Skin Pathology

1. Nodule in skin, sometimes have surface punctum, cannot

pinch skin over it, mobile over deeper tissue and non-tender

Dx: Sebaceous cyst

Gross appearance: Dermal cystic lesion containing keratinous
materal
Derived from hair follicle hence sometimes called an
infundibular cyst
Complications: infection, rupture and inflammation  abscess,
rarely malignant change

2. Microscopy shows neutrophils, cells debris, bacteria:

liquefactive necrosis

Dx: Carbuncle, Abscess

Gross appearance: Purulent lesion in skin
Pathogenesis: Bacterial infection, folliculitis, Furuncle,
Carbuncle
Principles of therapy: surgery, wound dressing, antibiotics

3. Asymmetry, Border, Colour, Diameter

Dx: malignant melanoma
Pigmented lesion, infiltrative, ulcerated, heaped up edges
Behaviour: locally invasive, metastasis
Prognostic factors: T - size, depth, surface ulceration, mitotic
activity , N and M (nodal or distant mets)
Epidemiology: more common in West; esp Australia, in western
context – occurs in sun exposed areas vs Asian – acral
location (distal extremities)

4. Invasive growth pattern, keratinising cells, intercellular

bridges, keratin pearls
Dx: SCC
Appearance: irregular controured tumour mass with ulcration,
How else lesion may appear clincally: crusted plaque, warty
lesion, non-healing lesion with raised edges
Risk factors: uv exposure, immunosuppresion, genetic
susceptibility, viral – hpv, arsenic – in the past Chinese
medication, chronic ulcers/wounds
 BCC is the most common skin cancer, its most important
risk factor is still uv, it tends to invade locally and not
metastasise (risk is 1%), Gorlin syndrome is a syndromic
multiple BCC syndrome related to PTCH1 mutation (also
mutated in sporadic BCCs) AD inheritance
5. Patient has DM and PVD
Dx: Foot gangrene
Gross pathology: gangrenous necrosis, forefoot amputation
Pathogenesis: atherosclerosis  ischemia, DM
microangiopathy; infection; neuropathy
Principles of therapy: antibiotics, amputation, wound care, DM
control, optimise the blood control

6. Other features are light brown skin macules, lesion in iris,

scoliosis
Dx: NF1 at Nature of skin lesions: multiple papules and
nodules, neurofibromas
What are some other tumours that patient can develop: optic
glioma, brain gliomas, spinal cord dumbbell tumour, MPNST
Genetics: AD, new mutations i.e. sporadic

7. Enlarging nodule over ear lobes, sternotomy scars

Dx: keloid
Gross features: circumscribed fibrous nodule
Healing wound, excessive growth of fibroblasts and production
of collagen
Genetic, factors that impair wound healing
Symptoms: cosmesis, pain, itching

8. Itchy rash over the nipple areolar complex (not better with
topical creams)
Dx: Paget disease of breast
Gross appearance: patch of plaque over nipple areolar
complex
Pathogenesis: underlying carcinoma/DCIS with tumour cells ->
lactiferous ducts  skin
Where else in the body this lesion can occur? Explain its
origin:
- Perineum (scrotum, vulva)
- Primary apocrine or originate from GU or lower GI tract
- In breast, Paget’s is associated with underying carcinoma
or carcinoma in situ, vs in GU – 80% not associated with
carcinoma (20% - adenoCa of colon, bladder)

9. Fibroepithelial polyp (meant to differentiate from keloid)