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this is a class lecture of Pathology for undergraduate students based on the topic 'Diseases of skin' following Robbibs Pathologic basis of disease. The lecture is prepared by Dr. Umme Kulsum Munmun, Assistant Professor for the 4th year students of Chandpur Medical College, Chandpur, Bangladesh. This was previously delivered to 4th year students of Cumilla Medical College. It contains a short description of the common diseases of skin and their pathology. Hopefully this will be helpful for all undergraduate medical students.
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Basal Cell Carcinoma (BCC)
BCC is the most common cancer in humans.
Caused by UVR; PTCH gene mutation in most cases.
Clinically different types: nodular, ulcerating, pigmented, sclerosing , and superficial.
BCC is locally invasive, aggressive, and destructive but slow growing, and there is very limited (literally no) tendency to metastasize.
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Cutaneous Melanoma
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I : De novo melanoma
A. Melanoma in situ (MIS)
B. Lentigo maligna melanoma (LMM)
C. Superficial spreading melanoma (SSM)
D. Nodular melanoma (NM)
E. Acral-lentiginous melanoma (ALM)
F. Melanoma of the mucous membranes
G. Desmoplastic melanoma
II Melanoma arising from precursors
Melanoma arising in dysplastic nevomelanocytic nevi
B. Melanoma arising in congenital nevomelanocytic nevi
C. Melanoma arising in common NMN
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The major genes involved in melanoma development reside on chromosome 9p21.
Etiology
UVR, mostly of the UVB spectrum (290–320 nm) that induces mutations in suppressor genes. The propensity for multiple BCC may be inherited. Associated with mutations in the PTCH gene in many cases.
Predisposing Factors
Genetic markers (CDKN2a mutation)
Skin type I/II
Family history of dysplastic nevi or melanoma
Personal history of melanoma
Ultraviolet irradiation, particularly sunburns during childhood and intermittent burning exposures
Number (>50) and size (>5 mm) of melanocytic nevi
Congenital nevi
Number of dysplastic nevi (>5)
Dysplastic melanocytic nevus syndrome
Immune suppression (debatable)
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Congenital nevi
Number of dysplastic nevi (>5)
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D- Diameter is usually large.
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Thumb rule:
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Differentiated SCC: is hard on palpation and has hyperkeratosis.
Exposure:
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Lesions :
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Melanoma
Cutaneous Melanoma
also known as malignant melanoma, is a type of cancer that develops from the pigment-containing cells known as melanocytes.
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I : De novo melanoma
A. Melanoma in situ (MIS)
B. Lentigo maligna melanoma (LMM)
C. Superficial spreading melanoma (SSM)
D. Nodular melanoma (NM)
E. Acral-lentiginous melanoma (ALM)
F. Melanoma of the mucous membranes
G. Desmoplastic melanoma
II Melanoma arising from precursors
Melanoma arising in dysplastic nevomelanocytic nevi
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C. Melanoma arising in common NMN
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Epidemiologic studies demonstrate a role for genetic predisposition and sun exposure in melanoma development.
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Etiology
UVR, mostly of the UVB spectrum (290–320 nm) that induces mutations in suppressor genes. The propensity for multiple BCC may be inherited. Associated with mutations in the PTCH gene in many cases.
Predisposing Factors
Genetic markers (CDKN2a mutation)
Skin type I/II
Family history of dysplastic nevi or melanoma
Personal history of melanoma
Ultraviolet irradiation, particularly sunburns during childhood and intermittent burning exposures
Number (>50) and size (>5 mm) of melanocytic nevi
Congenital nevi
Number of dysplastic nevi (>5)
Dysplastic melanocytic nevus syndrome
Immune suppression (debatable)
Number (>50) and size (>5 mm) of melanocytic nevi
Congenital nevi
Number of dysplastic nevi (>5)
Dysplastic melanocytic nevus syndrome
Immune suppression (debatable)
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D- Diameter is usually large.
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Squamous Cell Carcinoma (SCC)
Invasive Squamous Cell Carcinoma (SCC)
SCC of the skin is a malignant tumor of keratinocytes, arising in the epidermis.
SCC usually arises in epidermal precancerous lesions and, depending on etiology and level of differentiation, varies in its aggressiveness.
The lesion is a plaque or a nodule with varying degrees of keratinization in the nodule and/or on the surface.
Thumb rule:
Undifferentiated SCC: is soft and has no hyperkeratosis;
Differentiated SCC: is hard on palpation and has hyperkeratosis.
Exposure:
Sunlight. Phototherapy, PUVA (oral psoralen + UVA). Excessive photochemotherapy can lead to promotion of SCC, particularly in patients with skin phototypes I and II or in patients with history of previous exposure to ionizing radiation or methotrexate treatment for psoriasis.
Lesions :
Indurated papule, plaque, or nodule ; adherent thick keratotic scale or hyperkeratosis ; when eroded or ulcerated, the lesion may have a crust in the center and a firm, hyperkeratotic, elevated margin
Clark levels
level I, intra-epidermal;
level II, invades papillary dermis;
level III fills papillary dermis;
level IV, invades reticular dermis;
level V, invades subcutaneous fat.
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This document summarizes different types of cutaneous tuberculosis, their characteristics, and treatment approaches. The main types discussed are primary tuberculosis of the skin, miliary tuberculosis of the skin, lupus vulgaris, scrofuloderma, tuberculosis verrucosa cutis, tuberculosis cutis orificialis, and tuberculides. Lupus vulgaris is described as the most common form, presenting as reddish-brown plaques on the head and neck that can cause scarring and deformity. Treatment involves a combination of anti-tuberculosis medications like rifampicin, isoniazid, and ethambutol, as well as surgical excision for some small lesions.
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Melanin is the pigment produced by melanocytes in the skin that determines skin color. It protects the skin from UV damage. Vitiligo is a condition where melanocytes die or stop functioning, causing white patches of skin where no melanin is produced. It can affect any part of the body and is associated with autoimmune diseases. Treatments include cosmetic camouflage, phototherapy (PUVA), topical corticosteroids, and skin grafting. Prognosis varies and vitiligo may continue in cycles of pigment loss and stability.
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Eczema is an inflammatory skin condition characterized by redness, blistering, weeping, and crusting. It has both acute and chronic stages. There are many types of eczema classified by etiology as endogenous, exogenous, or combined. Common types include atopic dermatitis, contact dermatitis, seborrheic dermatitis, dyshidrotic eczema, and stasis dermatitis. Eczema is diagnosed clinically and treatment involves identifying triggers, moisturizing, topical corticosteroids, oral antihistamines, and managing complications.
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Pleomorphic adenoma is the most common salivary gland tumor, accounting for 60% of cases. It occurs most often in the parotid glands and presents as a painless, firm mass. Histologically, it contains both epithelial and mesenchymal elements arranged in a trabecular pattern within a fibrous stroma. Treatment involves complete surgical removal of the tumor with adequate margins to prevent recurrence due to microscopic projections outside the capsule. Imaging such as CT or MRI is used to identify the location and characteristics of the tumor prior to surgery.
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Dermatology Atlas
1) Keloid and hypertrophic scars differ in that keloids grow beyond the boundaries of the original wound while hypertrophic scars remain within the boundaries and eventually regress.
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This document summarizes various types of skin malignancies:
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This document provides information on various skin conditions and disorders. It describes conditions like acne, athlete's foot, burns of varying degrees, dermatitis, eczema, herpes, impetigo, psoriasis, ringworm, scabies, and several types of skin cancer. It also defines different types of skin lesions like macules, vesicles, pustules, and papules. Treatments are mentioned for many of the conditions.
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This document summarizes common ear, eye, and skin disorders. It describes otitis media (inflammation of the middle ear), its types including acute suppurative and chronic suppurative otitis media. It also describes conjunctivitis, its causes and types including bacterial, viral, and trachoma. Finally, it discusses various skin conditions like infections (bacterial, viral, fungal), dermatitis, and malignant tumors (squamous cell carcinoma, basal cell carcinoma, melanoma).
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This document discusses oral pigmentation and classifies it as either endogenous or exogenous based on its origin. Endogenous pigmentation is produced by the body and includes hemoglobin, melanin, and hemosiderin, while exogenous pigmentation comes from outside sources like tobacco or vegetables. Various diseases can cause changes in color, texture, or vascularization of oral tissues. Blue, brown, and black pigmentation can be attributed to the deposition of endogenous or exogenous pigments. The document then examines specific conditions that cause blue/purple, brown, or gray/black pigmentation like hemangiomas, varices, Kaposi's sarcoma, and various nevi. It provides details on the features, causes, diagnoses
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A detailed presentation on the clinical features, predisposing factors and treatment of skin cancers especially Squamous Cell Carcinoma. Pre - malignant conditions like Actinic keratosis, Bowen disease, Porokeratosis are also discussed. Also the presentation provides a detail of the various differential diagnoses of the skin cancers. Useful for medical students, post graduate trainees and nursing staff. Role of sunlight is also discussed.
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The document provides an overview of diseases of the skin, including:
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This document provides information on various disorders, pathologies, and diseases that can affect the anterior structures of the eye. It discusses conditions such as:
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Lichen planus
Oral lichen planus is a chronic mucocutaneous disease that affects the skin and oral mucosa. It is caused by an abnormal immune reaction that results in apoptosis of epithelial cells. Clinically, it presents as white reticulated lines on the oral mucosa, as well as violaceous papules or plaques on the skin. Histologically, there is hyperorthokeratinization, saw-tooth rete pegs, and a band of inflammatory cells beneath the epithelium. Treatment focuses on managing symptoms with topical corticosteroids to resolve lesions and reduce cancer risk.
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This document provides definitions and descriptions of terms related to normal skin anatomy and pathology. It begins with labeling diagrams of normal skin structures from the macroscopic to microscopic level. It then covers various skin conditions including pigmentation disorders, benign and malignant epidermal and dermal tumors, dermatoses, bullae, appendage disorders, panniculitis, and infections/infestations. For each condition, it lists key characteristics and histologic findings to aid in identification and diagnosis.
Rash
Rash history
Much of the diagnosis comes from examining the rash or lesion itself, but history taking is still important.
History of presenting complaint
Features of the rash:
Evolution of rash/lesion over time.
Onset at multiple sites and/or symmetrical? Suggests an internal cause.
Does sun exposure make it worse (e.g. SLE) or better (e.g. psoriasis)?
Associated symptoms:
Itch (common) and pain (uncommon), both of which can be explored with SOCRATES.
Ooze or weeping? Suggests eczema.
Loosing sleep from discomfort?
Possible causes:
Contact with substances at work or as part of a hobby. May cause allergic or irritant contact dermatitis.
Medications.
Sun exposure history if you suspect cancer:
Do you tan/burn often?
Sunbed use.
Lived abroad?
Worked outside?
The medicos PDF app was used to collect this information. I stumbled discovered this amazing app when searching for various slides and books and decided to share it with you all. The Google Play Store has a free version of the app.
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This document summarizes various skin diseases and their oral manifestations. It describes different skin lesions such as macules, papules, nodules, plaques, vesicles, bullae, pustules, and vascular changes. It then discusses specific diseases including ectodermal dysplasia, white sponge nevus, hereditary benign intraepithelial dyskeratosis, pemphigus, cicatrial pemphigoid, bullous pemphigoid, erythema multiforme, lupus erythematosus, and systemic sclerosis; and their oral signs and symptoms, histopathological features, and treatments.
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Description of lesions
Macule / Patch
Papule
Nodule
plaque
Vesicle & Bullae
Scale dry, flaky area on skin
Lichenification thickened and rough skin characterized by prominent skin markings
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Gastrointestinal Infections
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Skin,.pptx
- 1. DISEASES OF SKIN Dr. Umme Kulsum Munmun Assistant Professor, Department of Pathology, Chandpur Medical College
- 8. Diseases of Skin Inflammatory dermatoses: - Urticaria (hives) - Eczematous dermatitis - Erythema multiforme
- 9. Inflammatory Dermatoses Hives Urticaria (wheal) Generalized Allergic reaction Bee sting Medications IgE mediated Histamine release Vascular dilation Fluid in tissues
- 10. Eczema, ‘Boiling Over’ Allergic contact dermatitis Atopic dermatitis Drug related atopic dermatitis Photoeczematous dermatitis Red, papulovesicular, oozing and crusted lesions Scaling plaque, if persistent
- 11. Chronic Inflammatory Dermatoses Persistent, months to years Skin is roughened due to excessive or abnormal scale formation and shedding Thickening Scaling Roughening Variable inflammation of dermis
- 12. Chronic Inflammatory Dermatoses Seborrhoec dermatitis – regions with high density of sebaceous glands, scalp etc
- 13. Psoriasis Ag/Ab reaction? Knees, elbows, scalp, lumbosacral areas, intergluteal cleft, glans Whole body is pretty bad At areas of trauma Pink to salmon – colored plaque covered by loosely adherent silver white scale
- 14. Lichen Planus Resolving spontaneously 1 to 2 years after onset Flat topped, pruritic, pink-purple, polygonal papule with white lacelike patterns of lines Papules may coalesce to form plaques
- 15. Lupus Eyrthematosis Autoimmune Two forms Systemic Discoid (skin only) Systemic problems Kidney failure Vasculitis and DVT with emboli Antibodies in serum Anti-DNA Other nuclear
- 16. Infections of Skin Bacterial Impetigo – Superficial bacterial infection Abscesses Acne – occlusion of sebaceous glands Fungal Ringworm Viruses Verurcae (warts), molluscum contagiosum, smallpox
- 17. Impetigo
- 18. Acne
- 19. Verrucae (Warts) Squamoproliferative disorders Caused by HPV Gray white to tan papules Verrucae vulgaris- most common, occur anywhere, frequently on hands, periungual areas Verrucae plana or fat wart- face, hands Verrucae plantaris- sole Verrucae palmaris- palm Condyloma acuminatum (veneral wart) – genital region
- 20. Verrucae (Warts)
- 21. Disorders of Epidermal Maturation Icthyosis
- 22. Epithelial tumours Benign: - Seborrheic keratosis - Acanthosis nigricans - Keratoacanthoma - Fibroepithelial polyp - Epidermal cyst Seborrheic Keratosis
- 23. Epithelial tumours Premalignant: - Actinic Keratosis
- 25. Basal Cell Carcinoma The most common malignancy we suffer from. Solar exposed skin. Common site- above imaginary line joining angle of mouth and pinna Pearly papule Raised edges Maybe central ulceration
- 26. Basal Cell Carcinoma Slow growing tumors Do not metastasize usually Recognized at early stage Cured by local excision A small number (0.5%) of tumors are locally aggressive Also called rodent ulcer
- 27. Squamous Cell Carcinoma Arises from differentiated squamous epithelium Sun exposed UV Metastasizes
- 28. Squamous Cell Carcinoma Cells produce keratin pearls Invade and spread High mitotic count
- 29. Squamous Cell Carcinoma Keratin Pearls
- 31. Vitiligo Autoimmune basis Hypopigmented/ white plaque pigment forming cells known as melanocytes are injured
- 32. Vitiligo
- 33. Proliferative Melanocytic Lesions Nevi Benign growths of young melanocytes. Many of them congenital. Dysplastic nevus Abnormal maturation. May become malignant Malignant melanoma
- 34. Dermal Nevus Clusters of young melanocytes. Confined to dermis.
- 35. Nevi
- 36. Dysplastic Nevus Abnormal maturation of nevus cells May proceed to malignant melanoma Sometimes part of a familial syndrome.
- 37. Malignant Melanoma Malignant melanocytic tumor Very unpredictable tumor Genetics Solar and UV exposure Ethnic Radial growth followed by Penetrating phase Metastasis
- 38. Malignant Melanoma Nodular or vertical growth Depth >2 mm Bad development Sites Skin Conjunctiva Retina Iris Meninges
- 40. Xanthomas Histiocytes containing lipid Around eyes Extensor surfaces of extremities Diabetes Liver disease Hyperlipidemia
- 41. Blistering Conditions Pemphigus vulgaris Bullous pemphigoid Dermatitis herpetiformis
- 42. Cleft Position is Important Subcorneal: Impetigo Suprabasalar: Pemphigus vulgaris Subepidermal or basilar: Bullous pemphigoid Dermatitis herpatiformis
- 44. Bullous Pemphigoid Antibodies against hemidesmosomes. Hemidesomsomes anchor epidermis to basement membrane
- 45. Skin Adnexal (Appendage) Tumour Eccrine poroma- sweat gland differentiation Cylindroma- Ductal (apocrine or eccrine differentiation) Syringoma- eccrine differentiation Sebaceous adenoma Pilomatricoma – hair follicular differentiation
- 46. Tumours of Cellular Migrants to Skin Mycosis Fungoides (Cutaneous T-cell Lymphoma)
- 47. THANK YOU