Difference between revisions of "Non-malignant skin disease"

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Non-malignant skin disease (view source)

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'''Non-malignant skin disease''' is relatively common.  The pathology may or may not be specific.  Some diseases require clinical information to diagnose.
'''Non-malignant skin disease''' is relatively common.  The pathology may or may not be specific.  Some diseases require clinical information to diagnose.  


An introduction to dermatopathology is in the ''[[dermatopathology]]'' article.  [[Nevi]] (moles) and other melanocytic lesions are dealt with in the article ''[[melanocytic lesions]]''.  Inflammatory skin conditions are dealt with in ''[[inflammatory skin disorders]]''.
An introduction to dermatopathology is in the ''[[dermatopathology]]'' article.  [[Nevi]] (moles) and other melanocytic lesions are dealt with in the article ''[[melanocytic lesions]]''.  Inflammatory skin conditions are dealt with in ''[[inflammatory skin disorders]]''.
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*[[Exocytosis]] - blood cell infiltrate the epidermis.
*[[Exocytosis]] - blood cell infiltrate the epidermis.


Images:
====Images====
*[[WC]]:
<gallery>
**[http://commons.wikimedia.org/wiki/File:Dermatomycosis_-_intermed_mag.jpg Dermatomycosis - intermed. mag. (WC)].
Image:Dermatomycosis_-_intermed_mag.jpg | Dermatomycosis - intermed. mag. (WC)
**[http://commons.wikimedia.org/wiki/File:Dermatomycosis_-_high_mag.jpg Dermatomycosis - high mag. (WC)].
Image:Dermatomycosis_-_high_mag.jpg | Dermatomycosis - high mag. (WC)
**[http://commons.wikimedia.org/wiki/File:Dermatomycosis_-_gms_-_low_mag.jpg Dermatomycosis - GMS stain - low mag. (WC)].
Image:Dermatomycosis_-_gms_-_low_mag.jpg | Dermatomycosis - GMS stain - low mag. (WC)
**[http://commons.wikimedia.org/wiki/File:Dermatomycosis_-_gms_-_high_mag.jpg Dermatomycosis - GMS stain - high mag. (WC)].
Image:Dermatomycosis_-_gms_-_high_mag.jpg | Dermatomycosis - GMS stain - high mag. (WC)
*www:
</gallery>
**[http://missinglink.ucsf.edu/lm/DermatologyGlossary/img/Dermatology%20Glossary/Glossary%20Histo%20Images/tinea_pas.jpg Dermatophytosis (ucsf.edu)].<ref>URL: [http://missinglink.ucsf.edu/lm/DermatologyGlossary/tinea.html http://missinglink.ucsf.edu/lm/DermatologyGlossary/tinea.html]. Accessed on: 25 February 2013.</ref>
www:
*[http://missinglink.ucsf.edu/lm/DermatologyGlossary/img/Dermatology%20Glossary/Glossary%20Histo%20Images/tinea_pas.jpg Dermatophytosis (ucsf.edu)].<ref>URL: [http://missinglink.ucsf.edu/lm/DermatologyGlossary/tinea.html http://missinglink.ucsf.edu/lm/DermatologyGlossary/tinea.html]. Accessed on: 25 February 2013.</ref>


===Stains===
===Stains===
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Notes:
Notes:
*It differs from verruca vulgaris... (1) orthokeratosis, (2) flat surface and base.
*It differs from [[verruca vulgaris]]... (1) orthokeratosis, (2) flat surface and base.
 
Images:
*[http://www.fujita-hu.ac.jp/~tsutsumi/case/case180.htm Verruca plana - several images (fujita-hu.ac.jp)].
*[http://bg.convdocs.org/pars_docs/refs/55/54881/54881_html_m70d4f7e5.jpg Verruca plana (convdocs.org)].<ref>URL: [http://bg.convdocs.org/docs/index-54881.html?page=10 http://bg.convdocs.org/docs/index-54881.html?page=10]. Accessed on: 9 October 2013.</ref>
*[http://www.dermatopathonline.com/verruca%20plana2.html Verruca plana - several good images (dermatopathonline.com)].


=Less common=
=Less common=
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==Clear cell acanthoma==
==Clear cell acanthoma==
===General===
{{Main|Clear cell acanthoma}}
*Benign.
*Elderly.
*Classically on the leg.<ref name=pmid18583817>{{Cite journal  | last1 = Akin | first1 = FY. | last2 = Ertam | first2 = I. | last3 = Ceylan | first3 = C. | last4 = Kazandi | first4 = A. | last5 = Ozdemir | first5 = F. | title = Clear cell acanthoma: new observations on dermatoscopy. | journal = Indian J Dermatol Venereol Leprol | volume = 74 | issue = 3 | pages = 285-7 | month =  | year =  | doi =  | PMID = 18583817 | URL = http://www.ijdvl.com/text.asp?2008/74/3/285/41396 }}</ref>
*Rare.
*Clinically not distinct.
**Suspected clinically in only ~3% of cases.<ref name=pmid20931670>{{Cite journal  | last1 = Morrison | first1 = LK. | last2 = Duffey | first2 = M. | last3 = Janik | first3 = M. | last4 = Shamma | first4 = HN. | title = Clear cell acanthoma: a rare clinical diagnosis prior to biopsy. | journal = Int J Dermatol | volume = 49 | issue = 9 | pages = 1008-11 | month = Sep | year = 2010 | doi =  | PMID = 20931670 }}</ref>
 
===Microscopic===
Features:<ref>URL: [http://www.drmihm.com/cases/case.cfm?CaseID=45 http://www.drmihm.com/cases/case.cfm?CaseID=45]. Accessed on: 7 February 2012.</ref>
*Psoriasiform pattern - epidermal thickening ([[acanthosis]]).
*Keratinocytes:
**Pale or light pink cytoplasm (when compared to surrounding non-lesional keratinocytes).
**Separated from one another (spongiosis).
*+/-Stratum corneum [[neutrophil]]s.
 
DDx:
*[[Psoriasis vulgaris]].
 
Images:
*[http://www.drmihm.com/cases/casefigure.cfm?figID=906&CaseID=45 CCA (drmihm.com)].
*[http://www.dermatlas.com/derm/IndexDisplay.cfm?ImageID=-327718365 CCA - low mag. (dermatlas.com)].
*[http://www.dermatlas.com/derm/IndexDisplay.cfm?ImageID=546460717 CCA - high mag. (dermatlas.com)].


==Chondrodermatitis nodularis chronica helicis==
==Chondrodermatitis nodularis chronica helicis==
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===General===
===General===
*Benign.
*Benign.
*Looks like zit.
*Looks like a zit.


===Microscopic===
===Microscopic===
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==Lichenoid keratosis==
==Lichenoid keratosis==
*[[AKA]] ''lichen planus-like keratosis''.
*[[AKA]] ''lichen planus-like keratosis''.
*[[AKA]] ''lichenoid keratosis''.
{{Main|Lichenoid keratosis}}
 
===General===
*Caucasians - middle age or older.
*May be a variant of [[seborrheic keratosis]] (with marked inflammation).<ref name=Ref_Derm346>{{Ref Derm|346}}</ref>
 
Clinical DDx:<ref name=Ref_Derm346>{{Ref Derm|346}}</ref>
*[[Basal cell carcinoma]], [[squamous cell carcinoma of the skin]], melanocytic neoplasm.
 
===Microscopic===
Features:<ref name=Ref_Derm347>{{Ref Derm|347}}</ref>
*Hyperkeratosis.
*Parakeratosis.
*Band of inflammatory cells at DE junction (lichenoid inflammation).
*Dead keratinocytes (Civatte bodies).
*Dermal melanophages.
 
DDx:
*[[Lichen planus]] - need clinical correlation (mucosal lesions).
*[[Drug reaction]].
*[[Cutaneous T-cell lymphoma]].
*Regressed melanocytic lesion, esp. [[malignant melanoma]].
*Lichenoid [[actinic keratosis]] - has atypical hyperchromatic basal cells - esp. at edge of lesion, usu. in the context of [[solar elastosis]].
 
Images:
*[http://www.dermpathexpert.com/id57.html Lichenoid keratosis (dermpathexpert.com)].
 
===Sign out===
<pre>
SKIN LESION, MID-MIDDLE BACK, PUNCH BIOPSY:
- LICHENOID KERATOSIS.
</pre>
 
====Incompletely excised====
<pre>
SKIN LESION, LEFT CHEST, PUNCH BIOPSY:
- LICHENOID KERATOSIS VERSUS ACTINIC KERATOSIS.
- NEGATIVE FOR BASAL CELL CARCINOMA.
- SEE COMMENT.
 
COMMENT:
No eosinophils are apparent. No melanocytic lesion is identified; however, excision of the
whole lesion to exclude a partially regressed melanocytic lesion is suggested.
</pre>


==Granuloma annulare==
==Granuloma annulare==
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Note:
Note:
*Several variants exist.<ref name=pmid18032900>{{Cite journal  | last1 = Jacyk | first1 = WK. | last2 = Rütten | first2 = A. | last3 = Requena | first3 = L. | title = Fibrous papule of the face with granular cells. | journal = Dermatology | volume = 216 | issue = 1 | pages = 56-9 | month =  | year = 2008 | doi = 10.1159/000109359 | PMID = 18032900 }}</ref>
*Several variants exist.<ref name=pmid18032900>{{Cite journal  | last1 = Jacyk | first1 = WK. | last2 = Rütten | first2 = A. | last3 = Requena | first3 = L. | title = Fibrous papule of the face with granular cells. | journal = Dermatology | volume = 216 | issue = 1 | pages = 56-9 | month =  | year = 2008 | doi = 10.1159/000109359 | PMID = 18032900 }}</ref>
===Images===
*[http://www.dermaamin.com/site/histopathology-of-the-skin/58-f/1739-fibrous-papule-angiofibroma-.html Fibrous papule (dermaamin.com)].


===Sign out===
===Sign out===
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==Angiokeratoma==
==Angiokeratoma==
===General===
{{Main|Angiokeratoma}}
*Rare.
*May be seen in the context of [[Fabry disease]].<ref name=pmid16403380/>
 
Notes:
*Shouldn't be confused with ''[[angiofibroma]]'' which is associated [[tuberous sclerosis]].
 
===Gross===
*Dark lesions.
 
Clinical DDx:
*[[Melanocytic lesions]].
====Images====
<gallery>
Image:Angiokeratoma_of_the_Scrotum_7.jpg | Angiokeratoma. (WC)
</gallery>
 
===Microscopic===
Features:<ref name=pmid16403380>{{Cite journal  | last1 = Karen | first1 = JK. | last2 = Hale | first2 = EK. | last3 = Ma | first3 = L. | title = Angiokeratoma corporis diffusum (Fabry disease). | journal = Dermatol Online J | volume = 11 | issue = 4 | pages = 8 | month =  | year = 2005 | doi =  | PMID = 16403380 }}</ref>
#Ectatic superficial dermal vessels.
#Overlying hyperkeratosis (thick stratum corneum).
*Should have "epidermal collarette".<ref name=Ref_Derm548>{{Ref Derm|548}}</ref>
**Vascular space surrounded by epidermis on three sides.
 
Others features:{{fact}}
*Irregular [[acanthosis]].
*Longer rete ridges.
 
DDx:
*[[Venous lake]].
 
====Images====
<gallery>
Image:Angiokeratoma_-_low_mag.jpg | Angiokeratoma - low mag. (WC/Nephron)
Image:Angiokeratoma_-_intermed_mag.jpg | Angiokeratoma - intermed. mag. (WC/Nephron)
</gallery>
www:
*[http://www.pathologyoutlines.com/images/skintumorangiokerat1.jpg Angiokeratoma (pathologyoutlines.com)].
 
===Sign out===
<pre>
SKIN LESION, LEFT POPITEAL FOSSA, PUNCH BIOPSY:
- ANGIOKERATOMA.
</pre>


==Inverted follicular keratosis==
==Inverted follicular keratosis==
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==Porokeratosis==
==Porokeratosis==
===General===
{{Main|Porokeratosis}}
*Genetic.
*Several subtypes.
 
Notes:
*Not the same as ''punctate porokeratotic keratoderma''.<ref name=pmid20137755>{{Cite journal  | last1 = Alikhan | first1 = A. | last2 = Burns | first2 = T. | last3 = Zargari | first3 = O. | title = Punctate porokeratotic keratoderma. | journal = Dermatol Online J | volume = 16 | issue = 1 | pages = 13 | month =  | year = 2010 | doi =  | PMID = 20137755 | URL = http://dermatology.cdlib.org/1601/case_presentations/ppk/alikhan.html }}</ref>
 
===Microscopic===
Features:
*Cornoid lamella (pathognomonic) - '''key feature''':
**Compact keratosis over a hair follicle.
*+/-Rete ridge loss.
 
====Images====
<gallery>
Image:Porokeratosis_-_intermed_mag.jpg | Porokeratosis - intermed. mag. (WC)
Image:Porokeratosis_-_very_high_mag.jpg | Porokeratosis - very high mag. (WC)
</gallery>


==Nevus sebaceous==
==Nevus sebaceous==
*[[AKA]] ''nevus sebaceous of Jadassohn''.
*[[AKA]] ''nevus sebaceous of Jadassohn''.
===General===
{{Main|Nevus sebaceous}}
*Congenital - considered a [[hamartoma]].<ref name=pmid23217958/>
*Usually sporadic - may be transmitted autosomal dominant.<ref name=pmid23217958/>
*Malignant tumours may arise within a ''nevus sebaceous''.
===Gross===
Features:<ref name=pmid23217958>{{Cite journal  | last1 = West | first1 = C. | last2 = Narahari | first2 = S. | last3 = Kwatra | first3 = S. | last4 = Feldman | first4 = S. | title = Autosomal dominant transmission of nevus sebaceous of Jadassohn. | journal = Dermatol Online J | volume = 18 | issue = 11 | pages = 17 | month = Nov | year = 2012 | doi =  | PMID = 23217958 }}</ref><ref name=pmid19171988>{{Cite journal  | last1 = Simi | first1 = CM. | last2 = Rajalakshmi | first2 = T. | last3 = Correa | first3 = M. | title = Clinicopathologic analysis of 21 cases of nevus sebaceus: a retrospective study. | journal = Indian J Dermatol Venereol Leprol | volume = 74 | issue = 6 | pages = 625-7 | month =  | year =  | doi =  | PMID = 19171988 }}</ref>
*Head and neck [[plaque]] or [[papule]] with:
**Well-circumscribed borders.
**Waxy, yellow appearance.
*Area usu. devoid of hair.<ref name=pmid22148058>{{Cite journal  | last1 = Kim | first1 = JH. | last2 = Park | first2 = HY. | last3 = Ahn | first3 = SK. | title = Nevus sebaceous accompanying secondary neoplasms and unique histopathologic findings. | journal = Ann Dermatol | volume = 23 | issue = Suppl 2 | pages = S231-4 | month = Oct | year = 2011 | doi = 10.5021/ad.2011.23.S2.S231 | PMID = 22148058 }}</ref>
 
DDx - gross:
*[[Seborrheic keratosis]].
 
Image:
*[http://www.dermnet.com/images/Nevus-Sebaceous/picture/17082?imgNumber=14 NS (dermnet.com)].
 
===Microscopic===
Features:<ref name=pmid19171988/>
*Abundant sebaceous glands.
*Immature/abortive hair follicles.
**No normal terminal hair follicles.
*Papillomatous epidermal hyperplasia.
 
Images:
*[http://commons.wikimedia.org/wiki/File:SkinTumors-P6260391.JPG NS (WC)].
*[http://www.dermnet.com/images/Nevus-Sebaceous/picture/17087 NS (dermnet.com)].


==Nevus lipomatosus superficialis==
==Nevus lipomatosus superficialis==
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*[[AKA]] ''nevus lipomatosus cutaneous superficialis'', abbreviated ''NLCS''.
*[[AKA]] ''nevus lipomatosus cutaneous superficialis'', abbreviated ''NLCS''.
*[[AKA]] ''nevus lipomatosus''.<ref name=pmid15677959>{{Cite journal  | last1 = Kaw | first1 = P. | last2 = Carlson | first2 = A. | last3 = Meyer | first3 = DR. | title = Nevus lipomatosus (pedunculated lipofibroma) of the eyelid. | journal = Ophthal Plast Reconstr Surg | volume = 21 | issue = 1 | pages = 74-6 | month = Jan | year = 2005 | doi =  | PMID = 15677959 }}</ref>
*[[AKA]] ''nevus lipomatosus''.<ref name=pmid15677959>{{Cite journal  | last1 = Kaw | first1 = P. | last2 = Carlson | first2 = A. | last3 = Meyer | first3 = DR. | title = Nevus lipomatosus (pedunculated lipofibroma) of the eyelid. | journal = Ophthal Plast Reconstr Surg | volume = 21 | issue = 1 | pages = 74-6 | month = Jan | year = 2005 | doi =  | PMID = 15677959 }}</ref>
===General===
{{Main|Nevus lipomatosus superficialis}}
*Rare.
*Congenital - considered a [[hamartoma]].<ref name=pmid22984661/>
*Usually young adults.<ref>URL: [http://www.dermpedia.org/dermpedia-textbook/nevus-lipomatosus http://www.dermpedia.org/dermpedia-textbook/nevus-lipomatosus]. Accessed on: 8 January 2013.</ref>
 
Clinically separated into:<ref name=pmid17288284>{{Cite journal  | last1 = Triki | first1 = S. | last2 = Mekni | first2 = A. | last3 = Haouet | first3 = S. | last4 = Mokni | first4 = M. | last5 = Kchir | first5 = N. | last6 = Ben Osman Dhahri | first6 = A. | last7 = Zitouna | first7 = M. | title = [Nevus lipomatosus cutaneous superficialis: a clinico-pathological study of 13 cases]. | journal = Tunis Med | volume = 84 | issue = 12 | pages = 800-2 | month = Dec | year = 2006 | doi =  | PMID = 17288284 }}</ref>
*''Solitary'' - one lesion.
*''Multiple'' - more than one lesion.
 
===Gross===
Features:<ref name=pmid22984661>{{Cite journal  | last1 = Goucha | first1 = S. | last2 = Khaled | first2 = A. | last3 = Zéglaoui | first3 = F. | last4 = Rammeh | first4 = S. | last5 = Zermani | first5 = R. | last6 = Fazaa | first6 = B. | title = Nevus lipomatosus cutaneous superficialis: Report of eight cases. | journal = Dermatol Ther (Heidelb) | volume = 1 | issue = 2 | pages = 25-30 | month = Dec | year = 2011 | doi = 10.1007/s13555-011-0006-y | PMID = 22984661  | PMC = 3437641 }}</ref>
*Pedunculated lesion.
*Soft.
*Usually lower trunk or gluteal region.<ref name=pmid1235780>{{Cite journal  | last1 = Jones | first1 = EW. | last2 = Marks | first2 = R. | last3 = Pongsehirun | first3 = D. | title = Naevus superficialis lipomatosus. A clinicopathological report of twenty cases. | journal = Br J Dermatol | volume = 93 | issue = 2 | pages = 121-33 | month = Aug | year = 1975 | doi =  | PMID = 1235780 }}</ref>
 
Image:
*[http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3437641/figure/Fig1/ NLS (nih.gov)].<ref name=pmid22984661/>
 
===Microscopic===
Features:<ref name=pmid19495497>{{Cite journal  | last1 = Yap | first1 = FB. | title = Nevus lipomatosus superficialis. | journal = Singapore Med J | volume = 50 | issue = 5 | pages = e161-2 | month = May | year = 2009 | doi =  | PMID = 19495497 | URL = http://smj.sma.org.sg/5005/5005cr3.pdf }}</ref>
*Benign adipose tissue in the dermis.
**Adipocytes in [[reticular dermis]] +/- [[papillary dermis]].<ref name=pmid20673540>{{Cite journal  | last1 = Ghosh | first1 = SK. | last2 = Bandyopadhyay | first2 = D. | last3 = Jamadar | first3 = NS. | title = Nevus lipomatosus cutaneous superficialis: An unusual presentation. | journal = Dermatol Online J | volume = 16 | issue = 7 | pages = 12 | month =  | year = 2010 | doi =  | PMID = 20673540 }}</ref>
 
DDx:
*[[Lipoma]].
*[[Fibroepithelial polyp]] (skin tag).
*[[Intradermal nevus]] with adipocytes.<ref name=pmid9810886>{{Cite journal  | last1 = Eng | first1 = W. | last2 = Cohen | first2 = PR. | title = Nevus with fat: clinical characteristics of 100 nevi containing mature adipose cells. | journal = J Am Acad Dermatol | volume = 39 | issue = 5 Pt 1 | pages = 704-11 | month = Nov | year = 1998 | doi =  | PMID = 9810886 }}</ref>
 
Images:
*[http://www.dermaamin.com/site/images/histo-pic/n/nevus-lipomatosus-superficialis/nevus-lipomatosus-superficialis1.jpg NLS (dermamin.com)].<ref>URL: [http://www.dermaamin.com/site/histopathology-of-the-skin/66-n/1971-nevus-lipomatosus-superficialis----.html http://www.dermaamin.com/site/histopathology-of-the-skin/66-n/1971-nevus-lipomatosus-superficialis----.html]. Accessed on: 7 March 2012.</ref>
*[http://www.humpath.com/IMG/jpg/nevus_superficialis_lipomatosus_01_1.jpg NLS (humpath.com)].<ref>URL: [http://www.humpath.com/spip.php?article8134 http://www.humpath.com/spip.php?article8134]. Accessed on: 17 December 2012.</ref>
*[http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3437641/figure/Fig3/ NLS (nih.gov)].<ref name=pmid22984661/>
*[http://www.dermpedia.org/dermpedia-textbook/nevus-lipomatosus Nevus lipomatosus (dermpedia.org)].
 
===Sign out===
<pre>
SKIN LESION ("SKIN TAG"), LEFT HIP, EXCISION:
- NEVUS LIPOMATOSUS SUPERFICIALIS.
</pre>


=Bullous disease=
=Bullous disease=
Michael
49,009

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