Pathomorph Lab 22 Skin Pathology

1. Molluscum contagiosum (855).

a. Firm, pink imbilicated papules due to Poxvirus infections (DNA virus)
b. Most often in children
c. Also in sexually active adults, common in AIDs
d. Clinical:
i. Multiple lesions on the skin and mucous membranes, predilection
for the trunk and anogenital areas
ii. 0.2-0.4 cm pink to skin colored umbilicated papules
e. Macro:
i. Small bowl shaped lesions with central areas of depression filled
with keratin
ii. Depression contains viral particles called mulluscum bodies
iii. Giemsa staining
2. Seborrheic keratosis (853).
a. Most common benign tumor, most common in older people
b. Benign pigmented epidermal tumor
c. Extremities and shoulders most common sites occurs commonly on the
faces in elderly patients
d. Gross: raised lesion, papule or nodule, brownish or grayish in color, and
very dry
e. Micro:
i. Proliferation of squamous cells
ii. Sheets of basal like cells (pink), hyperkeratosis, and keratin filled
cysts
3. Keratoacanthoma (854).
a. Male predominance
b. Grows on sun exposed skin of elderly adults
c. Benign crateriform tumor
d. Clinical:
i. Exo-endophytic architecture
ii. Cup shaped with a central, keratin filled plug
e. Micro:
i. Symmetric crater like nodule has a prominent central keratin plug
ii. Keratin filled crater is lined by glass proliferating keratinocytes
that invade the dermis
f. Histopath:
i. Parakeratosis
ii. Keratin filled central crater with overhanging epidermal lips
iii. Mild to moderate keratinocytic nuclear atypia, especially at the
base
4. Benign pilomatrixoma (858).
a. Occurs mainly in children and young adults
b. Located on the head, neck, and upper extremities

Pathomorph Lab 22 Skin Pathology

c.
d.
e.
f.

AKA a calcifying epithelioma of Malherbe

Benign tumor
Often becomes red
Histo:
i. Shadow or ghost cells, with no nuclei
ii. Basoloid cells at the periphery
iii. The basoloid cells undergo abrupt keratiniztion, leading to the
formation of ghost and shadow cells

5. Basal cell carcinoma (857).

a. Semimalignant tumor
b. Location:
i. Face and upper lip
c. Risk factors:
i. Chronic sun exposure, in people with fair skin ,light hair, and
blue , green or gray eyes
ii. Albinism
d. Clinical:
i. Elevated nodule w/central area of ulceration
ii. Pearly papule often containing prominent, dilated subepidermal
blood vessels
e. Micro:
i. Nests of basoloid cells within the dermis
f. Locally invasive- slow growing semimalignant neoplasm, invades stroma
but almost never metastasizes, may ulcerate
6. Pigmented compound nevus (135).
a. AKA: pigmented nevus, mole
b. Def: tumore of modified melanocytes (nevus cells)
c. Types:
i. Junctional nevus- intraepithelial nests
ii. Compound nevusiii. Dermal nevus- only in the dermis
d. Elevated and pigmented. Tan to brown <6 mm across
e. May become more prominent during pregnancy
f. Micro:
i. Melanin is present in the cytoplasm of some of the nevus cells
ii. Nests in epidermis surrounded by keratinocytes
g.
7. Malignant melanoma (859).
a. Malignant neoplasm of melanocytes
b. Risk factors:
i. Albinism
ii. Prolonged exposure to sunlight
iii. Xeroderma pigmentosum

Pathomorph Lab 22 Skin Pathology

iv. Susceptibility genes
c. Clinical:
i. ABCD
1. Asymmetry of shape
2. Border is irregular
3. Color variation
4. Diameter >6 mm
ii. More common in whites. Especially people with fair skin and gray,
green or blue eyes
d. Two growth patterns
i. Radial: grows horizontally along epidermis. No metastases and
brown in color and flat lesion
ii. Vertical: grows downward and associated with metastases. Black
in color and raised lesion
e. Histo:
i. The nuclei shows cytologic features of malignancy
ii. Binucleated tumor cells
iii. Large nuclei
8. Keloid (852).
a. Refers to type of scar that extends beyond the skin adjacent to the wound.
b. Benign and non-contagois tumor
c. Keloid is composed of fibrous issue and collagen
d. More common in African Americans
e. Clinical:
i. Earlobe, upper arm, shoulder, upper back and anterior chest
ii. Firm, rubbery lesions or shiny, fibrous nodules
iii. Red to dark brown in color
f. Micro:
i. Keloidal collagen bundles that are thickened markedly
eosionophilic
ii. Normal epidermis