Difference between revisions of "Dermal scar"

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#redirect [[Non-malignant_skin_disease#Cicatrix]]
{{ Infobox diagnosis
| Name      = {{PAGENAME}}
| Image      = ScarHistology.JPG
| Width      =
| Caption    = Dermal scar. [[H&E stain]].
| Micro      = dense collagen - fibers run parallel to the DE junction, loss of dermal papilla, loss of adnexal structures, thin-wall blood vessels
| Subtypes  =
| LMDDx      = [[malignant melanoma]] desmoplastic-neurotropic type, [[dermatofibroma]], desmoplastic [[Spitz nevus]], sclerosing [[blue nevus]]
| Stains    = S-100 -ve (mostly)
| IHC        =
| EM        =
| Molecular  =
| IF        =
| Gross      =
| Grossing  =
| Site      = [[skin]]
| Assdx      =
| Syndromes  =
| Clinicalhx = trauma, previous excision or biopsy
| Signs      =
| Symptoms  =
| Prevalence = common
| Bloodwork  =
| Rads      =
| Endoscopy  =
| Prognosis  = benign
| Other      =
| ClinDDx    =
}}
{{ Infobox external links
| Name          = {{PAGENAME}}
| EHVSC          =
| EHVSC_mult    = {{EHVSC3|10187|Dermal scar adjacent to a basal cell carcinoma}}
| pathprotocols  =
| wikipedia      = Scar
| pathoutlines  =
}}
'''Dermal scar''', also simply '''scar''', is commonly seen in [[dermatopathology]]. It is also known a '''cicatrix'''.
 
==General==
*Previous surgery, biopsy, trauma.
 
==Gross==
*Raised irregularity - may be linear.
*Typically pale.<ref>{{Cite journal  | last1 = Velangi | first1 = SS. | last2 = Rees | first2 = JL. | title = Why are scars pale? An immunohistochemical study indicating preservation of melanocyte number and function in surgical scars. | journal = Acta Derm Venereol | volume = 81 | issue = 5 | pages = 326-8 | month =  | year =  | doi =  | PMID = 11800137 }}</ref>
**May be hyperpigmented.<ref name=pmid23162241>{{Cite journal  | last1 = Chadwick | first1 = S. | last2 = Heath | first2 = R. | last3 = Shah | first3 = M. | title = Abnormal pigmentation within cutaneous scars: A complication of wound healing. | journal = Indian J Plast Surg | volume = 45 | issue = 2 | pages = 403-11 | month = May | year = 2012 | doi = 10.4103/0970-0358.101328 | PMID = 23162241 }}</ref>
 
===Images===
<gallery>
Image:Scars 2yrs.png | Scars. (WC)
</gallery>
 
==Microscopic==
Features:
*Loss of dermal papilla.
*Dense collagen - fibers run parallel to the dermal-epidermal (DE) junction<ref name=Ref_Derm499>{{Ref Derm|499}}</ref> - '''key feature'''.
*Loss of adnexal structures.
 
Other feature:
*Thin-walled blood vessels.
**Described as running perpendicular to the surface<ref name=Ref_Derm499>{{Ref Derm|499}}</ref> - this may not be apparent.
 
Note:
*There should not be any nuclear hyperchromasia or pleomorphism.<ref name=Ref_Derm479>{{Ref Derm|479}}</ref>
 
DDx:
*[[Malignant melanoma]], desmoplastic-neurotropic type - nuclear pleomorphism and/or hyperchromasia; may be focal.<ref name=Ref_Derm479>{{Ref Derm|479}}</ref>
**Epidermal hyperplasia and the preservation of adnexal structures is very suspicious.
*[[Dermatofibroma]].
*Desmoplastic [[Spitz nevus]].
*Sclerosing [[blue nevus]].
 
===Image===
<gallery>
Image:ScarHistology.JPG | Scar. (WC)
</gallery>
 
==IHC==
*S100 focal/scattered +ve.
**Desmoplastic melanoma strong +ve.
*HMB-45 -ve.
**Sclerosing blue nevus +ve.
 
==Sign out==
<pre>
SKIN, LOWER MID BACK, RE-EXCISION:
- DERMAL SCAR.
- SOLAR ELASTOSIS.
</pre>
 
<pre>
SKIN LESION, LEFT UPPER ABDOMINAL WALL, RE-EXCISION:
- DERMAL SCAR, COMPLETELY EXCISED.
- BENIGN PIGMENT.
- NEGATIVE FOR DYSPLASIA AND NEGATIVE FOR MALIGNANCY.
</pre>
 
===Micro===
The sections show skin with a dermis with dense collagen fibres that run parallel to the skin surface without adnexal structures.  The overlying dermal-epidermis interface lacks the typical undulation.
 
==See also==
*[[Non-malignant skin disease]].
*[[Dermatopathology]].
*[[Cesarean scar defect]].
 
==References==
{{Reflist|2}}
 
[[Category:Diagnosis]]
[[Category:Dermatopathology]]

Latest revision as of 15:56, 9 October 2018

Dermal scar
Diagnosis in short

Dermal scar. H&E stain.
LM dense collagen - fibers run parallel to the DE junction, loss of dermal papilla, loss of adnexal structures, thin-wall blood vessels
LM DDx malignant melanoma desmoplastic-neurotropic type, dermatofibroma, desmoplastic Spitz nevus, sclerosing blue nevus
Stains S-100 -ve (mostly)
Site skin
Clinical history trauma, previous excision or biopsy
Prevalence common
Prognosis benign
Dermal scar
External resources
EHVSC 10187 (Dermal scar adjacent to a basal cell carcinoma)
Wikipedia Scar

Dermal scar, also simply scar, is commonly seen in dermatopathology. It is also known a cicatrix.

General

  • Previous surgery, biopsy, trauma.

Gross

  • Raised irregularity - may be linear.
  • Typically pale.[1]
    • May be hyperpigmented.[2]

Images

  • Scars. (WC)

Microscopic

Features:

  • Loss of dermal papilla.
  • Dense collagen - fibers run parallel to the dermal-epidermal (DE) junction[3] - key feature.
  • Loss of adnexal structures.

Other feature:

  • Thin-walled blood vessels.
    • Described as running perpendicular to the surface[3] - this may not be apparent.

Note:

  • There should not be any nuclear hyperchromasia or pleomorphism.[4]

DDx:

Image

  • Scar. (WC)

IHC

  • S100 focal/scattered +ve.
    • Desmoplastic melanoma strong +ve.
  • HMB-45 -ve.
    • Sclerosing blue nevus +ve.

Sign out

SKIN, LOWER MID BACK, RE-EXCISION:
- DERMAL SCAR.
- SOLAR ELASTOSIS.

SKIN LESION, LEFT UPPER ABDOMINAL WALL, RE-EXCISION:
- DERMAL SCAR, COMPLETELY EXCISED.
- BENIGN PIGMENT.
- NEGATIVE FOR DYSPLASIA AND NEGATIVE FOR MALIGNANCY.

Micro

The sections show skin with a dermis with dense collagen fibres that run parallel to the skin surface without adnexal structures. The overlying dermal-epidermis interface lacks the typical undulation.

See also

References

  1. ↑ Velangi, SS.; Rees, JL.. "Why are scars pale? An immunohistochemical study indicating preservation of melanocyte number and function in surgical scars.". Acta Derm Venereol 81 (5): 326-8. PMID 11800137.
  2. ↑ Chadwick, S.; Heath, R.; Shah, M. (May 2012). "Abnormal pigmentation within cutaneous scars: A complication of wound healing.". Indian J Plast Surg 45 (2): 403-11. doi:10.4103/0970-0358.101328. PMID 23162241.
  3. ↑ 3.0 3.1 Busam, Klaus J. (2009). Dermatopathology: A Volume in the Foundations in Diagnostic Pathology Series (1st ed.). Saunders. pp. 499. ISBN 978-0443066542.
  4. ↑ 4.0 4.1 Busam, Klaus J. (2009). Dermatopathology: A Volume in the Foundations in Diagnostic Pathology Series (1st ed.). Saunders. pp. 479. ISBN 978-0443066542.
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