mets or kill

115

what do merkel cells act like

melanomas

116
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what is this

actinic keratosis

117
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what is this

actinic keratosis

118

what does actinic keratosis lead into

SCC in situ of skin (bowen's disease)

119
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what is this

SCC

120

what is the name for SCC IS

Bowen's disease

121

does SCC have a collarette

no

122
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what is this here

SCC

PEARLS: well differentiated

123
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what is this

squamous dysplasia

maybe actinic keratosis leading into SCC

124

what is the most common malignancy of skin

BCC

125

what do stratum basale cells look like they are doing

palisading

126

what are the classic BCC places

behind ear and on nose

127
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what is this

BCC (note peripheral palisading)

128

why are BCCs blue

because bassl cells have a greater percentage of nucleus to cytoplasm

129
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what is this

merkel cell tumor

130

is a merkel cell tumor rare and usually malignant

yep

131

what does MCC look like

small cell carcinoma of the lung

132

what are the dermis tumors

dermatofibroma
dermatofibrosarcoma protuberans
malignant fibrous histiocytoma
xanthmoa
vascular tumors

133

why are there no fibromas in dermis tumors

because tumors of pure fibroblasts of the dermis are rare

134
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what is this

benign fibrous histiocytoma or dermatofibroma

135
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what is this

benign fibrous histiocytoma or dermatofibroma

136
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what is this

malignant fibrous histiocytoma

137
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what is this

xanthoma

138

what are xanthomas filled with

cholesterol and lipids

139
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is this a malignant tumor

no: xanthoma filled with cholesterol and lipids

140
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what is this

hemangioma

141

what are hemangiomas

congenital birth marks that can regress with againg

142

what is a red lesion that blanches when you put pressure on it suspected to be

vascular tumor

143
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what is this

Kaposi's sarcoma

144

what causes kaposi's sarcoma

HHV 8

145

what might you have to do for kaposi's sarcoma

factor 8 stain

146

what are some some cellular "immigrants" in the skin cancers

langerhans cells (histiocytosis)

mycosis fungoides (T cell cutaneous lymphoma)

mastocytosis (mast cell tumors)

147
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what is this

ichthyosis

148

what is often common in icthiosis

lamellar

149

what are some acute dermatoses

urticaria
eczema
erythema multiforme

150

what are some chronic dermatoses

psoriasis
seborrheic dermatitis
lichen planus
lupus erthymatosus

151

what are dermatoses

inflammatory skin diseases

152

can dermatoses be diagnosed just looking at microscope slide

nope

153

what is urticaria

dermal edema

154

what happens in urticaria

dilation of vascular spaces

early perivascular cuffing of inflammatory cells

155

what is urticaria synonymously used with

type I hypersensitivity

156
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what is this

urticaria (hives)

157

what is the classic skin response to type I hypersensitivity

urticaria

158

what is eczema

myriad of acute inflammatory disorders with allergic, drug related, sun related etiologies

159

what is the common histologic feature of eczema

spongiosis

160

what if there is a rash that is both flat and bumpy

maculopapule rash

161

what is spongiosis

intercellular edema of epidermis

162
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what is this

eczema (keratinocytes on the right are more spread out)

163
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what is seen here

pustules (extreme spongiosis)

- if just water: blister/bulla

164
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what are these

ulcerated pustules

165
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what is this

erythema multiforme

166

what is erythema multiforme due to

unknown cause, possibly mediated by deposition of immune complex (IgM) in superficial microvasculature of skin and oral mucus membrane that usually follows an infection or drug exposure

167

what could erythema multiforme be related to

extreme urtricaria

168

how much of US has psoriasis

1-2%

169

where is psoriasis most common

elbows, knees

170

what is keratosis really

parakeratosis, genrealized epidermal hyperplasia, elongation of rete pegs, extensive chronic inflammatory cell infiltrates, munro intraepidermal microabscesses

171
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what is going on here

classical psoriasis

172
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what is this and what is it common in

seborrheic dermatitis

HIV

173

what disease cause pigmentary incontinence

lichenoid disorders

via melanophages, NOT melanocyte

174

what happens in lupus

antibodies vs. DNA

175
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what is this

stasis dermatitis

176
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what is this

stasis dermatitis

177

is purple stasis dermatitis more severe

yes

178
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what is this

stasis dermatitis

179
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what is this

stasis dermatitis

180

what will stasis dermatitis show

hyperpigmented lesions and can vary in severity (ulcerations even)

most common in places that are vulnerable to arterial ischemia

181

what are bullous diseases

pemphigus (vulgaris)
bullous pemphigoid
dermatitis herpetiformis
epidermolysis bullosa
porphyria
acantholysis

182

what is the common unifying finding of the bullous diseases

acantholysis
basement membrane immunoglobulins

183

what is a bulla

fluid filled raised lesion greater than 5 mm across

184

what is acantholysis

loss of intercellular connections resulting in loss of cohesion between keratinocytes

185
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what is this

pemphigus, fresh bullae

186
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what is this

pemphigus, ruptured and scabbed bullae

187
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what is happening here

acantholysis in the bullous family of diseases

188

what are the "acanthocytes" of the skin

stratum spinosum

189

where can separation be in acanthosis

stratum spinosum or dermal/epidermal junction

190

what are many of the bullous diseasae disesaes of

basement membrane and tonofibrils

191

what is the bread and butter of dermatology

acne vulgaris

192

what is main feature of acne vulgaris

sebaceous duct blockage with secondary inflammation is main feature

193

what breask down sebaceous oils

propionibacterium acnes, resulting fatty acids act as irritants

194

what is acne then

folliculitis

195
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whats this

ACNE!

196

what are two versions of panniculitis

erythema nodosum
erythema induratum

197

how many causes have an unknown cause of EN

30-50%

198

what is EN associated

many diseases
TB, strep, myocplasma, yersinia, EBV, coccidiomycosis, sarcoid, IBD, autoimmune, pregnancy, meds, cancers

199

are there lots of granulomatous disease related to EN

yes

200

is EI related to some other disease

TB

201
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what is this

EN (red nodules on legs)

202
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what is this

erythema induratum

203

what is a panniculitis

primary inflammation of the subdermal CT/hypodermis/subcutis

204
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what is this

panniculitis

205

what are the infectious of the skin

verrucae (HPV)
mulluscum contagiosum
impetigo (staph, strep)
fungi
arthropods

206

how manay viruses besides HPV can you think of which cause squamous proliferations in ANY part of the body

not many

207

what is a wart caused by

epidermal proliferations due to virus usually

208
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what is going on here

papillomatous epidermal hyperplasia of WARTS and hypergranulosis at bottom

209

what type of virus is molluscum contagiosum

pox virus

210
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what is this

molluscum contagiosum

211
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what is this

molluscum contagiosum

212

how does molluscum contagiosum progress

red to purple to blue

213
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what is this

impetigo

but could be HSV 1 or 2 also

214

what are the tineas

capitis
barbae
corporis
cruris
pedis
onychomycosis

215

what species causes the tineas

trichophyton
microsporum
epidermophyton

216
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what have we here

ringworm of scalp: tinea capitis

217
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what is going on here

tinea barbae

218
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what is going on here

tinea corporis

219
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what is going on here

tinea cruris

220

what is this

tinea pedis

221

if your patient has a gangrenous toe, which one is most likely

toe 5

222
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what is this

onychomycosis

223
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what is prominent in this histologic slice

hyphae (PAS stain)

224

what do arthropods do typically

bites
stings
infestations

225

what scabies are of medical importance

scabies
pediculosis
demodex
ticks, mites

226

where is scabies most common

knuckles

227

what is another name for body lice

pediculosis

228

what is another name for pubic louse

phthrius pubis

229

where do mite larva like to live

hair follicle/next to hair shaft

230

why is a mite an arachnid and not an insect

8 legs

231
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what is this

tick