Dermato-Pathology

Fajar L. Gultom
Departemen Patologi Anatomik FK UKI
September 2018
 Layers of the Skin

Epidermis

Dermis

Subcutis
 Skin Pathology
• Pigmentation
• Epidermal tumor
• Dermal tumor
• “Immigrant” tumor
• Maturation disorder
• Dermatoses (inflammation)
• Blister/ bulla: PV, Impetigo, Epidermolysis bullosa
• Adnexal disorder
• Panniculitis
• Infection
 Infection
• Verrucae/ warts → HPV
• Moluscum contagiosum: viral
• Impetigo: S. aureus
• Fungi: Tinea
• Arthropod
• Mycobacterium
Verrucae
• Common warts (verruca
vulgaris), children –
adolescent
• HPV-1, HPV-2, HPV-4
• Solitary – multiple →
exposed parts
Molluscum contagiosum
• Poxvirus infection
(Molluscipoxvirus)
• Head n neck, flexural
area, genitalia
• Swimming pools
associated infection
• Eosinophilic inclusion
bodies → molluscum
bodies
Condyloma acuminatum
• Genital warts, Anogenital
region → Sexually
transmitted infection
• HPV-6, HPV-11
• Acanthosis, papillomatosis,
hyperkeratosis, koilocytes
cell
• Vaccines → promise for the
future
 Mycobacterial Infections
Primary tuberculosis (no previous exposure)
• Penetrating injury (tattoing, ritual
circumcision, surgeon)
Secondary tuberculosis (re-activation)
• Lupus vulgaris, tuberculosis cutis,
scrofuloderma

Genetic susceptibility: NRAMP1 gene (natural

resistence-associated macrophage protein 1)
 Leprosy, Morbus Hansen
• M. Leprae
• Close contact, aerosol spread, ± 5 yrs
• Found in schwann cells, endothelial cells,
monocyte/ macrophages system
• Spectrum of clinical characteristic:
histopathological and immunological status
Ridley, D.S. Histological classification and the immunological spectrum
of leprosy. Bull. WHO., 1974
Fite Faraco Stain: +
 Pigmentation
Vitiligo
Freckle (Ephelis)
Melasma
Lentigo
Nevus
“Dysplastic” Nevus
Malignant Melanoma
 Nevus
• Melanocytic nevi
• Common, benign neoplasm
• Main things → differentiate with melanoma
• Junctional: more pigmented, closely
associated with melanoma
• Intradermal
• Compound: Both (dermal n junctional)
Development of melanocytic nevi
Junctional Nevus

Robbins Basic Pathology 9ed, 2015

Intradermal Nevus
Compound Nevus

Robbins Basic Pathology 9ed, 2015

 Melanoma
1. Incidence rising
2. Related to SUN
3. Quickly metastasizes
4. Both VERTICAL and HORIZONTAL growth
phase but prognosis is 100% related to the
VERTICAL
5. DIFFICULT to differentiate from NEVUS
clinically and often microscopically
 Melanoma
• Asymetry
• Border
• Color
• Diameter
Melanoma

Teaching slide PA FK UKI

 Benign Epidermal Tumor
Seborrheic Keratosis
Acanthosis Nigricans
Fibroepithelial Polyp (skin tag)
Epidermal (inclusion) Cyst
Adnexal tumors : Eccrine, Apocrine
Keratoacanthoma
 Seborrheic Keratosis
• Middle-older
individual (senile
warts)
• Head and neck,
trunk
 Fibroepithelial Polyp (skin tag)
• Papilloma
• Skin polyp lesion
• Axilla, neck, groin,
eyelids
Epidermal (inclusion) Cyst

Epidermis

Dermis

Cyst
 Premalignant - Malignant
• Actinic (solar)Keratosis → precursor
SCC
• Squamous Cell Carcinoma
• Basal Cell Carcinoma
 Actinic Keratosis
• Premalignant
• Sun-damaged skin
• Hyperkeratosis – dysplasia
• Local eradication: excision, chemotheurapetic
agent topical
Actinic Keratosis
Actinic Keratosis
 Squamous Cell Carcinoma
• 2nd most common, sun exposed site, older
people.
• DNA damaged → exposure to UV light → TP53
mutation
• UVB → transient immunosuppressive effect →
impairing antigen presentation by Langerhans cell
• Others risk factor: industrial carcinogens, chronic
ulcers, draining osteomyelitis
• HPV infection with immunosupresion
SCC
 Basal Cell Carcinoma
• Locally aggressive cutaneus tumor
• Sun exposed sites
• Slow growing – rarely metastasize
• Mutation that activate Hedgehog signaling
• Local excision with free surgical margin
BCC

https://en.wikipedia.org/wiki/Basal-cell_carcinoma
BCC
 Dermatoses
• Acute inflammatory dermatoses
– Days-weeks
– urticaria, eczema
• Chronic inflammatory dermatosis
– Months-years
– Psoriasis
 Urticaria
• Type 1 hypersensitivity
• Mast cell degranulation
• Dermal edema, dilatation
vascular spaces
• Perivascular inflammatory cells:
eosinophils, neutrophils
 Psoriasis
• Abnormal hyperproliferation of
epidermis.
• Elbows, knees, scalps, lumbosacral
• Autoimmun
• Parakeratosis, hyperplasia, elongation of
rete ridges (acanthosis), microabscess
intraepidermal
Psoriasis
TERIMA KASIH..