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.  


==General classification (Inflammatory)==
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]]''.
*Bullous.
*Interface.
*Nodular & diffuse.
*Spongiotic.
*Vasculitis.
*Perivascular.
*Panniculitis.
*Psoriasiform.


'''Tabular comparison of inflammatory skin disease (adapted from ''Brister''<ref name=pmid18418089>{{cite journal |author=Brinster NK |title=Dermatopathology for the surgical pathologist: a pattern based approach to the diagnosis of inflammatory skin disorders (part I) |journal=Adv Anat Pathol |volume=15 |issue=2 |pages=76–96 |year=2008 |month=March |pmid=18418089 |doi=10.1097/PAP.0b013e3181664e8d |url=}}</ref>):'''
=Other=
{| class="wikitable"
==Lichen simplex chronicus==
| '''Pattern''' || '''Key histologic feature''' || '''Subclassifications''' || '''Example'''
{{Main|Lichen simplex chronicus}}
|-
| Bullous || "Empty space" || -Subcorneal<br>-Suprabasillar<br>-Subepidermal || -?<br>-?<br>-?
|-
| Interface || Inflammation at DE junction || -Vacuolar (minimal)<br>-Lichenoid (band-like) || -Erythema multiforme<br>-Lichen simplex chronicus (LSC)
|-
| Nodular & diffuse || Nodular & diffuse || ? ||
|-
| Spongiotic || Edema between keratinocytes || -Acute<br>-Subacute<br>-Chronic || -Poison Ivy<br>-Nummular dermatitis<br>-Atopic dermatitis
|-
| Vasculitis || Inflammation of vessel wall || ? || ?
|-
| Perivascular || Inflammation around vessels || ? || ?
|-
| Panniculitis || Inflamm. of SC tissue || -Septal<br>-Nodular ||
|-
| Psoriasiform || Epidermal thickening<br>and long rete ridges || -Regular<br>-Irregular ||
|}
Notes:
*''DE junction'' = dermal-epidermal junction.
*The "empty space" in bullous disease ''in situ'' is filled with fluid.


==Lichen planus==
==Prurigo nodularis==
*Abbreviated ''PN''.
*[[AKA]] ''chronic prurigo'' and ''picker nodule''.<ref name=Ref_Derm26>{{Ref Derm|26}}</ref>
===General===
===General===
*An oral pathology.
*Can be thought of as a localized/focal version of [[lichen simplex chronicus]] (LSC).
*May be seen where the sun don't shine - penis,<ref name=pmid20082512>{{Cite journal  | last1 = Teichman | first1 = JM. | last2 = Sea | first2 = J. | last3 = Thompson | first3 = IM. | last4 = Elston | first4 = DM. | title = Noninfectious penile lesions. | journal = Am Fam Physician | volume = 81 | issue = 2 | pages = 167-74 | month = Jan | year = 2010 | doi =  | PMID = 20082512 }}</ref> vulva and vagina.<ref name=pmid20062629>{{Cite journal  | last1 = Gupta | first1 = R. | last2 = Bansal | first2 = B. | last3 = Singh | first3 = S. | last4 = Yadav | first4 = I. | last5 = Gupta | first5 = K. | last6 = Kudesia | first6 = M. | title = Lichen planus of uterine cervix - the first report of a novel site of occurrence: a case report. | journal = Cases J | volume = 2 | issue =  | pages = 9306 | month =  | year = 2009 | doi = 10.1186/1757-1626-2-9306 | PMID = 20062629 }}</ref>


===Microscopy===
===Gross===
*Dome-shaped/raised - papular (<1 cm) ''or'' nodular (>1 cm).<ref>URL: [http://www.pediatrics.wisc.edu/education/derm/text.html http://www.pediatrics.wisc.edu/education/derm/text.html]. Accessed on: 23 August 2012.</ref>
 
===Microscopic===
*See ''[[lichen simplex chronicus]]''.
 
DDx:
*[[Lichen simplex chronicus]] - a more diffuse process, not a raised lesion.
 
===Sign out===
<pre>
SKIN LESION, LEFT CHIN, BIOPSY:
- PRURIGO NODULARIS.
</pre>
 
====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===
*[[microorganisms|Fungal infection]] of skin.
 
Note:
*''Dermatophytosis'' (ring worm) is a type of dermatomycosis.
 
===Microscopic===
Features:
Features:
*Loss of rete ridges.
*Microorganisms - '''key feature'''.
*Loss of basal cells (stratum basale).
**Often hyphae (candida) - like twigs of a tree... branching.
*Interface dermatitis (lymphocytes at dermal-epidermal junction).
***May be very fragmented in section ~ size of a neutrophil.
*Perivascular inflammation, esp. neutrophils.
*[[Exocytosis]] - blood cell infiltrate the epidermis.
 
====Images====
<gallery>
Image:Dermatomycosis_-_intermed_mag.jpg | Dermatomycosis - intermed. mag. (WC)
Image:Dermatomycosis_-_high_mag.jpg | Dermatomycosis - high mag. (WC)
Image:Dermatomycosis_-_gms_-_low_mag.jpg | Dermatomycosis - GMS stain - low mag. (WC)
Image:Dermatomycosis_-_gms_-_high_mag.jpg | Dermatomycosis - GMS stain - high mag. (WC)
</gallery>
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===
*[[GMS stain]].
*[[PAS-D stain]].
 
===Sign out===
<pre>
SKIN, BIOPSY:
- SKIN WITH SUPERFICIAL FUNGAL ORGANISMS CONSISTENT WITH CANDIDA.
- REACTIVE CHANGES OF THE EPITHELIUM.
</pre>


Ref.: [http://emedicine.medscape.com/article/1078327-overview http://emedicine.medscape.com/article/1078327-overview].
====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.


Images:
The epithelium has parakeratosis, acanthosis and spongiosis. No mitotic activity is appreciated. The keratinocytes are moderately enlarged and have evident nucleoli.
*[http://commons.wikimedia.org/wiki/File:Lichen_planus_intermed_mag.jpg Lichen planus - intermed. mag. (WC)]
*[http://commons.wikimedia.org/wiki/File:Lichen_planus_low_mag.jpg Lichen planus - low mag. (WC)].


==Lichen sclerosus==  
==Cicatrix==
*AKA ''chronic atrophic vulvitis'' (when vulvar lesion).
{{Main|Dermal scar}}


===Etiology===
==Fibroepithelial polyp==
*Scratching due to pruritis.
{{Main|Fibroepithelial polyp}}


===Histology===
==Actinic keratosis==
Key feature:<ref>PBoD P.1065-6</ref>
{{Main|Actinic keratosis}}
*Subepithelial fibrosis.


==Lichen simplex chronicus==
==Actinic cheilitis==
===Histology===
===General===
Key features:<ref>PBoD P.1065-6</ref>
*[[Actinic keratosis]] of the lip.<ref name=pmid3305604>{{Cite journal  | last1 = Picascia | first1 = DD. | last2 = Robinson | first2 = JK. | title = Actinic cheilitis: a review of the etiology, differential diagnosis, and treatment. | journal = J Am Acad Dermatol | volume = 17 | issue = 2 Pt 1 | pages = 255-64 | month = Aug | year = 1987 | doi =  | PMID = 3305604 }}</ref>
*Acanthosis (epithelial thickening).  
 
*Hyperkeratosis.
===Microscopic===
:See ''[[actinic keratosis]]''.
 
===Sign out===
<pre>
LESION, LOWER LIP, BIOPSY:
- ACTINIC CHEILITIS.
- SOLAR ELASTOSIS.
</pre>
 
====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==
==Seborrheic keratosis==
{{Main|Seborrheic keratosis}}
==Pilomatricoma==
{{Main|Pilomatricoma}}
==Dermatofibroma==
{{Main|Dermatofibroma}}
==Ezcema==
===General===
*A nebulous thingy.
*Very common.
DDx:
*Contact allergy.
*[[Drug reaction]].
*Food allergy.
===Microscopic===
Features:<ref>{{Ref PBoD8|1188}}</ref>
*Spongiosis (epidermal edema); keratinocytes spacing increased - '''key feature'''.
*+/-Interdermal vesicles.
*+/-Eosinophils (may suggest Rx reaction).
*Perivascular lymphocytes.
==Acne vulgaris==
===General===
===General===
*Benign.
*Extremely common - esp. among adolescents.
*Common.
*Very rarely seen by pathologists.


===Epidemiology===
Treatments:
*Old people.
*Antibiotic (minocycline).
*Isotretinoin [[AKA]] all-trans retinoic acid (ATRA).


===Gross===
===Gross===
*"Stuck-on" appearance - raised lesion.
*Papules, pustules, nodules or cysts.
**White, black or erythematous.


Image(s):  
Images:
*[http://www.dermatlas.org/derm/IndexDisplay.cfm?ImageID=91774460 SK - gross image (dermatlas.org)].
*[http://commons.wikimedia.org/wiki/File:Blackheads.JPG Blackheads (WC)].
 
===Microscopic===
Features:<ref>{{Ref Derm|76}}</ref>
*Folliculitis:<ref name=Ref_Derm77>{{Ref Derm|77}}</ref>
**[[Neutrophil]]s 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:<ref name=Ref_Derm77>{{Ref Derm|77}}</ref>
*[[Rosacea]].
*Infective folliculitis.
*Perioral dermatitis.
*Acne vulgaris.
 
Image:
*[http://www.dermnet.com/images/Acne-Histology/picture/4069 Acne (dermnet.com)].
 
==Solar elastosis==
*[[AKA]] ''actinic elastosis''.<ref>URL: [http://www.dermnetnz.org/dermal-infiltrative/solar-elastosis.html http://www.dermnetnz.org/dermal-infiltrative/solar-elastosis.html]. Accessed on: 27 March 2013.</ref>
===General===
*Very common.
*Caused by sun exposure - specifically UV light.<ref name=pmid20802019>{{Cite journal  | last1 = Thomas | first1 = NE. | last2 = Kricker | first2 = A. | last3 = From | first3 = L. | last4 = Busam | first4 = K. | last5 = Millikan | first5 = RC. | last6 = Ritchey | first6 = ME. | last7 = Armstrong | first7 = BK. | last8 = Lee-Taylor | first8 = J. | last9 = Marrett | first9 = LD. | title = Associations of cumulative sun exposure and phenotypic characteristics with histologic solar elastosis. | journal = Cancer Epidemiol Biomarkers Prev | volume = 19 | issue = 11 | pages = 2932-41 | month = Nov | year = 2010 | doi = 10.1158/1055-9965.EPI-10-0686 | PMID = 20802019 }}</ref>
**Severity correlated with cumulative exposure to UV light..<ref name=pmid17204514/>
*Often co-localized with skin cancers - as UV light is risk factor for skin cancers.<ref name=pmid17204514 >{{Cite journal  | last1 = Karagas | first1 = MR. | last2 = Zens | first2 = MS. | last3 = Nelson | first3 = HH. | last4 = Mabuchi | first4 = K. | last5 = Perry | first5 = AE. | last6 = Stukel | first6 = TA. | last7 = Mott | first7 = LA. | last8 = Andrew | first8 = AS. | last9 = Applebaum | first9 = KM. | title = Measures of cumulative exposure from a standardized sun exposure history questionnaire: a comparison with histologic assessment of solar skin damage. | journal = Am J Epidemiol | volume = 165 | issue = 6 | pages = 719-26 | month = Mar | year = 2007 | doi = 10.1093/aje/kwk055 | PMID = 17204514 }}</ref>
*Benign.


===Microscopic===
===Microscopic===
Features:
Features:
*Normal appearing epidermis - raised above skin surface.
*Grey, spaghetti-like material in the superficial dermis.
*"Horn cysts" - collections of keratin.
 
DDx:
*[[Actinic keratosis]].
*[[Basal cell carcinoma]].
*[[Squamous cell carcinoma of the skin|Squamous cell carcinoma]].
 
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====
<gallery>
Image:Solar_elastosis_-_intermed_mag.jpg | Solar elastosis - intermed. mag. (WC)
Image:Solar_elastosis_-_high_mag.jpg | Solar elastosis - high mag. (WC)
</gallery>
www:
*[http://dermpathexpert.com/id88.html Solar elastosis - several images (dermpathexpert.com)].


Image(s):
===Sign out===
*[http://commons.wikimedia.org/wiki/File:Seborrheic_keratosis_(1).jpg Seborrheic keratosis (WC)].
<pre>
*[http://www.dermatlas.org/derm/IndexDisplay.cfm?ImageID=-1985374774 Seborrheic keratosis - high mag. (dermatlas.org)].
SKIN, RIGHT CHEEK, RE-EXCISION:
*[http://www.dermatlas.org/derm/IndexDisplay.cfm?ImageID=-1880960893 Seborrheic keratosis - low mag.  (dermatlas.org)].
- DERMAL SCAR.
- EXTENSIVE SOLAR ELASTOSIS.
</pre>


=====Prominent blood vessels=====
<pre>
SKIN LESION, LEFT CHEEK, BIOPSY:
- SKIN WITH SOLAR ELASTOSIS AND PROMINENT SMALL BLOOD VESSELS.
</pre>
<pre>
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.
</pre>
====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==
==Verruca vulgaris==
{{Main|Verruca vulgaris}}
==Verruca plana==
===General===
===General===
*[[AKA]] Wart.
*Common.
*Etiology: HPV. (???)
*Usu. hands and face.<ref name=Ref_WMSP480>{{Ref WMSP|480}}</ref>


===Microscopic===
===Microscopic===
Features:
Features:<ref name=Ref_WMSP480>{{Ref WMSP|480}}</ref>
*Hyperkeratosis (more keratin - thick stratum corneum).
*Orthokeratosis with basketweave pattern.
*Hypergranulosis (thicker stratum granulosum).
*Hypergranulosis.
*Rete ridges lengthened (~7-10x normal).
*Viral keratohyaline.
*Acanthosis (thickening of the stratum spinosum).
*Koilocytes.
*Large blood vessels at the dermal-epidermal junction.
*[[Acanthosis]] - yet flat surface and base.
 
Notes:
*It differs from [[verruca vulgaris]]... (1) orthokeratosis, (2) flat surface and base.
 
====Images====
www:
*[http://www.fujita-hu.ac.jp/~tsutsumi/case/case180.htm Verruca plana - several images (fujita-hu.ac.jp)].
*[http://www.dermatopathonline.com/verruca%20plana2.html Verruca plana - several good images (dermatopathonline.com)].
 
=Less common=
==Chronic folliculitis==
:''Folliculitis'' redirect here.
===General===
*Common.
*Infrequently biopsied.


Ref.:<ref>URL: [http://missinglink.ucsf.edu/lm/DermatologyGlossary/verruca_vulgaris.html http://missinglink.ucsf.edu/lm/DermatologyGlossary/verruca_vulgaris.html]. Accessed on: 14 July 2010.</ref>
===Gross===
*Erythema.<ref>URL: [http://www.webmd.com/skin-problems-and-treatments/tc/folliculitis-topic-overview http://www.webmd.com/skin-problems-and-treatments/tc/folliculitis-topic-overview]. Accessed on: 7 November 2012.</ref>


==Molluscum contagiosum==
DDx gross:
*Etiology: caused by ''molluscum contagiosum virus''.
*[[Melanocytic lesion]]s.


===Microscopic===
===Microscopic===
Features:
Features:
*A suprabasilar epidermal lesion consisting of "molluscum bodies", i.e. ''molluscum bodies'' are found above the stratum basale.<ref>[http://www.missionforvisionusa.org/anatomy/2006/08/what-is-molluscum-contagiosum.html http://www.missionforvisionusa.org/anatomy/2006/08/what-is-molluscum-contagiosum.html]</ref>
*Inflammation around the hair follicle - '''key feature'''.
*Molluscum bodies:
**Lymphocytes - usu. predominant.
**Large cells with abundant granular eosinophilic cytoplasm.
*+/-Chronic changes:
**Small peripheral nucleus.
**[[Acanthosis]].
**Hyperkeratosis.
**Hypergranulosis.
 
DDx:
*[[Acne vulgaris]].
 
===Sign out===
<pre>
SKIN LESION, UPPER ARM, BIOPSY:
- CHRONIC FOLLICULITIS WITH SECONDARY SURFACE CHANGES.
</pre>


Image(s):
====Micro====
*[http://commons.wikimedia.org/wiki/File:Molluscum_contagiosum_high_mag.jpg Molluscum contagiosum - high mag. (WC)].
The sections show hair-bearing skin with abundant lymphocytes around and within the hair follicle wall.  
*[http://commons.wikimedia.org/wiki/File:Molluscum_contagiosum_low_mag.jpg Molluscum contagiosum - low magnification (WC)].


Note:
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.
*Molluscum bodies vaguely resemble ''[[signet ring cell]]s'' -- but:
**Cytoplasm eosinophilic and granular.
**Nucleus usually smaller than in signet ring cell.
**''Molluscum bodies'' are only the epidermis - an uncommon place to find SRCs without finding them elsewhere.
*The granular eosinophilic cytoplasm represents accumulated virons.


==Dermal nevus==
There are no granulomas.
*Think ''melanoma''.


Clinical: ''ABCD'' = asymmetric, borders (irregular), colour (black), diameter (large).
==Clear cell acanthoma==
{{Main|Clear cell acanthoma}}
 
==Chondrodermatitis nodularis chronica helicis==
*[[AKA]] ''chondrodermatitis nodularis helicis''.
*Abbreviated ''CNCH''.
*[[AKA]] ''Winkler disease''.<ref>URL: [http://www.head-face-med.com/content/4/1/2 http://www.head-face-med.com/content/4/1/2]. Accessed on: 16 January 2014.</ref>
{{Main|Chondrodermatitis nodularis chronica helicis}}
 
==Cutaneous calcinosis==
*[[AKA]] ''calcinosis cutis''.
{{Main|Cutaneous calcinosis}}
 
==Dilated pore of Winer==
===General===
*Benign.
*Looks like a zit.


===Microscopic===
===Microscopic===
Features:<ref>need ref</ref>
Features:<ref name=Ref_WMSP486>{{Ref WMSP|486}}</ref>
*Symmetrical lesion.
*Dilated hair follicle with keratin.
*"Matures" with depth - less cellular, less atypia.
*[[Acanthosis]].
*No destruction of surrounding structures.
*Budding of epidermis (into dermis).
*Only in dermis '''key feature'''.
 
**Otherwise it is something else, e.g. ''dermal nevus'', ''junctional nevus''.
DDx:
*[[Pilar sheath acanthoma]].
 
Image:
*[http://dermpathexpert.com/id90.html Dilated pore of Winer (dermpathexpert.com)].
 
==Lichenoid keratosis==
*[[AKA]] ''lichen planus-like keratosis''.
{{Main|Lichenoid keratosis}}
 
==Granuloma annulare==
{{Main|Granuloma annulare}}
 
==Necrobiosis lipoidica==
{{Main|Necrobiosis lipoidica}}
 
==Keloid==
{{Main|Keloid}}
 
==Angiofibroma==
:See also: ''[[nasopharyngeal angiofibroma]]''.
:Should '''not''' be confused with ''[[angiokeratoma]]''.
{{Main|Angiofibroma}}
 
==Benign fibrous papule==
*[[AKA]] ''fibrous papule''.
 
===General===
*An ''[[angiofibroma]]'' on the face that is solitary.<ref name=Ref_Derm505>{{Ref Derm|505}}</ref><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>
 
===Gross===
*Solitary lesion of the face - '''important'''.<ref name=Ref_Derm505>{{Ref Derm|505}}</ref>
**Usually on the nose.<ref name=pmid18032900/>


===Microscopic===
===Microscopic===
*Basaloid cells mixed with squamous cells.  
Features:<ref name=Ref_WMSP492>{{Ref WMSP|492}}</ref>
*Keratin-filled invaginations.  
*Dome-shaped.
*Horn cysts - intraepidermal, brown globule-like structures.  
*Fibrotic dermis.
**Melanocytes at the dermoepidermal junction.<ref>[http://emedicine.medscape.com/article/1059477-overview http://emedicine.medscape.com/article/1059477-overview]</ref>
**Enlarged fibroblasts.
*Dilated small vessels.
*+/-Multinucleated stromal cells.<ref name=pmid543528>{{Cite journal  | last1 = Ragaz | first1 = A. | last2 = Berezowsky | first2 = V. | title = Fibrous papule of the face. A study of five cases by electron microscopy. | journal = Am J Dermatopathol | volume = 1 | issue = 4 | pages = 353-6 | month =  | year = 1979 | doi =  | PMID = 543528 }}</ref>
*+/-Stellate cells.<ref name=pmid543528/>


==Pilomatrixoma==
DDx:
===General===
*[[Angiofibroma]] - not solitary or not on the nose.
*Benign skin tumour.
 
*Most common solid skin tumour of children.<ref name=emed1058965>[http://emedicine.medscape.com/article/1058965-overview http://emedicine.medscape.com/article/1058965-overview]</ref>
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>
 
===Images===
*[http://www.dermaamin.com/site/histopathology-of-the-skin/58-f/1739-fibrous-papule-angiofibroma-.html Fibrous papule (dermaamin.com)].
 
===Sign out===
<pre>
SKIN LESION, CHIN, BIOPSY:
- BENIGN FIBROUS PAPULE.
</pre>
 
==Molluscum contagiosum==
{{Main|Molluscum contagiosum}}
 
==Superficial dermal infiltrates==
Discussed in detail by Alsaad and Ghazarian.<ref name=pmid16311340>{{Cite journal  | last1 = Alsaad | first1 = KO. | last2 = Ghazarian | first2 = D. | title = My approach to superficial inflammatory dermatoses. | journal = J Clin Pathol | volume = 58 | issue = 12 | pages = 1233-41 | month = Dec | year = 2005 | doi = 10.1136/jcp.2005.027151 | PMID = 16311340 }}</ref>


Clinical:
===Dermal perivascular lymphoeosinophilic infiltration===
*Hard nodule - calcification.
*Abbreviated ''DPLI''.
*+/-Painful. (???)


Treatment:
Microscopic appearance is just what it is called:
*Surgical excision.<ref name=emed1058965>[http://emedicine.medscape.com/article/1058965-overview http://emedicine.medscape.com/article/1058965-overview]</ref>
*Lymphocytes and eosinophils around the vessels in the superficial dermis.


===Microscopic===
DDx:<ref name=pmid16311340/>
Features:<ref name=emed1058965dx>[http://emedicine.medscape.com/article/1058965-diagnosis http://emedicine.medscape.com/article/1058965-diagnosis]</ref>
*Insect bite - classically wedge-shaped.<ref name=Ref_PBoD1269>{{Ref PBoD|1269}}</ref>
*Location: lower dermis/subcutaneous fat; thus, usu. surrounded by connective tissue.
*[[Drug reaction]].
*Sharpy demarcated island of cells.
*Urticarial reaction.
*Calcification in 75% - with calcium staining (von Kossa).  
*Prevesicular early stage of [[bullous pemphigoid]].
*Cells:<ref>[http://www.bccancer.bc.ca/HPI/CE/cytotechnology/cytosleuthquiz/nongyne/ngcase02d.htm http://www.bccancer.bc.ca/HPI/CE/cytotechnology/cytosleuthquiz/nongyne/ngcase02d.htm]</ref>
*[[HIV]] related dermatoses.
**Basaloid epithelial cells - have prominent nucleoli.
**Anucleate squamous cells ("ghost cells").  
*Giant cell foreign body type granulomas (form in reaction to keratin).


Notes:
Notes:
*Keratin a prominent feature on cytology - lots of orange stuff.
*May superficially resemble cutaneous lymphoma.<ref name=Ref_PBoD1269>{{Ref PBoD|1269}}</ref>


Images:
Images:
*[http://www.bccancer.bc.ca/HPI/CE/cytotechnology/cytosleuthquiz/nongyne/ngcase02.htm Pilomatrixoma - cytology (bccancer.bc.ca)].
*[http://en.wikipedia.org/wiki/File:Dermal_perivascular_lymphoeosinophilic_infiltrate_-_very_low_mag.jpg DPLI - very low mag. (WC)].
*[http://www.dermrounds.com/photo/1980062:Photo:431 Pilomatrixoma - histology (dermrounds.com)].
*[http://en.wikipedia.org/wiki/File:Dermal_perivascular_lymphoeosinophilic_infiltrate_-_very_high_mag.jpg DPLI - very high mag. (WC)].
DDx:
 
*Epidermal inclusion cyst.
==Congenital dermal melanocytosis==
*[[AKA]] ''Mongolian spots''.
*Classically seen in asian children.
 
Gross:
*Brown or blue-grey patch in the lumbosacral area.
 
==Mastocytosis==
{{Main|Mastocytosis}}


==Syringoma==
==Ichthyosis==
*Benign sweat duct tumour. (???)
===General===
*Eccrine differentiation.
*Comes in different flavours.
*Usu. inherited... thus a pediatric condition.


===Microscopic===
===Gross===
Features:<ref>URL: [http://emedicine.medscape.com/article/1059871-diagnosis http://emedicine.medscape.com/article/1059871-diagnosis]. Accessed on: 12 May 2010.</ref>
*Fish scale-like appearance.
*Proliferation of benign ducts with lined by a bilayer (as in normal sweat ducts) with abnormal architecture:
**Tadpole like appearing ducts.


Image:
Image:
*[http://www.flickr.com/photos/euthman/2329061316/ Syringoma (flickr.com)].
*[http://commons.wikimedia.org/wiki/File:Ichthyosis_1.jpg Ichtyosis (WC)].


==Inverted follicular keratosis==
===Microscopic===
*Benign skin lesion.
Features:<ref name=Ref_PBoD8|1185>{{Ref PBoD8|1185}}</ref>
*Rare.
*Thick stratum corneum without basket-weave pattern.
*May mimic squamous cell carcinoma or basal cell carcinoma.<ref>URL: [http://www.ncbi.nlm.nih.gov/pmc/articles/PMC475744/ http://www.ncbi.nlm.nih.gov/pmc/articles/PMC475744/]. Accessed on: 11 May 2010.</ref>


Images:
==Palmar fibromatosis==
*[http://www.flickr.com/photos/euthman/3059309003/ Inverted follicular keratosis - low mag. (flickr.com)].
*[[AKA]] ''Dupuytren's contracture''.
*[http://www.flickr.com/photos/euthman/3060145702/ Inverted follicular keratosis - high mag. (flickr.com)].
*[[AKA]] ''Dupuytren disease''.
{{Main|Palmar fibromatosis}}


==Dermal cylindroma==
==Angiomyoma==
*Do '''not''' confuse with ''[[aggressive angiomyxoma|angiomyxoma]]''.
===General===
===General===
*Benign skin lesion.
*Benign.
*Should not be confused with ''cylindroma'' (adenoid cystic carcinoma).
*Female > male.<ref name=pmid3201831 >{{cite journal |author=Katenkamp D, Kosmehl H, Langbein L |title=[Angiomyoma. A pathologo-anatomic analysis of 229 cases] |language=German |journal=Zentralbl Allg Pathol |volume=134 |issue=4-5 |pages=423–33 |year=1988 |pmid=3201831 |doi= |url=}}</ref>


===Microscopic===
===Microscopic===
Features:
Features:
*Nests of cells that are surrounded by hyaline (i.e. glassy, eosinophilic, acellular) material.
*Well-circumscribed lesion with [[fascicular]] architecture.
*Spindle cells/epithelioid cell with moderate eosinophilic (pink) cytoplasm.
*Thick-walled blood vessels. (???)


Images:
Images:
*[http://commons.wikimedia.org/wiki/File:Dermal_cylindroma_intermed_mag.jpg Dermal cylindroma (WC)].
*[http://commons.wikimedia.org/wiki/File:Cutaneous_angiomyoma_%281%29.jpg Angiomymoma (WC)].
*[http://commons.wikimedia.org/wiki/File:Dermal_cylindroma_intermed_mag_deep.jpg Dermal cylindroma - high mag. (WC)].
*[http://commons.wikimedia.org/wiki/File:Cutaneous_angiomyoma_%282%29.jpg Angiomymoma (WC)].
 
==Angiokeratoma==
{{Main|Angiokeratoma}}


==Keratoacanthoma==
==Inverted follicular keratosis==
*Abbreviated ''KA''.
*Abbreviated ''IFK''.<ref name=pmid11411260>{{Cite journal | last1 = Shih | first1 = CC. | last2 = Yu | first2 = HS. | last3 = Tung | first3 = YC. | last4 = Tsai | first4 = KB. | last5 = Cheng | first5 = ST. | title = Inverted follicular keratosis. | journal = Kaohsiung J Med Sci | volume = 17 | issue = 1 | pages = 50-4 | month = Jan | year = 2001 | doi = | PMID = 11411260 }}</ref>
*Generally considered to be benign.
===General===
**Rare reports of metastases suggesting it may be a form of squamous cell carcinoma.<ref>{{cite journal |author=Mandrell JC, Santa Cruz D |title=Keratoacanthoma: hyperplasia, benign neoplasm, or a type of squamous cell carcinoma? |journal=Semin Diagn Pathol |volume=26 |issue=3 |pages=150–63 |year=2009 |month=August |pmid=20043514 |doi= |url=}}</ref>
*Benign skin lesion.
*Central face - middle age.<ref name=Ref_Derm387>{{Ref Derm|387}}</ref>
*Uncommon.
*May be considered a variant of ''[[seborrheic keratosis]]'' that is predominantly endophytic.<ref name=Ref_Derm341>{{Ref Derm|341}}</ref>


===Clinical===
Clinical DDx:<ref name=Ref_Derm387>{{Ref Derm|387}}</ref><ref>URL: [http://www.ncbi.nlm.nih.gov/pmc/articles/PMC475744/ http://www.ncbi.nlm.nih.gov/pmc/articles/PMC475744/]. Accessed on: 11 May 2010.</ref>
*May grow rapidly (weeks or months) then involute.
*[[BCC]].
*Main DDx is squamous cell carcinoma.
*[[Wart]].
*Exophytic lesion, well-circumscribed.


===Microscopic===
===Microscopic===
Features:<ref>Klatt. AOP. P. 378.</ref>
Features:<ref name=Ref_Derm387>{{Ref Derm|387}}</ref>
*Expansion of stratum spinosum - pushing tongue-like downward growth of epidermis into the dermis.
*Keratinocyte of cytologically benign proliferation.
*Keratin collection (keratin plug) at the center of lesion-superficial aspect.
*"Squamous eddies" (whorls of keratin).
*Cells have glassy pink cytoplasm.
*Coarse keratohyaline granules.
*Minimal/no nuclear atypia.
 
DDx:
*[[Squamous cell carcinoma of the skin]].
*[[Trichilemmoma]].
*[[Seborrheic keratosis]] - has an exophytic component.


Image:
Images:
*[http://commons.wikimedia.org/wiki/File:Skin_keratoacanthoma_whole_slide.jpg Keratocanthoma (WC).]
*[http://www.flickr.com/photos/euthman/3059309003/ Inverted follicular keratosis - low mag. (flickr.com)].
*[http://www.flickr.com/photos/euthman/3060145702/ Inverted follicular keratosis - high mag. (flickr.com)].
*[http://mckeedermpath.com/SPOT%20DIAGNOSIS%20CASE%20474.html Inverted follicular keratosis - several images (mckeedermpath.com)].
 
===Sign out===
<pre>
SKIN LESION, FACE, BIOPSY:
- INVERTED FOLLICULAR KERATOSIS.
</pre>
 
====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.


==Dermatofibroma==
==Focal cutaneous mucinosis==
===General===
===General===
*AKA ''fibrous histiocytoma''.
*Benign.
*Reactive process -- it is ''not'' a neoplasm.
*May be associated with systemic disease.<ref>{{Cite journal  | last1 = Gandhi | first1 = V. | last2 = Dogra | first2 = D. | last3 = Pandhi | first3 = RK. | title = Cutaneous focal mucinosis. | journal = Indian J Dermatol Venereol Leprol | volume = 62 | issue = 4 | pages = 260-1 | month =  | year =  | doi =  | PMID = 20948074 }}</ref>
*Usually assoc. with previous trauma.
**In women... usually legs.


===Microscopic===
===Microscopic===
Features:<ref>WMSP P.492.</ref>
Features:
*Prominent fibrous bundles, especially at the edge of the lesion.
*Light blue whispy material in the dermis - '''key feature'''.
**Surrounded by spindle cells (fibroblasts).
 
***Usually thought of as fibroblasts surrounded by fibrous material ("collagen-trapping").
DDx:
*Lack of adnexal structures, i.e. no sweat glands, no hair.
*Dermal edema.
*+/-Acanthosis (thickened epithelial layer - specifically thickened ''stratum spinosum'') with basal keratinocyte hyperpigmentation.
*[[Digital mucous cyst]].
**May vaguely resemble ''basal cell carcinoma''.
 
==Panniculitis==
{{Main|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|Necrotizing fasciitis}}
 
==Porokeratosis==
{{Main|Porokeratosis}}


Images:
==Nevus sebaceous==
*[http://missinglink.ucsf.edu/lm/DermatologyGlossary/dermatofibroma.html Dermatofibroma (ucsf.edu)].
*[[AKA]] ''nevus sebaceous of Jadassohn''.
{{Main|Nevus sebaceous}}


DDx:
==Nevus lipomatosus superficialis==
*Neurofibroma.
*Abbreviated ''NLS''.
*Blue nevus.
*[[AKA]] ''nevus lipomatosus cutaneous superficialis'', abbreviated ''NLCS''.
*Dermatofibroma pertuberans (DFSP).
*[[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>
*Melanoma.
{{Main|Nevus lipomatosus superficialis}}


==Bullous disease==
=Bullous disease=
{{main|Bullous disease}}
{{main|Bullous disease}}


==Cysts==
=Cysts=
{{main|Dermal cysts}}
{{main|Dermal cysts}}


==See also==
=See also=
*[[Dermatopathology introduction]].
*[[Dermatopathology introduction]].
*[[Malignant skin disease]].
*[[Malignant skin disease]].


==References==
=References=
{{reflist|2}}
{{reflist|2}}


[[Category:Non-malignant skin disease]]
[[Category:Non-malignant skin disease]]
[[Category:Dermatopathology]]
[[Category:Dermatopathology]]
Michael
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