Non-malignant skin disease
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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.
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.
Other
Lichen simplex chronicus
Main article: Lichen simplex chronicus
Prurigo nodularis
General
- Can be thought of as a localized/focal version of lichen simplex chronicus (LSC).
Gross
- Dome-shaped/raised - papular (<1 cm) or nodular (>1 cm).[2]
Microscopic
DDx:
- Lichen simplex chronicus - a more diffuse process, not a raised lesion.
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SKIN LESION, LEFT CHIN, BIOPSY: - PRURIGO NODULARIS.
Micro
The sections show a raised lesion with compact hyperkeratosis and irregular acanthosis. Spongiosis is seen focally. There is minimal hypergranulosis.
There is no thinning of the suprapapillary plate and no dilated superficial blood vessels. There is no interface activity.
Very common
Dermatomycosis
- Dermatophytosis redirects here.
General
- Fungal infection of skin.
Note:
- Dermatophytosis (ring worm) is a type of dermatomycosis.
Microscopic
Features:
- Microorganisms - key feature.
- Often hyphae (candida) - like twigs of a tree... branching.
- May be very fragmented in section ~ size of a neutrophil.
- Often hyphae (candida) - like twigs of a tree... branching.
- Perivascular inflammation, esp. neutrophils.
- Exocytosis - blood cell infiltrate the epidermis.
Images:
- WC:
- www:
Stains
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SKIN, BIOPSY: - SKIN WITH SUPERFICIAL FUNGAL ORGANISMS CONSISTENT WITH CANDIDA. - REACTIVE CHANGES OF THE EPITHELIUM.
Micro
The sections show skin with a neutrophilic infiltrate in the superficial epidermis. PAS-D staining demonstrates fungal organisms with a morphology suggestive of candida.
The epithelium has parakeratosis, acanthosis and spongiosis. No mitotic activity is appreciated. The keratinocytes are moderately enlarged and have evident nucleoli.
Cicatrix
Main article: Dermal scar
Fibroepithelial polyp
Main article: Fibroepithelial polyp
Actinic keratosis
Main article: Actinic keratosis
Actinic cheilitis
General
- Actinic keratosis of the lip.[4]
Microscopic
- See actinic keratosis.
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LESION, LOWER LIP, BIOPSY: - ACTINIC CHEILITIS. - SOLAR ELASTOSIS.
Micro
The sections show skin with moderate basal nuclear hyperchromasia and atypia, and parakeratosis. The squamous epithelium has maturation to the surface. There is no inflammation at the dermal-epidermal interface. Solar elastosis is present.
Seborrheic keratosis
Main article: Seborrheic keratosis
Pilomatricoma
Main article: Pilomatricoma
Dermatofibroma
Main article: Dermatofibroma
Ezcema
General
- A nebulous thingy.
- Very common.
DDx:
- Contact allergy.
- Drug reaction.
- Food allergy.
Microscopic
Features:[5]
- Spongiosis (epidermal edema); keratinocytes spacing increased - key feature.
- +/-Interdermal vesicles.
- +/-Eosinophils (may suggest Rx reaction).
- Perivascular lymphocytes.
Acne vulgaris
General
- Extremely common - esp. among adolescents.
- Very rarely seen by pathologists.
Treatments:
- Antibiotic (minocycline).
- Isotretinoin AKA all-trans retinoic acid (ATRA).
Gross
- Papules, pustules, nodules or cysts.
- White, black or erythematous.
Images:
Microscopic
Features:[6]
- Folliculitis:[7]
- Neutrophils around hair follicle and infiltrate into it - including the follicular canal.
- Epidermal invagination or cyst at site of a hair follicle - contains:
- Sebum.
- +/-Bacteria (Propionibacterium acnes) and inflammatory cells - typically neurophils.
Subtyped into:
- Open comedones ("blackheads") - no extension to epidermal surface.
- Closed comedones ("whiteheads") - to epidermal surface have wide opening.
DDx - acneiform disorder:[7]
- Rosacea.
- Infective folliculitis.
- Perioral dermatitis.
- Acne vulgaris.
Image:
Solar elastosis
General
- Very common.
- Caused by sun exposure - specifically UV light.[9]
- Severity correlated with cumulative exposure to UV light..[10]
- Often co-localized with skin cancers - as UV light is risk factor for skin cancers.[10]
- Benign.
Microscopic
Features:
- Grey, spaghetti-like material in the superficial dermis.
DDx:
Note:
- The DDx above is things associated with sun damaged skin.
- Dermal mucin (as my be seen in lupus erythematosus) is a possible mimic - but it isn't spaghetti-like and the "background" (an interface dermatitis) is different.
Images
Solar elastosis - intermed. mag. (WC)
Solar elastosis - high mag. (WC)
www:
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SKIN, RIGHT CHEEK, RE-EXCISION: - DERMAL SCAR. - EXTENSIVE SOLAR ELASTOSIS.
Prominent blood vessels
SKIN LESION, LEFT CHEEK, BIOPSY: - SKIN WITH SOLAR ELASTOSIS AND PROMINENT SMALL BLOOD VESSELS.
SUPERIOR SHOULDER, LEFT, PUNCH BIOPSY: - BENIGN SKIN WITH MODERATE SOLAR ELASTOSIS, PROMINENT SMALL BLOOD VESSELS AND SCATTERED PERIVASCULAR LYMPHOCYTES AND PLASMA CELLS. - NEGATIVE FOR BASAL CELL CARCINOMA. - NEGATIVE FOR ACTINIC KERATOSIS.
Micro
The sections show hair bearing skin with solar elastosis and numerous small dilated blood vessels. The dermis is mildly fibrotic. Compact keratin is present.
The epidermis matures to the surface. A granular layer is present. There is no basal epidermal atypia. No melanocytic nests are identified. There is no palisading of the basal cells. Rare scattered lymphocytes are in the dermis.
Very common - viral
Verruca vulgaris
Main article: Verruca vulgaris
Verruca plana
General
- Common.
- Usu. hands and face.[11]
Microscopic
Features:[11]
- Orthokeratosis with basketweave pattern.
- Hypergranulosis.
- Viral keratohyaline.
- Koilocytes.
- Acanthosis - yet flat surface and base.
Notes:
- It differs from verruca vulgaris... (1) orthokeratosis, (2) flat surface and base.
Images:
Less common
Chronic folliculitis
- Folliculitis redirect here.
General
- Common.
- Infrequently biopsied.
Gross
- Erythema.[13]
DDx gross:
Microscopic
Features:
- Inflammation around the hair follicle - key feature.
- Lymphocytes - usu. predominant.
- +/-Chronic changes:
- Acanthosis.
- Hyperkeratosis.
- Hypergranulosis.
DDx:
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SKIN LESION, UPPER ARM, BIOPSY: - CHRONIC FOLLICULITIS WITH SECONDARY SURFACE CHANGES.
Micro
The sections show hair-bearing skin with abundant lymphocytes around and within the hair follicle wall.
The non-hair follicle epidermis has acanthosis, hypergranulosis and compact hyperkeratosis. There is no inflammatory cell infiltrate in the non-hair follicle epidermis or at the non-hair follicle interface.
There are no granulomas.
Clear cell acanthoma
General
- Benign.
- Elderly.
- Classically on the leg.[14]
- Rare.
- Clinically not distinct.
- Suspected clinically in only ~3% of cases.[15]
Microscopic
Features:[16]
- 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 neutrophils.
DDx:
Images:
Chondrodermatitis nodularis chronica helicis
Main article: Chondrodermatitis nodularis chronica helicis
Cutaneous calcinosis
- AKA calcinosis cutis.
Main article: Cutaneous calcinosis
Dilated pore of Winer
General
- Benign.
- Looks like a zit.
Microscopic
Features:[18]
- Dilated hair follicle with keratin.
- Acanthosis.
- Budding of epidermis (into dermis).
DDx:
Image:
Lichenoid keratosis
General
- Caucasians - middle age or older.
- May be a variant of seborrheic keratosis (with marked inflammation).[19]
Clinical DDx:[19]
- Basal cell carcinoma, squamous cell carcinoma of the skin, melanocytic neoplasm.
Microscopic
Features:[20]
- 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:
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SKIN LESION, MID-MIDDLE BACK, PUNCH BIOPSY: - LICHENOID KERATOSIS.
Incompletely excised
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.
Granuloma annulare
Main article: Granuloma annulare
Necrobiosis lipoidica
Main article: Necrobiosis lipoidica
Keloid
Main article: Keloid
Angiofibroma
- See also: nasopharyngeal angiofibroma.
- Should not be confused with angiokeratoma.
Main article: Angiofibroma
Benign fibrous papule
- AKA fibrous papule.
General
- An angiofibroma on the face that is solitary.[21][22]
Gross
Microscopic
Features:[23]
- Dome-shaped.
- Fibrotic dermis.
- Enlarged fibroblasts.
- Dilated small vessels.
- +/-Multinucleated stromal cells.[24]
- +/-Stellate cells.[24]
DDx:
- Angiofibroma - not solitary or not on the nose.
Note:
- Several variants exist.[22]
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SKIN LESION, CHIN, BIOPSY: - BENIGN FIBROUS PAPULE.
Molluscum contagiosum
Main article: Molluscum contagiosum
Superficial dermal infiltrates
Discussed in detail by Alsaad and Ghazarian.[25]
Dermal perivascular lymphoeosinophilic infiltration
- Abbreviated DPLI.
Microscopic appearance is just what it is called:
- Lymphocytes and eosinophils around the vessels in the superficial dermis.
DDx:[25]
- Insect bite - classically wedge-shaped.[26]
- Drug reaction.
- Urticarial reaction.
- Prevesicular early stage of bullous pemphigoid.
- HIV related dermatoses.
Notes:
- May superficially resemble cutaneous lymphoma.[26]
Images:
Congenital dermal melanocytosis
- AKA Mongolian spots.
- Classically seen in asian children.
Gross:
- Brown or blue-grey patch in the lumbosacral area.
Mastocytosis
Main article: Mastocytosis
Ichthyosis
General
- Comes in different flavours.
- Usu. inherited... thus a pediatric condition.
Gross
- Fish scale-like appearance.
Image:
Microscopic
Features:[27]
- Thick stratum corneum without basket-weave pattern.
Palmar fibromatosis
Main article: Palmar fibromatosis
Angiomyoma
- Do not confuse with angiomyxoma.
General
- Benign.
- Female > male.[28]
Microscopic
Features:
- Well-circumscribed lesion with fascicular architecture.
- Spindle cells/epithelioid cell with moderate eosinophilic (pink) cytoplasm.
- Thick-walled blood vessels. (???)
Images:
Angiokeratoma
Main article: Angiokeratoma
Inverted follicular keratosis
- Abbreviated IFK.[29]
General
- Benign skin lesion.
- Central face - middle age.[30]
- Uncommon.
- May be considered a variant of seborrheic keratosis that is predominantly endophytic.[31]
Microscopic
Features:[30]
- Keratinocyte of cytologically benign proliferation.
- "Squamous eddies" (whorls of keratin).
- Coarse keratohyaline granules.
DDx:
- Squamous cell carcinoma of the skin.
- Trichilemmoma.
- Seborrheic keratosis - has an exophytic component.
Images:
- Inverted follicular keratosis - low mag. (flickr.com).
- Inverted follicular keratosis - high mag. (flickr.com).
- Inverted follicular keratosis - several images (mckeedermpath.com).
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SKIN LESION, FACE, BIOPSY: - INVERTED FOLLICULAR KERATOSIS.
Micro
The sections show skin with acanthosis, pseudohorn cysts, and focal basal epidermal pigmentation. There is no basal nuclear atypia, no mitoses and there are no melanocytic nests. There is minimal dermal inflammation. There is no apparent solar elastosis.
Focal cutaneous mucinosis
General
- Benign.
- May be associated with systemic disease.[33]
Microscopic
Features:
- Light blue whispy material in the dermis - key feature.
DDx:
- Dermal edema.
- Digital mucous cyst.
Panniculitis
Main article: Panniculitis
This is dealt with in the panniculitis article.
DDx for panniculitis:
- Erythema nodosum.
- Erythema induratum.
- Self-inflicted trauma.
- Systemic lupus erythematosus.
- Weird stuff.
Rare
Necrotizing fasciitis
- Not to be confused with nodular fasciitis.
- AKA flesh-eating disease.
Main article: Necrotizing fasciitis
Porokeratosis
Main article: Porokeratosis
Nevus sebaceous
- AKA nevus sebaceous of Jadassohn.
Main article: Nevus sebaceous
Nevus lipomatosus superficialis
- Abbreviated NLS.
- AKA nevus lipomatosus cutaneous superficialis, abbreviated NLCS.
- AKA nevus lipomatosus.[34]
Main article: Nevus lipomatosus superficialis
Bullous disease
Main article: Bullous disease
Cysts
Main article: Dermal cysts
See also
References
- ↑ Busam, Klaus J. (2009). Dermatopathology: A Volume in the Foundations in Diagnostic Pathology Series (1st ed.). Saunders. pp. 26. ISBN 978-0443066542.
- ↑ URL: http://www.pediatrics.wisc.edu/education/derm/text.html. Accessed on: 23 August 2012.
- ↑ URL: http://missinglink.ucsf.edu/lm/DermatologyGlossary/tinea.html. Accessed on: 25 February 2013.
- ↑ Picascia, DD.; Robinson, JK. (Aug 1987). "Actinic cheilitis: a review of the etiology, differential diagnosis, and treatment.". J Am Acad Dermatol 17 (2 Pt 1): 255-64. PMID 3305604.
- ↑ Kumar, Vinay; Abbas, Abul K.; Fausto, Nelson; Aster, Jon (2009). Robbins and Cotran pathologic basis of disease (8th ed.). Elsevier Saunders. pp. 1188. ISBN 978-1416031215.
- ↑ Busam, Klaus J. (2009). Dermatopathology: A Volume in the Foundations in Diagnostic Pathology Series (1st ed.). Saunders. pp. 76. ISBN 978-0443066542.
- ↑ 7.0 7.1 Busam, Klaus J. (2009). Dermatopathology: A Volume in the Foundations in Diagnostic Pathology Series (1st ed.). Saunders. pp. 77. ISBN 978-0443066542.
- ↑ URL: http://www.dermnetnz.org/dermal-infiltrative/solar-elastosis.html. Accessed on: 27 March 2013.
- ↑ Thomas, NE.; Kricker, A.; From, L.; Busam, K.; Millikan, RC.; Ritchey, ME.; Armstrong, BK.; Lee-Taylor, J. et al. (Nov 2010). "Associations of cumulative sun exposure and phenotypic characteristics with histologic solar elastosis.". Cancer Epidemiol Biomarkers Prev 19 (11): 2932-41. doi:10.1158/1055-9965.EPI-10-0686. PMID 20802019.
- ↑ 10.0 10.1 Karagas, MR.; Zens, MS.; Nelson, HH.; Mabuchi, K.; Perry, AE.; Stukel, TA.; Mott, LA.; Andrew, AS. et al. (Mar 2007). "Measures of cumulative exposure from a standardized sun exposure history questionnaire: a comparison with histologic assessment of solar skin damage.". Am J Epidemiol 165 (6): 719-26. doi:10.1093/aje/kwk055. PMID 17204514.
- ↑ 11.0 11.1 Humphrey, Peter A; Dehner, Louis P; Pfeifer, John D (2008). The Washington Manual of Surgical Pathology (1st ed.). Lippincott Williams & Wilkins. pp. 480. ISBN 978-0781765275.
- ↑ URL: http://bg.convdocs.org/docs/index-54881.html?page=10. Accessed on: 9 October 2013.
- ↑ URL: http://www.webmd.com/skin-problems-and-treatments/tc/folliculitis-topic-overview. Accessed on: 7 November 2012.
- ↑ Akin, FY.; Ertam, I.; Ceylan, C.; Kazandi, A.; Ozdemir, F.. "Clear cell acanthoma: new observations on dermatoscopy.". Indian J Dermatol Venereol Leprol 74 (3): 285-7. PMID 18583817.
- ↑ Morrison, LK.; Duffey, M.; Janik, M.; Shamma, HN. (Sep 2010). "Clear cell acanthoma: a rare clinical diagnosis prior to biopsy.". Int J Dermatol 49 (9): 1008-11. PMID 20931670.
- ↑ URL: http://www.drmihm.com/cases/case.cfm?CaseID=45. Accessed on: 7 February 2012.
- ↑ URL: http://www.head-face-med.com/content/4/1/2. Accessed on: 16 January 2014.
- ↑ Humphrey, Peter A; Dehner, Louis P; Pfeifer, John D (2008). The Washington Manual of Surgical Pathology (1st ed.). Lippincott Williams & Wilkins. pp. 486. ISBN 978-0781765275.
- ↑ 19.0 19.1 Busam, Klaus J. (2009). Dermatopathology: A Volume in the Foundations in Diagnostic Pathology Series (1st ed.). Saunders. pp. 346. ISBN 978-0443066542.
- ↑ Busam, Klaus J. (2009). Dermatopathology: A Volume in the Foundations in Diagnostic Pathology Series (1st ed.). Saunders. pp. 347. ISBN 978-0443066542.
- ↑ 21.0 21.1 Busam, Klaus J. (2009). Dermatopathology: A Volume in the Foundations in Diagnostic Pathology Series (1st ed.). Saunders. pp. 505. ISBN 978-0443066542.
- ↑ 22.0 22.1 22.2 Jacyk, WK.; Rütten, A.; Requena, L. (2008). "Fibrous papule of the face with granular cells.". Dermatology 216 (1): 56-9. doi:10.1159/000109359. PMID 18032900.
- ↑ Humphrey, Peter A; Dehner, Louis P; Pfeifer, John D (2008). The Washington Manual of Surgical Pathology (1st ed.). Lippincott Williams & Wilkins. pp. 492. ISBN 978-0781765275.
- ↑ 24.0 24.1 Ragaz, A.; Berezowsky, V. (1979). "Fibrous papule of the face. A study of five cases by electron microscopy.". Am J Dermatopathol 1 (4): 353-6. PMID 543528.
- ↑ 25.0 25.1 Alsaad, KO.; Ghazarian, D. (Dec 2005). "My approach to superficial inflammatory dermatoses.". J Clin Pathol 58 (12): 1233-41. doi:10.1136/jcp.2005.027151. PMID 16311340.
- ↑ 26.0 26.1 Cotran, Ramzi S.; Kumar, Vinay; Fausto, Nelson; Nelso Fausto; Robbins, Stanley L.; Abbas, Abul K. (2005). Robbins and Cotran pathologic basis of disease (7th ed.). St. Louis, Mo: Elsevier Saunders. pp. 1269. ISBN 0-7216-0187-1.
- ↑ Kumar, Vinay; Abbas, Abul K.; Fausto, Nelson; Aster, Jon (2009). Robbins and Cotran pathologic basis of disease (8th ed.). Elsevier Saunders. pp. 1185. ISBN 978-1416031215.
- ↑ Katenkamp D, Kosmehl H, Langbein L (1988). "[Angiomyoma. A pathologo-anatomic analysis of 229 cases]" (in German). Zentralbl Allg Pathol 134 (4-5): 423–33. PMID 3201831.
- ↑ Shih, CC.; Yu, HS.; Tung, YC.; Tsai, KB.; Cheng, ST. (Jan 2001). "Inverted follicular keratosis.". Kaohsiung J Med Sci 17 (1): 50-4. PMID 11411260.
- ↑ 30.0 30.1 30.2 Busam, Klaus J. (2009). Dermatopathology: A Volume in the Foundations in Diagnostic Pathology Series (1st ed.). Saunders. pp. 387. ISBN 978-0443066542.
- ↑ Busam, Klaus J. (2009). Dermatopathology: A Volume in the Foundations in Diagnostic Pathology Series (1st ed.). Saunders. pp. 341. ISBN 978-0443066542.
- ↑ URL: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC475744/. Accessed on: 11 May 2010.
- ↑ Gandhi, V.; Dogra, D.; Pandhi, RK.. "Cutaneous focal mucinosis.". Indian J Dermatol Venereol Leprol 62 (4): 260-1. PMID 20948074.
- ↑ Kaw, P.; Carlson, A.; Meyer, DR. (Jan 2005). "Nevus lipomatosus (pedunculated lipofibroma) of the eyelid.". Ophthal Plast Reconstr Surg 21 (1): 74-6. PMID 15677959.