Dermal scar

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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

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

IHC

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

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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.