Professional Documents
Culture Documents
Learning Objectives
Understanding of burn types
Knowledge of skin lesion terminology
Discuss lesions of epithelium, melanocyte
and dermis within context of lesion
terminology and pathology
Understanding of reactive and hypertrophic
skin lesions
Knowledge of blistering and infectious lesions
Skin Histology
Cutaneous Burns
1st - degree, congestion, pain, vasodilation,
edema but no necrosis
2nd - degree, necrosis of epidermis but spares
dermis
Blisters separating epidermis from dermis
Partial thickness burn
Lesion Terminology
Flat Lesions
Macule
Less than 5 mm,
different color than
surrounding skin
Patch
Greater than 5 mm
Raised Lesions
Papule
less than 5 mm,
discrete solid elevated
lesion
Plaque
Greater than 5mm
Fluid-Filled Lesions
Vesicle
Less than 5 mm, fluid
may be clear, serous,
hemorrhagic or
purulent
Bulla
Greater than 5 mm
Pustule
Usually less than 5
mm, filled with pus
Crust
A hardened layer of
serum, blood or purulent
exudate on the surface of
skin
Eschar
Adherent thick, dry black
crust
Purpura
(skin hemorrhage)
Petechiae
1-2 mm, nonblanchable
macules resulting from
tiny hemorrhages
Ecchymosis
Collection of blood into
skin or mucous
membrane forming
macules and patches
Palpable purpura
Plaques of ecchymoses
Skin Loss
Ulcer
Loss of epidermis and
at least the upper
dermis
Erosion
Loss of epidermal or
mucosal epithelium
EPITHELIAL TUMORS OF
SKIN
Seborrheic Keratosis
Arise spontaneously in
adults
Round, flat, coin-like,
stuck on,
pigmented, velvety
papule
Exophytic proliferation of
basaloid cells above the
D/E junction
Hyperkeratosis,
acanthosis, horn cysts,
melanin pigmentation
Fibroepithelial Polyp
AKA skin tag, acrochordon,
squamous papilloma
Bag-like, flesh-colored protrusions
Fibrovascular core covered by
benign squamous epithelium
Axilla, neck, trunk, face,
intertriginous areas
A/W diabetes and intestinal
polyposis
Acanthosis Nigricans
Thickened hyperpigmented skin in flexural
areas
Acanthosis of epidermis, increased melanin pigment
Acanthosis Nigricans
Actinic Keratosis
Dysplasia of the squamous epithelium
secondary to sun exposure
Ionizing radiation, hydrocarbons, arsenicals
Actinic
Keratosis
Squamous Cell
Carcinoma
Rarely metastasize
Basal Cell
Carcinoma
Viral transformation
HPV sequences detected in precursors
Chemical Mutagens
Adnexal Tumors
Adnexal Tumors
Tumors arising from skin appendages
Cylindroma
Common on forehead
and scalp
Often multiple
Islands of basaloid
cells (puzzle pieces)
Fibrous matrix
Melanocyte Lesions
DISORDERS OF PIGMENTATION
Vitiligo: melanocyte loss
Albinism: tyrosinase enzyme defect
Freckle (ephelis): increased melanin
production
Melasma: increased melanin
Epidermal type
Dermal type
VITILIGO
LENTIGO
Oval tan brown
macules, that do not
darken when exposed
to sun (ddx freckle)
<10mm
Involve mucous
membranes and skin
Linear melanocytic
hyperplasia,
non-nested, basal,
(lentiginous)
Nevi
Junctional Nevi
nests of melanocytes at DE jct
Benign Nevi
Junctional, compound,
dermal
MALIGNANT MELANOMA
Neoplasm derived from melanocytes (or
possibly from nevus cells)
Most rapidly increasing cancer
Incidence has doubled over last 30 years
6th most common cancer (1st in young
females)
Fair skin
Multiple benign nevi (>50)
Dysplastic nevi
Personal or family history of melanoma
UV radiation, severe blistering sunburns
and chronic tanning
Immunodeficiency
Malignant Melanoma
Irregular shape and color,
large, intensely black, nodular
and flat
Melanoma
unusual sites
Asymmetry
Border irregularity
Color variation
Diameter >10 mm
Elevation or formation of a
nodule
Any change in a nevus
Dermal lesions
Tumors of Dermis
Xanthomas
collections of foamy histiocytes within
dermis
appear as yellow streaks or nodules
eruptive xanthomas
tuberous/tendinous xanthomas
plane xanthomas
xanthelasma
Lipoma
Skin leiomyoma
Keloid
Hemangiomas
Benign, more common in females (5:1)
Appear at birth and usually involute by
fibrosis with time (90% of cases by 9 yrs of
age)
Sturge-Weber Syndrome
5% of patients with PWS that involve the
upper eyelid or forehead
PWS with distribution of the trigeminal
nerve and includes vascular malformation
in the CNS
Kaposi Sarcoma
Neoplastic cells that line lymph or blood vessels
Lesions are purple, red to brown, violaceous
plaques
Most commonly found on legs and face but could
also be mucosal
Types
AIDS-related
Classic (Mediterranean)
Endemic (African)
Transplant-related
Skin 2
Neurofibromatosis I
Neurofibromas are the
most common tumors
Usually develop
around puberty
6 or more caf-au-lait
spots, pigmented
macules
Lisch nodules on the
iris
Infections
Infection/Infestation
Molluscum contagiosum
poxvirus
contagious, but self-limited
spread by direct contact
umbilicated papules seen especially on
trunk and anogenital region
molluscum bodies seen microscopcally
Fungal Tinea
Group of fungal
infection that include
ringworm, athletes
foot and jock itch
Trichotillomania
A disorder that
involves recurrent
urges to pull out hair
from your scalp
Disorders of Epidermal
Maturation
Ichthyosis
fishy
Genetically inherited
disorders
Hyperkeratosis resulting
in fish-like scales
Some acquired variants
exista/w lymphoid and
visceral malignancies
Acute Inflammatory
Dermatoses
Urticaria
Also known as hives
Common; localized mast cell
degranulation with resultant dermal
microvascular hyperpermeability
Results in pruritic edematous plaques
called wheals
Angioedema is similar but with deeper
edema of dermis and subcutaneous fat
Urticaria, pathogenesis
Antigen-induced release of vasoactive mediators
from mast cell granules through sensitization
from specific IgE antibodies
Follows exposure to antigens such as: pollens,
foods, insects, drugs
Can also be IgE-independent as in reactions to
opiates, curare, radiographic contrast media,
and antibiotics
These substances directly cause mast cell
degranulation
Figure 25-22 Urticaria. Clinically, there are erythematous, edematous, often circular plaques covered by a normal epidermal surface.
Downloaded from: Robbins & Cotran Pathologic Basis of Disease (on 5 December 2007 09:06 PM)
2007 Elsevier
Figure 25-25 Eczematous dermatitis. A, In an acute allergic contact dermatitis, numerous vesicles appear at the site of antigen exposure (in this case, laundry detergent
that persisted in clothing). B, Histologically, intercellular edema produces widened intercellular spaces within the epidermis, eventually resulting in small, fluid-filled
intraepidermal vesicles.
Downloaded from: Robbins & Cotran Pathologic Basis of Disease (on 5 December 2007 09:06 PM)
2007 Elsevier
Chronic Inflammatory
Dermatoses
Introduction
Persistent
Roughened skin surface
Four conditions:
Psoriasis
Seborrheic dermatitis
Lichen planus
Lupus erythematosis
Psoriasis
Common
All ages
Arthritis, myopathy, enteropathy,
spondylitic joint disease, or AIDS
Skin of extensor surfaces, scalp,
intergluteal cleft, and glans penis
Psoriasis, gross
Well-demarcated, salmon-colored plaque
covered by loosely adherent silver-white
scale
Psoriasis, histology
Acanthosis
Regular downward elongation of rete
ridges
Mitotic figures above basal layer
Parakeratosis
Psoriasis, histology
Auspitz sign Thinned suprapapillary
plates overlying dilated vessels within the
dermal papillae
spongiform pustules and Munro
microabscesses
Lupus erythematosus
Non-inflammatory:
Porphyria
Epidermolysis bullosa
Pemphigus
Rare, autoimmune disease, M=F, age 3050
Loss of integrity of the normal intercellular
attachments within the epidermis and
mucosal epithelium
Four variants:
Pemphigus vulgaris
Pemphigus vegetans
Pemphigus foliaceus
Pemphigus erythematosus
Pemphigus vulgaris
80% of pemphigus cases worldwide
Mucosa and skin; often presents with ulcers in
the mouth
Superficial vesicles and bullae that rupture
easily; can involve the whole body
Acantholysis selectively involves the layer of
cells above the basal cell layer (suprabasal
acantholytic blister)
Uniformly fatal if untreated
Pemphigus, morphology
All forms exhibit acantholysis
Epithelial cells lose attachments and
become rounded
The single layer of basal cells at the blister
base resembles a row of tombstones
In all forms, there is a superficial dermal
infiltrate of lymphocytes, histiocytes, and
eosinophils
Pemphigus vulgaris
Pemphigus, pathogenesis
Sera contain IgG to intercellular cement
substance of skin and mucous
membranes
DIF: net-like pattern of intercellular IgG
deposits to sites of acantholysis
Vulgaris: antibody to desmoglein 3
Bullous pemphigoid
Bullous pemphigoid
Tense bullae with clear fluid on normal or
erythematous skin
Do not rupture as easily as the blisters in
pemphigus
Heal without scarring, unless infected
Inner thigh, flexor surfaces of forearms,
axilla, groin, and lower abdomen
Dermatitis herpetiformis
Rare; M > F; age 20-30
Papules, vesicles, and occasional bullae
on an erythematous, urticarial base
Major association with celiac disease
Responds to gluten free diet
Extremely pruritic
Bilateral and symmetrical; extensor
surfaces, upper back, and buttocks
Dermatitis herpetiformis
DIF: granular deposits of IgA at the tips of
the dermal papillae
Pathogenesis: antibodies against gliadin
HLA-B8 and HLA-DRw3