Fundamentals of Pathology of Skin Venkataram Mysore, Namitha Chathra, Kisalay Ghosh
INDEX
Page numbers followed by b refer to box, f refer to figure, fc refer to flowchart, and t refer to table.
A
Acantholysis 115f
epidermal secondary 81f
neoplastic 34
primary 34
Acanthoma, large cell 271, 353
Acanthosis 30f, 31, 31f, 76, 76f, 88f, 100, 102, 102f, 209, 211f, 218, 238f, 267, 274
conspicuous 209
nigricans 32, 211, 211f
Acid orcein Giemsa 24, 27
Acid-fast bacilli 23, 91, 187
stain 18f
Ackerman's criteria 107b
Ackerman's scheme 64
reaction patterns of 65f
Acne 184
conglobate 184
vulgaris 15, 41, 184
Acrodermatitis
chronica atrophicans 228, 231
enteropathica 98
Acrokeratosis verruciformis 32, 213
Acrosyringium 15, 72, 87
Acrotrichium 87
Actinomycetoma 228
Actinomycosis 228
Adenocarcinoma 347
metastatic 348f
Adenoma, sebaceous 295
Adnexa 66
Adnexal diseases 353
Adnexal tumors
classification of 288
diagnosis of 298, 299fc
Alarm reaction 76
Albinism 180
Alcian blue stain 26, 48
Algae infection 228, 239
Alizarin red stains 48, 222
Alopecia 187, 196t, 197fc, 198fc
areata 190, 190f, 351, 353
classification of 189
diagnosis of 197
mucinosa 196
Alpha-antitrypsin deficiency 204, 207, 208
Amyloid 6, 22, 26f, 28, 48
stains for 25
Amyloidosis 44, 217
nodular 219
Anagen 19
hair 17f, 20, 188, 188f
Anaplasia 41
atypical cells 42f
Anaplastic cells 311f
Androgenic alopecia 192
Anetoderma 223
Angioedema 80, 82
Angiokeratoma
acral pseudolymphomatous 335
circumscriptum 309, 309f
corporis diffusum 309
Angioleiomyoma 53, 304
Angiolipoma 304
Angiolymphoid hyperplasia 308
Angiosarcoma 53, 260, 313
Anhidrotic ectodermal dysplasia 353
Antigen 109
Antineutrophil cytoplasmic antibody 135, 136
Antinuclear antibody 246, 256, 257
Antiphospholipid syndrome 144, 351
Apocrine
coils 15
enzymes 6
gland 13, 15f
modified 21
hidradenoma 292
hidrocystoma 266
Apoptotic bodies 87
Apoptotic cell 95
Appendageal diseases 184
Argyria 352, 353
Arrectores 8
muscle 15f, 195f
pilorum 351
muscle 20f
Arteriole 11f, 12
vasculitis of 146f
Arteritis, temporal 144
Artery 12
Arthropod bite 46, 79
Ashy dermatosis 86, 92, 93
Aspergillosis 52
Aspergillus 228, 351
Atopic eczema 74
three stages of 74t
Atrophie blanche 144
Atrophy 66
of stratum Malpighi 33f, 125f, 131
Autoimmune diseases 138
Autosensitization 76, 79
B
Bacilli, demonstration of 230
Bacteria 23, 217
Bacterial stains 27
Balloon cell
melanoma 325
nevus 318
Ballooning degeneration 36, 36f, 232f, 351
Basal cell
carcinoma 41, 44, 53, 110, 268, 278, 278f, 279f, 352
characteristics of 278
histological features of 278
metatypical 281
morpheic 280f
nodular type of 279f
degeneration 37, 38, 38f, 67, 88f, 91f, 93f, 95, 126f
extensive 90f
focal 92
epithelioma 296, 296t, 353
layer 8
tombstone appearance of 111f
vacuolar degeneration of 33, 81
vacuolization 38, 64
Basal layer
hyperpigmentation of 211
liquefaction of 125f
pigmentation 180f, 211f
Basaloid cell 53, 54f
proliferation 269f
Basement membrane 10, 11f, 22, 39, 94, 97, 215, 273
Basidiobolomycoses 228
Basket-weave
hyperkeratosis 80
pattern 9
Basophilia 49
Basophilic fat necrosis 201
Bazin erythema induratum 201, 208
B-cell
lymphoma 43, 44f, 51, 336, 337, 337t, 343
cutaneous 260f, 344f
pattern 335
pseudolymphoma 336, 337
cutaneous 336f
Becker's nevus 294, 353
Bees appearance, swarm of 191
Behcet's disease 138, 147, 247
Biochemical acantholysis 34
Biopsy 3, 215
commandments of 3
reaching subcutaneous fat, advantages of 3b
specimen, transportation of 245
Birbeck granules 10
Birefringence 27
Blastomycosis 52, 113, 228, 282
Bleeding diathesis 46
Blistering diseases 46
Blood vessels 11
cutaneous 64
dilatation of 99f, 102f
types of 11f
Blue granuloma 49
Blue nevus 320, 353
Borrelia spirochetes 83
Borreliosis 23, 351
cutaneous 228, 231
Borst–Jadassohn phenomenon 55, 270, 270f, 274
Botryomycosis 228, 231, 351
Bowen's disease 31, 39, 40f, 54, 54f, 55, 60, 260, 271, 274276, 276f, 277, 353
Bowenoid papulosis 52, 276
Breast
carcinoma of 347f
Paget's disease of 277
scirrhous carcinoma of 347f
Breslow classification 326
Bromoderma 282
Brown–Brenn stain 27, 229
Bulla
formation, level of 109
pemphigus group of 111fc
types of 116
Bullous dermatosis, chronic 121, 123
Bullous diabeticorum 117
Bullous diseases 109, 245t
chronic 253
diagnosis of 255fc
Bullous impetigo 103
Bullous lichen planus 89, 90f, 117, 254
Bullous lupus erythematosus 117, 252
Bullous mastocytosis 117, 122
Bullous pemphigoid 46, 109, 116118, 118f, 119f, 123, 250, 250f, 254
antigen 215, 245, 247, 250
noninflammatory bullae of 117
variants 118
Buschke scleredema 6, 221, 352
Buschke–Lowenstein tumor 283
C
Café-au-lait
macules 183
spot 352
Calcinosis 257, 259
cutis 48, 222
Calcium 22, 25
deposition disorders 217, 222
Candidal infection 35, 56
Candidiasis 72, 228
Cannon ball appearance 352
Carcinoembryonic antigen 277
Carcinoma 307
basosquamous 281
breast 51
cuniculatum 283
epidermotropic metastatic 271
in situ 273
metastatic 51
Cartwheel nucleus 58
Catagen hair 19, 20, 188
cross section of 20f
Cells 10, 55, 59f
acantholytic 34, 110, 111f, 112, 114f, 116
apoptosis of 86
atypical 273f, 285f, 334
degeneration 34
fried egg appearance of 333f
size of 334
types of 55
vacuolation of 142f
Cellular
abnormalities 323
blue nevus 320
dermis 117
Cellulitis 36, 58
eosinophilic 58, 64, 84
Central centrifugal cicatricial alopecia 195
Cerebriform 339
Chancroid 228, 230
Cholesterol 23
cleft 44
emboli 44
Cholesterolosis, extracellular 139
Chondrodermatitis nodularis helicis 225
Chondroid syringoma 292
Chondroitin sulfate 26
Chromoblastomycosis 228, 241f, 282
Churg-Strauss
disease 144
syndrome, allergic granulomatosis of 58, 148
Cicatricial alopecia 193, 194f
Cicatricial pemphigoid 116, 119, 245, 247, 251, 254
diagnosis of 119
Civatte body 38, 86, 89f
Clark nevus 319
Clear cell
acanthoma 53, 267
hidradenoma 52, 53
syringoma 53
tumors 53
Clefts 43, 44, 116
acantholytic 213f
Clonal seborrheic keratosis 55, 270f
Coccidioidomycosis 228
Collagen 23
fibers 11f, 12, 301f
transepidermal elimination of 226f
stains for 26
thick bundles of 43
Colloid 38
body 23, 47, 86, 89f, 90f, 124
degeneration, nodular 219
milium 43, 44, 48, 217, 219
juvenile 219
Columnar basal cell layer 276f
Coma bullae 117
Comedone 184
Compound nevi 316
Condyloma acuminatum 233
Congo red staining 26f
Conidiobolomycoses 228
Connective tissue
disease 95, 124, 138, 254
stroma 291f
tumors 301
Contact dermatitis 110
Copper penny bodies 241f
Cornoid lamella 42, 64, 66, 211
Cortex 17
Corynebacterium acne 15
Cowden's syndrome 295
Cowpox 351
Crust 33
Cryoglobulinemia 257
Cryoglobulinemic vasculitis 138, 148
Cryptococcosis 228, 351
Crystal violet 25
Cutaneous anaplastic large-cell lymphoma 341, 342
Cuticle 17
Cuticular cell 292
Cutis laxa 213
Cylindroma 292, 293f
Cystic lesions 184
Cysts 265, 266, 352
epidermal 266
infundibular 266
proliferating trichilemmal 40, 266
ruptured 58
Cytophagic panniculitis 205
D
Dandruff 75
Darier's disease 34, 39, 40, 46, 112, 115, 116, 212, 213f
De Galantha stains 26
Deep dermal perivascular lymphocytic inflammation 242
Degos acanthoma 267
Degos disease 144
Dematiaceous fungi 27, 228
Demodex folliculorum 15
Dense lymphocytes around blood vessels 140
Dermal atrophy 51
Dermal changes 86, 103, 124, 351
Dermal contact dermatitis 77
Dermal dendritic cells 10
Dermal edema 46, 71f, 81f, 124
papillary 73f
Dermal eosinophilic infiltrate 58
Dermal melanoma 43
Dermal mononuclear infiltrate 140f
Dermal mucin 124
Dermal papilla 112, 218f
Dermal perivascular mononuclear infiltrates 141
Dermal polymorphonuclear infiltrate 57, 57f
Dermal sheath hyaline membrane 18
Dermatitis 30, 46, 69, 73f, 74, 109
allergic contact 72, 78
atopic 58, 72, 78
chronic 98, 107
deep perivascular 64, 65f
diffuse 64
exfoliative 77
fibrosing 64, 65f
herpetiformis 58, 109, 116, 120, 120f, 121f, 123, 245, 253, 254
histological signs of 74t
irritant contact 72, 74, 78
nodular 64
nummular 78
photosensitizing 77
seborrheic 15, 30, 72, 74, 78, 98
superficial perivascular 64, 65f
Dermatofibroma 43, 49, 60, 301, 301f, 304
variants of 302b
Dermatofibrosarcoma 352
protuberans 33, 303
Dermatology, electron microscopy in 258, 260b
Dermatomyositis 39, 48, 86, 95, 96, 132, 222, 244
Dermatopathology 22, 29, 63, 349
Dermatophyte 35, 228
infection 35
Dermatophytosis 56, 72, 79, 98, 236
Dermatosis 36
invisible 52, 66, 243, 352
papulosa nigra 270
Dermis 7, 8, 8f, 11, 44, 141, 221
gelatinous appearance of 351
superficial 33
Dermoepidermal junction 8, 44, 45f, 65, 66, 68, 86, 109, 124, 189, 249f 315, 350
anatomy of 248f
Dermoid cyst 267
Diabetes mellitus 224, 227
Diabetic bullae 117
Diffuse normolipemic plane xanthoma 332
Dihydroxyphenylalanine
stain 22
test 6
Direct immunofluorescence 6, 83, 112, 128, 147, 150, 187, 215, 244, 257
Dirty feet appearance 315, 350f
Discoid
eczema 72
lupus erythematosus 37, 124, 125f, 126f, 128, 129, 194, 254
scalp 94, 94t
Disseminated infundibulo-folliculitis 184
Disseminated intravascular coagulation 144
Donovan bodies 22, 24
Donovanosis 22, 35, 228, 352
Dowling–Degos disease 216, 349
Drugs eruptions 98, 140
Dyskeratosis 39
acantholytic 39, 40, 64, 66, 212
neoplastic 39, 40f
Dyskeratotic cells 95, 116, 212, 274
Dysmorphic keratohyalin granule 39
Dysplastic nevus 319
Dystrophic calcinosis 222
E
Eccrine 6, 13, 266, 292
coils 14
glands 348f
poroma 52, 53, 55, 290
epidermal variant of 271
spiradenoma 52, 290, 291f
Ectoderm 8
Ectopic apocrine coils 294f
Eczema 72
dyshidrotic 75
nummular 75
Eczematous tissue reaction 64, 71, 72
Edema 82, 86, 351
intercellular 71, 94
lower leg 48
Elastic fibers 13
disorder of 217
Elastic tissue 23
diseases of 223
stains for 27, 187
Elastoglobes 47
Elastolysis 213
Elastosis perforans serpiginosa 224, 227
Endarteritis obliterans 351
Endometrioma 304
Endothelial cell 12
single layer of 310f
swelling 47, 140
Enzyme studies 6
Eosinophilia 49, 308
Eosinophilic fasciitis 58, 132
Eosinophilic folliculitis 36, 184
Eosinophilic inclusion bodies 236f
Eosinophilic pustular folliculitis 72
Eosinophilic pustulosis 36
Eosinophilic spongiosis 72, 112
Eosinophils 58, 117, 118f, 242, 351
Epidermal atrophy 33, 86, 180f, 194f
Epidermal eosinophilic infiltrate 58
Epidermal melanin unit 10
Epidermal microabscesses 35, 56
Epidermal nevi 32, 267
Epidermal proliferation unit 8
Epidermal spongiosis 242
Epidermis 8, 8f, 10, 64, 65, 87, 95, 124, 128, 140, 145, 180, 218, 274, 291, 321
atrophic 95, 129f, 130f, 338f
benign tumors of 267
hyperplasia of 32
hypertrophic 118
layers of 9
malignant tumors of 273
premalignant tumors of 273
pronounced hyperplasia of 283
structures of 9
Epidermodysplasia verruciformis 228, 233, 234f
Epidermoid inclusion cysts 266
Epidermolysis 39
bullosa 214, 215t, 216f
acquisita 109, 117, 121, 123, 245, 251, 254
dystrophica 117
Epidermotropism 33, 33f, 35, 328f, 334, 337, 338f
Epithelioid cell 60, 321
nevi 320
Epithelioid granuloma 69
Epithelioid hemangioma 308
Epithelioid histiocytoma 302
Epithelioid nevus 321
Epithelioma
intraepithelial 274
sebaceous 295
Erythema 82
annulare centrifugum 83, 84f
chronicum migrans 83
dyschromicum perstans 92
elevatum diutinum 43, 138, 148, 150
gyratum repens 83
induratum 147
marginatum rheumaticum 83
multiforme 37, 80, 81f, 83, 86, 96, 97fc, 117, 123, 141, 142, 350
nodosum 200, 201, 201f, 208
leprosum 47, 207
reactive 80
Erythroderma 58, 77, 98
Esophageal dysmotility 257, 259
Ewing's sarcoma, metastatic 53
Exanthematous pustulosis, acute generalized 35, 103, 147
Exocytosis 35
lymphocytic 94, 141
Eyelids 7
F
Fabry's disease 23, 27, 309
Factitial panniculitis 205
Fasciitis, nodular 52, 304
Fat
giant cell 60
necrosis 204
ischemic 201
liquefactive 201
subcutaneous 44, 205
Feet, verrucous carcinoma of 283
Fibrin 22
Fibrinoid 22
deposit 48
Fibrosis 138, 202f, 351
nodular cutaneous 301
Fibroxanthoma, atypical 53, 60, 260, 303
Filaggrin 9
Fite-Faraco stain 27
Fixed-drug eruption 37, 82, 92, 93, 96, 183
Flame thrower-like appearance 351
Floret giant cell 60
Foam cells 60
Foamy lipophages 351
Follicular
eczema 72
keratinization 19
lesions 75
lichen planus 41, 127
mucinosis 48
seborrheic dermatitis 42
spongiosis 72, 185
tumors 53
unit 189
Folliculitis 35, 6466, 184, 242
chronic 58
decalvans 58, 196
deep
infective 184
noninfective 184
superficial 184
infective 184
noninfective 184
Fontana-Masson stain 229t
Foot, dorsum of 9f
Foreign body giant cell 61, 61f, 202f
reaction 297f
Fox–Fordyce disease 72, 185, 349
Fried egg appearance 332, 333f, 352
Frontal fibrosing alopecia 194
Fungal
granuloma 351
infection 43, 236, 352
stains 27
Fungi 22, 23, 217
Furuncle 36, 58, 184
G
Galli–Galli disease 216
Gaucher's disease 27
Genital leiomyoma 304
Genital verrucous carcinoma 283
Genodermatoses 7, 39, 209
Geographic tongue 72
Ghost cells 351, 352
Giant cell 60, 203f
reticulohistiocytic 330
tumor 60
Giant condyloma acuminatum 283
Giemsa stain 22, 24, 25, 25f
Gingivitis, desquamative 247
Glands, sebaceous 8, 15, 15f, 16f, 76, 190f, 192f
Glandular cysts 266
Glomangioma 310, 310f
Glomangiomyomas 310
Glomus tumor 304, 310
Glucagonoma syndrome 98
Glycogen 22, 23
Glycosaminoglycan 13
Gomori's methenamine silver 229
Gonococcemia 138
Goose flesh 16
Gottron's papules 132
Gout 6, 217, 221
crystals 28, 49
Gower's disease 40
Graft-versus-host disease 37, 86, 95, 96, 117, 132, 133, 353
Granular cell 302
tumor 304, 307
Granular degeneration 39
Granular layer 9, 209, 210
Granule formation 351
Granuloma 49, 69, 146f, 150, 351
annulare 43, 48, 51, 58, 351, 352
causes of 69
eosinophilic 58, 327, 328
faciale 43, 58, 59, 138, 139, 148
inguinale 230
pyogenicum 308, 308f
suppurative 50, 206, 242
types of 69
Granulomatosis 136, 143
eosinophilic 144
Granulomatous diseases 224
Granulomatous reaction 64, 66, 84
Granulomatous slack skin syndrome 340
Grocott-Gomori stain 27, 229
Ground glass cytoplasm 332
Growing hair 20
Guttate hypomelanosis, idiopathic 180f
Guttate parapsoriasis 102, 141
Guttate psoriasis 101, 102, 103t, 352
Guttate scaly lesion 102
Gyrate erythema 140
H
Hailey–Hailey disease 5f, 34, 34f, 39, 115, 115f, 116
Hair 16
cycle 19f
follicle 8, 15f, 72, 126f, 193
basal cell degeneration of 93f
destruction of 195f
level of 196
matrix, benign tumors of 352
microscopic anatomy of 17
rupture of 184
stages of 19, 19t
tumors 295
Halo nevus 319
Halodermas 72
Halogenoderma 57, 113
Hand–Schuller–Christian disease 327, 328
Hansen's disease 69
Haphazard spongiosis 72
Hard keratin 17
Hemangioma
lobular capillary 308
sclerosing 49, 301
Hematoxylin and eosin 22, 244, 229
Hemidesmosomes 8, 215
Hemochromatosis 217, 223, 352
Hemosiderin 23, 49
Henderson–Patterson bodies 350
Henoch–Schönlein purpura 69, 136, 138, 148, 150
Herpes
gestationis 58, 109, 116, 119, 123, 245, 248, 250
infection 349
simplex 34, 110, 228, 351
zoster 36, 110
Herpetic folliculitis 184
Hidradenitis suppurativa 184, 186, 187f
Hidradenoma 291
Hidroacanthoma simplex 271, 289
Histiocyte 36, 60, 242
Histiocytoma 351
aneurysmal fibrous 302
fibrous 301, 302
malignant fibrous 60, 303
Histiocytosis 327
malignant 327
Histoplasma 22
Histoplasmosis 352
Hobnail angioma 352
Hodgkin's disease 60
Horn
cutaneous 286, 287f
cysts 40, 41f
pearl 40
Human immunodeficiency virus 228
infection 235
Human papilloma virus 228
Hyaline
deposit 217
fat necrosis 201
fibromatosis, juvenile 217
Hydroquinone 219
Hyperchromatic nuclei 42f
Hypereosinophilic syndrome 52
Hypergranulosis 29f, 32, 67, 86, 90f, 209, 210
wedge-shaped 32f, 88f, 90f
Hyperkeratosis 29, 30f, 69, 88f, 99, 99f, 209, 210f, 211, 211f, 218, 233f, 267, 275, 350
epidermolytic 31, 32, 39, 64, 66, 122, 209, 210f
focal 125f
lamellated 29f
massive 76f, 90f
Hyperpigmented lesions 181
Hyperplasia 32, 218
epidermal 64, 138, 309
irregular epidermal 86, 242
lentiginous 316f
progressive epidermal 73f
pseudocarcinomatous 281
pseudoepitheliomatous 32, 40, 43, 281, 282, 282b, 282t
sebaceous 294
Hypertrophic discoid lupus erythematosus 86
Hypogranulosis 33, 99f, 100, 100f, 352
Hypomelanosis of Ito 352
Hyponychium 21
Hypopigmentation, postinflammatory 180
Hypopigmented lesions 182fc, 183fc
diagnosis of 181
I
Ichthyosiform erythroderma, bullous congenital 209
Ichthyosis 209
vulgaris 29, 209, 352
Id eruption 76
Immunobullous diseases 109t
Immunobullous disorder 35
Immunofluorescence 244
Immunoglobulin A pemphigus 57, 72, 115, 247, 254
Immunohistochemistry 257, 258b, 331
Immunomethods 244
Immunoperoxidase 6
Impetigo 35, 56
Inclusion bodies 351
Incontinentia pigmenti 36, 39, 214
Indirect immunofluorescence 244, 248
Infections 35, 224, 228
bacterial 230
histopathology of 228
subcutaneous 200
Inflammations, deep perivascular 66
Inflammatory cells 33, 38
exocytosis of 71
Inflammatory diseases 1, 32, 70
Inflammatory linear verrucous epidermal nevus 30, 98, 267
Infundibulum 16
Injuries, physical 95
Inner root sheath 18, 188
Insect bite 140
reaction 46, 84
Intercellular intraepidermal edema 64
Intercellular substance 109, 111
Intercellular surface staining 247
Interface dermatitis 38, 66, 68, 86
differential diagnosis of 97fc
Intradermal nevi 32, 60, 316
Intraepidermal bulla 110, 118f
Intraepidermal bullous diseases 64, 65f, 109, 110, 110t, 122fc
Intraepidermal edema 71
Intraepidermal epithelioma, Borst–Jadassohn type of 55
Intraepidermal polymorphonuclear leukocytes 69
Intraepidermal vesiculation 243
Inverted follicular keratosis 286
Iododerma 282
Isthmus 16
Itchy disorder, chronic 351
J
Jigsaw puzzle-like appearance 293f
K
Kamino bodies 23, 321
Kaposi's sarcoma 46, 49, 302, 311, 311f
nodular 312f
Keloid 301, 352
Keratinization, epidermal 266, 266t
Keratinocytes 8, 55f
apoptotic 38
atypical 234f, 267
ballooning degeneration of 232f
extensive vacuolation of 81f, 210f
giant cell 60, 275f
large atypical 275f
vacuolation of 140f, 210, 212f, 234f
Keratoacanthoma 40, 52, 225, 271, 271f, 272, 282, 282t
Keratohyalin granules 9
Keratosis 96
acanthotic seborrheic 269f
actinic 32, 34, 39, 40, 59, 271, 273, 273f, 286, 353
lichenoides chronica 29
pilaris 42, 186
seborrheic 5f, 41, 41f, 53, 268, 271, 286
Kidney, hypernephroma of 347
Kogoj's macropustules 103
Kogoj's pustules 102
Kogoj's spongiform pustule 35
Koilocytes 351
Krause's end bulb 13
Kyrle's disease 224, 225, 227
L
Lamellar ichthyosis 31, 209
Lamina lucida 215
Langerhans cells 7, 8, 10, 24, 36
histiocytosis 35, 60, 327
classification of 327b
microgranuloma 35
stains for 24
Langhans giant cell 61, 62f
Lanugo hairs 16
Large plaque parapsoriasis 106, 107
nosology of 107
Larva migrans 58, 351
Leder stain 22
Leiomyoma 43, 304, 305f
Leiomyosarcoma 53, 260
Leishman's stain 110
Leishmania 22
Leishmaniasis 228, 351
cutaneous 352
Lentigo
maligna 325
simplex 315
Lepra reaction 46, 147
Lepromatous leprosy 43, 60
Leprosy 351
Lesion, primary 69
Letterer–Siwe disease 327, 329
Leukemia
cutis 43
granulocytic 58
Leukemic infiltrates 53, 344
Leukocyte 59
Leukocytoclasis 47
Leukocytoclastic vasculitis 47, 57, 69, 136, 137f, 138, 148, 149, 150fc, 200, 207
causes of 138
Levaditi stain 27
Lichen
amyloidosis 218, 218f, 219f
myxedematous 48
nitidus 94, 95f, 96
planopilaris 93, 93f, 94t, 193
planus 32, 37, 44, 45f, 70, 86, 87, 88f, 92, 93, 96, 122, 127, 127t, 131t, 244, 256f, 257
atrophic 33, 90
drug-induced 29, 93
etiopathogenesis of 89fc
hypertrophic 89, 90f
pemphigoides 89, 118
pigmentosus 91f, 92fc, 93t, 183
sclerosus 33, 39, 41, 46, 86, 131
et atrophicus 37, 117, 130, 130f, 131, 131t, 351
simplex chronicus 31, 32, 76, 76f, 98, 105, 105t
striatus 94, 96
Lichenoid 66
dermatitis 68
drug eruptions 96
keratosis, benign 37
lesions 95
purpura 96
rash 133
reaction 64, 87b
drug-induced 37, 86
tissue reaction 29, 87, 86
classic 86
Light
eruption, polymorphous 46
reaction 79
Linear immunoglobulin A bullous
dermatosis 109, 245
disease 117, 121, 253, 254
Lipids 23
stains 27
Lipoatrophy 352
Lipoid proteinosis 48, 217
Lipoma 53
Lipophagic fat necrosis 200
Lipophagic panniculitis 60
Livedoid
vasculitis 144, 145f, 148
vasculopathy 144
Lobomycosis 43, 228
Lobular panniculitis 65, 65f, 66, 200, 203, 203f, 206, 207fc
classification of 200b
Lung, metastatic oat cell carcinoma of 53, 260
Lupus
erythematosus 33, 48, 59, 70, 86, 96, 124, 125, 251, 252f, 257
acute cutaneous 46, 86, 129
clinicopathological features of 127t
cutaneous 129t, 244
diagnosis of 39
overlap 118
miliaris disseminatus faciei 185
panniculitis 203, 204t
vulgaris 33, 282
Lutzner cells 339
Lymph vessels 12
Lymphangioma circumscriptum 309, 310f
Lymphatics drain 7
Lymphocytes 36, 59, 59f, 95, 117, 118f, 140, 351
around hair follicles 351
exocytosis of 71f, 76, 81, 103, 140f
focal collection of 95f, 338f
mediated scarring alopecia 194
Lymphocytic infiltrate 202f
atypical 33f
band-like 88f
Lymphocytoma cutis 43, 51
Lymphogranuloma venereum 150, 228
Lymphohistiocytosis, hemophagocytic 327
Lymphoid 327
follicles 351
infiltrates 22, 334
classification of 335b
diagnosis of 344
mild 212
T-cell pattern of 334
Lymphoma 53, 60, 260
classification of 334
cutaneous 98
Lymphomatoid
granulomatosis 144, 148
papulosis 46, 52, 60, 140, 142, 341, 341f
Lymphomononuclear infiltrate 59, 76
Lymphoplasmacytoid B cell 59
Lymphoproliferative diseases, diagnosis of 345fc, 346fc
M
Macrophage 59f, 60, 351
granulomas 242
parasitized 242
Macular amyloidosis 217, 352
Majocchi's granuloma 52, 184, 237
Malherbe calcifying epithelioma 297
Marschalko plasma cell 58
Masson Fontana stain 22, 24
Masson trichrome stain 26, 27
Mast cell 117, 327
granules 22
stains for 25
Mastocytosis 117, 332, 333f, 352
Matchstick appearance 352
Max Joseph spaces 37, 44, 87, 90f, 88f
Mechanobullous diseases 214
Medulla 17
Melanin 22, 23, 49
incontinence 33, 33f, 124
stains for 24
Melanoacanthoma 268
Melanocytes 7, 8, 10, 314, 314t
giant cell 60, 61f
normal 314
stains for 24
Melanocytic nevi, congenital 51, 316, 318f
Melanoma 60, 260, 319, 320t
amelanotic 325
cell 314, 314t
desmoplastic 325
general histologic features of 324b
in situ 271
malignant 320, 322, 323f
metastatic 326
neurotropic 325
pedunculated 326
superficial spreading 276
Melanophages 60
Melanosomes 10
Melasma 181
Membranous fat necrosis 201
Meningococcemia 138
Mercury pigmentation 353
Merkel cells 7, 10
tumor 53, 260, 307
Mesoderm 8
Metachromasia 25
Metaplasia 41
Metastasis, cutaneous 346
Microabscesses 35
lymphocytic 35
papillary 120f
Microcystic adnexal carcinoma 51
Microvesicle formation 73f
Miliaria 349
rubra 72
Miliarial spongiosis 72
Milker's nodule 32, 228, 235, 282
Mixed cell
granuloma 50
infiltration 351
Mixed connective tissue disease 256, 257, 259
Mold 228
Moll's glands 21
Molluscum body 236f, 350
Molluscum contagiosum 228, 235, 235f, 236f, 350
Mongolian spot 319
Monoclonal antibodies 6
use of 215
Monomorphic bland endothelial cells 352
Monomorphic infiltrate 334, 351
Mononuclear cells 71
exocytosis of 141
Monster cell 302
Morbilliform rash, generalized 132
Morphea 129, 129f
Mucin 6
deposition disorders 217, 221
Mucinosis 352
focal 222
Mucinous stroma 306f
Mucopolysaccharide 22
stains for 26
Mucorale 228
Mucormycosis 228, 351
Mucosa, candidiasis of 237
Mucus membrane pemphigoid 245, 251
Multiforme 96
Munro's abscess 102, 102f
Munro's microabscess 35, 99f, 100f, 103
Muscle 23, 27
Mycelia 238f
Mycetoma 228, 238, 238f, 239, 351
granule 238f, 239
Mycobacterium
leprae 23
tuberculosis 147, 229
Mycosis
cell 340
fungoides 33f, 35, 48, 58, 95, 106, 335, 338, 338b, 338f, 353
histology of 338
patch stage of 107b
subcutaneous 282
Myeloma, multiple 59
Myxedema 48
N
Nails 8, 20
folds, lateral 21
Naked granuloma 50
Necrobiosis 49
lipoidica 59, 200, 351
diabeticorum 33, 207
Necrobiotic diseases 224
Necrobiotic xanthogranuloma 44, 60, 200, 331
Necrolytic migratory erythema 57
Necrotic
debris 225f
keratinocytes 37, 37f, 80, 86, 94, 141
reaction, acute 84
Neoplasm 265
Nephrogenic fibrosing dermopathy 48
Nerves 8, 13
cells 305b
involvement of 351
Neural crest 8
Neurilemmoma 53, 304, 306
section 306f
Neurofibroma 53, 305, 306f
Neurofibrosarcoma 53
Neuroma 304
Neutral mucopolysaccharide 26
Neutrophilic spongiosis 72
Neutrophils 351
prominent 242
Nevi of Ota 319
Nevus
cells 44, 314, 314t, 315, 321, 321f
characteristics of 315b
cytological atypia of 319
intraepidermal lentiginous hyperplasia of 319
types of 315
depigmentosus 180
elasticus 352
evolution of 314f
sebaceous of Jadassohn 294, 294f
Nodule 351
Nonfollicular dry scaly lesions 75
Nonfollicular lesions 105
Noninflammatory bullae 117
Non-Langerhans cell histiocytosis 60
Nonscarring alopecia 189b, 190
Nonsulfated acid 23, 26
Nonxanthogranuloma 329
Norwegian scabies 98
Nuclear dust 47, 47f, 135
Nuclei
eel-shaped 16
horseshoe-shaped arrangement of 62f
Nucleus
ghost of 352
size of 334
O
Obesity, morbid 48
Occasional perivascular lymphoid infiltrate 209
Ochronosis 49, 181f, 217, 222
Odland bodies 9
Onchocerciasis 58, 351
Onion skin arrangement 75
Oral florid papillomatosis 283
Oral lichen planus 92
Oral verrucous carcinoma 283
Organoid nevus 294
Orthohyperkeratosis 29
massive compact vertical 209
Owl's eye appearance 350
P
Pacinian corpuscles 13
Paederus dermatitis 72
Paget's cell 54
Paget's disease 23, 54, 260, 271, 275277, 277f, 277t
extramammary 277
Paget's phenomenon 277
Pagetoid cell 54
Pagetoid melanoma 260
Pagetoid reticulosis 54, 340
Pagetoid tumors 260
Pagoda red 25
Pale cell acanthoma 267
Palisading granuloma 49
Palmoplantar keratoderma 209, 211
Palms, localized pustular psoriasis of 104
Pandermatitis 124
Panniculitis 60, 64, 146f, 199, 202f, 351
classification of 199
histological features of 206t
infective 205
lobular eosinophilic 206
neutrophilic lobular 206
pancreatic 204, 351
post steroid 44
traumatic 205
Papillary dermis 11, 65, 99f, 100f
sclerosis of 131
Papillomatosis 32, 64, 66, 210f, 211, 211f, 218, 233f, 267, 275, 350
cutis carcinoides 283
Papular mucinosis 48
Papular xanthomas 329
Paracoccidioidomycosis 228
Parakeratosis 29, 30, 69, 71, 72, 73f, 92, 94, 99f, 102, 103, 125f, 140, 140f, 234f, 274
focal 30f, 76, 99f, 102f, 141
mild 99f
Paraneoplastic pemphigus 115, 247, 254
Parapsoriasis 98, 106, 352
small plaque 106, 107
Parasites 351
Parasitic diseases 236
Parasitized multinucleate giant cells 242
Pasini atrophoderma 132, 352
Patch stage 107b, 338
Pautrier microabscess 35, 339, 339f
Peeling technique 245
Pellagra 98
Pemphigoid
band 250
gestationis 250, 254
Pemphigus 34, 112f, 113f, 246
chronic benign familial 115
erythematosus 109, 114, 246, 254
foliaceus 35, 72, 109, 114, 114f, 246, 254
group 110
herpetiformis 114
like pattern 116
vegetans 32, 112, 282
vulgaris 34, 36, 109, 111, 111f, 112f, 115, 116, 246f, 254
Perforating folliculitis 184, 224, 225, 227
Perforation, acquired disorder of 224, 227
Perifollicular lymphocytic infiltration 194f
Perifolliculitis 64, 65, 65f, 66, 242
Periodic acid-Schiff 22, 23, 87, 94, 97, 124, 148, 187, 220, 229, 231, 307
stain 24f, 39
Perioral dermatitis 72, 185
Perivascular inflammatory cells 99f
Perivascular lymphocytic infiltrate 81f, 82, 194f
Perivascular mononuclear cell 103
Perivasculitis 84f
Perl's sign 38
Phosphotungstic acid hematoxylin 22, 48
Photodermatitis 95
Phrynoderma 42
Pigment incontinence 38, 38f, 86, 88f, 93f, 217
outstrips infiltrate 90
Pigmentation
disorder of 179
postinflammatory 92
Piloleiomyoma 304
Pilomatricoma 52, 53, 297, 297f, 352
Pink collagen, broad bundles of 352
Pink-purple intracytoplasmic inclusions 350
Pinkus, fibroepithelioma of 280, 281f
Pityriasiform spongiosis 72
Pityriasis
amiantacea 75
lichenoides 96
lichenoides chronica 102, 141, 142f
et varioliformis acuta 37, 46f, 72, 82, 83t, 86, 140, 140f, 141f, 142, 148, 149, 349
rosea 39, 72, 79, 102, 106, 352
rubra pilaris 30, 42, 98, 105, 349
versicolor 237
Pityrosporum ovale 15
Plane warts 233, 352
Plasma cells 23, 58, 242, 351
infiltrate 351
stains for 27
Pleomorphic lipoma 60
Plexiform neurofibroma 306
pigmented 306
Poikiloderma 33, 33f, 37, 95, 96
congenital 95
lesions 132
Polyangiitis 136, 143, 144
microscopic 136
Polyarteritis nodosa 136, 138, 139, 148, 200, 201, 207, 208
Polymerase chain reaction 107, 229, 334
Polymorphic light eruption 77, 128
Polymorphonuclear cells 55, 308f, 349
accumulation of 100f
Polymorphonuclear microabscesses 35
Polymorphs 103, 117, 351
Pompholyx 75, 78
Poroid
cell 292
hidradenoma 292
Porokeratosis 211, 212f, 352
Poroma group 289
Porphyria 23, 48, 217, 220
cutanea tarda 117, 122, 123, 220
Post kala-azar dermal leishmaniasis 43, 44f
Pox virus 228
Pregnancy, toxic erythema of 140
Pressure 117
Pretibial myxedema 48
Prickle cell layer 9
Primitive hair structures 8
Progeria 33
Progressive pigmented purpura 49, 140, 149
Protoporphyria, erythropoietic 220
Protothecosis 239
Protozoal infection 228
Proximal nail folds 21
Prurigo nodularis 77, 98, 282
Pseudocarcinoma 52
Pseudo-Kaposi's sarcoma 352
Pseudolymphomas 52, 335, 336f, 336t, 337t, 351
types of 335
Pseudomalignancy 52
Pseudomelanoma 52
Pseudo-ochronosis 181
Pseudo-Pautrier abscess 35
Pseudopelade of Brocq 193, 195f
Pseudopemphigus 248
Pseudoporphyria 117
Pseudosarcoma 52
Pseudovesicles 147
Pseudoxanthoma 352
elasticum 43, 213, 223, 352
Pseuodolymphoma cutis 59
Psoralen 179
Psoriasiform 66, 98, 275
hyperplasia 86, 242
reactions 64, 98, 105
aids-related 98, 108
diagnosis of 108fc
major 98
pattern 69
Psoriasis 31, 35, 56, 69, 70, 72, 76, 98, 99f, 100f, 101, 105
early 102f
etiopathogenesis of 101fc
hypertrophic 99f, 102
lesion of 99f
seborrheic 70
variants of 101
Psuedoporphyria 244
Purpura 82
fulminans 144
Purpuric dermatosis, pigmented 86, 97
Pustular drug eruption 35, 72
Pustular psoriasis 103, 104f
Pustular vasculitis 57, 138f
Pustule 184
Pyoderma 113
gangrenosum 57, 147, 148
vegetans 32, 57, 113, 282
Q
Queyrat erythroplasia 275
R
Radiation dermatitis 37
Radiodermatitis 95
Rash, poikilodermatous 133
Raynaud phenomenon 257, 259
Reactive perforating collagenosis 224, 226, 227
Red blood cells 12, 125, 349
extravasation of 46, 47, 82, 103, 135f, 140, 141
Red granuloma 49
Reed–Sternberg cell 60
Refsum disease 29
Regional lymph nodes 7
Reiter's disease 35, 56, 72, 102
features of 102
Reiter's syndrome 98, 103, 107
Renal cell carcinoma, metastatic 53
Renal disease 224, 227
Rete ridges 11
irregular psoriasiform downgrowths of 76
loss of 95
Reticular degeneration 36, 351
Reticular dermis 11, 66, 351
Reticular erythematous mucinosis syndrome 48, 221
Reticulate seborrheic keratosis 270f
Reticuloendothelial system 49
Reticulohistiocyte 329
Reticulohistiocytosis
congenital self-healing 327, 329
multicentric 332
Reticulum fibers 23
Retiform hemangioendothelioma 352
Retraction spaces 44
Rheumatoid 351
neutrophilic vasculitis 138
nodule 200
Rhinoscleroma 60, 351, 352
Rhinosporidiosis 228, 351
Rhizopus 228
Rickettsial infections 140
Rosacea 185
Rosai–Dorfman disease 327
Round cell tumors 53, 260
Ruffini end organ 13
S
Salt split skin, use of 252
Sandwich sign 236, 349
Saponification 204
Sarcoid granuloma 50
Sarcoidosis 98, 200
Satellite cell necrosis 81, 95, 133
Saw-tooth appearance 68
Scabies 56, 228, 236, 352
Scalp
biopsy 187
horizontal section of 18f
Scar, hypertrophic 352
Scarring alopecia 193, 194b
Schwann cell 307
Schwannoma, cutaneous 306
Scleredema 6, 48, 221352
Sclerema neonatorum 205
Sclerodactyly 257, 259
Scleroderma 33, 59, 129, 133, 193, 200, 351, 352
cutaneous 129
early 130
systemic 129
Scleromyxedema 48, 221
Sclerosis
progressive systemic 222, 257, 259
systemic 48, 129
Sclerotic bodies 241f
Sclerotic lower dermis 351
Sebaceoma 53
Sebaceous glands 8, 15, 15f, 16f, 76, 190f, 192f, 294f
detachment of 193
hyperplasia 294
tumors 60
Seborrheic keratosis 5f, 40, 41, 41f, 52, 53, 268, 271, 286
histological subtypes of 268
hyperkeratotic type of 269f
Septa, widening of 202f
Septal panniculitis 66, 199, 199f, 201, 201f, 202f, 206, 207fc
classification of 200b
Septic vasculitis 138, 139, 148
Sexually transmitted diseases 228
Sezary cells 334
Sezary syndrome 340
Shoulder parakeratosis 30, 75
Skin 7, 51f, 329
appendages 13
candidiasis of 237
components of 7
development of 8, 8b
diseases 70, 70fc
embryology of 7
lymphoid infiltrates of 334
regional variation of 21
structure of 7, 8, 8f
tumors, painful 304b
Smooth muscle cells 305b
Sneddon's syndrome 144, 145
Soft keratin 17
Solar elastosis 223, 351
Soles, localized pustular psoriasis of 104
Solitary reticulohistiocytoma 327, 329, 331
Spindle cell 286
B-cell lymphoma 53
carcinoma 53, 260
formations 311f
melanoma 53, 260, 325
pseudotumors 243
tumors 53, 260
Spindle nevus 321
Spindle shaped cell 306f
proliferation 138
storiform pattern of 301f
Spiradenoma glass slide 291f
Spirochetes 23
Spitz nevus 23, 44, 45f, 52, 60, 61f, 320, 321f, 322
Splendore–Hoeppli phenomenon 52, 231
Spongiosis 35, 69, 72, 76, 80, 103
mechanism of 71
mild 141
process of 71
prominent 140
Spongiotic dermatitis 71, 73f, 78t
pattern 116
Spongiotic dermatosis 71
Spongiotic diseases 72
classification of 72
Spongiotic disorders, diagnosis of 78
Spongiotic drug rash 72
Spongiotic reaction pattern 69
Spores 238f
Sporotrichosis 52, 228
Squamous cell carcinoma 32, 34, 39, 40, 44, 59, 90, 110, 268, 272, 275, 278, 282284, 284f, 285f, 286
distinction of 282t
Staphylococcal scalded skin syndrome 110, 229
Stasis dermatitis 49, 75, 78
Steatocystoma multiplex 266
Stellate keratinocytes 36
Steroid acne 185
Storiform
appearance 352
pattern 52, 301f
Stratum basale 7, 10
Stratum corneum 7, 9, 14f, 29, 57f, 99f, 100f, 103, 239f, 349
thickening of 29
Stratum granulosum 7, 9
Stratum lucidum 10
Stratum malpighi 7
Stratum spinosum 7, 10, 276f
Subacute cutaneous lupus erythematosus 84, 86, 128, 129, 257, 259
Subcorneal cleft 114f
Subcorneal pustular dermatoses 34, 35, 72, 109, 103, 116, 116f, 122
Subcutaneous fungal infections 32, 57, 237
features of 237b
Subcutaneous granuloma annulare 200
Subcutis 13
Subepidermal blister 119f
Subepidermal bullous
diseases 66, 109, 116, 117, 123fc, 248
classification of 117, 249b
disorder 64, 65f
Subepidermal cleft 90f, 118f
Sudan black stains 27
Suprabasal acantholysis 115
Suprabasal bullae 34
Suprabasal cleft 111f
formation 212
Sutton's law 63
Sweat coils 8, 14f
Sweat ducts 15, 14f
proliferation of 289f
Sweat gland 8, 13
carcinoma 41
tumor 53, 288
Sweet's syndrome 46, 47, 57, 147, 148, 351
Swollen cells 352
Symplasmatic mass 279f
Syphilis 200, 228, 230, 351
secondary 37, 84, 86, 98, 102, 352
Syringocystadenoma papilliferum 59, 293, 294f
Syringoid eccrine carcinoma 290f
Syringoma 288, 289f, 351, 353
histology of 288f
Systemic lupus erythematosus 256, 257, 259
bullous 26, 123, 245
T
Tadpole appearance 289
Tattoo 223
pigment 217
T-cell lymphoma 204, 337t, 342
cutaneous 334, 335, 337, 340, 345
Telangiectasia 95, 257, 259, 351
Telogen 19
effluvium 192
hair 20, 188, 188f
Tendons, giant cell tumor of 60
Terminal hair 16
Thrombophlebitis
migratory 208
superficial 200
Thrombotic thrombocytopenic purpura 144
Tier parakeratosis 31
Tinea
corporis 352
versicolor 352
Tissue 22
necrosis 242
reactions 64
sections 243
subcutaneous 8f
Toluidine blue 22
Tomb-stone appearance 350
Tonofibrils 8
Touton giant cell 61, 62f
multiple 330f
Toxic epidermal necrolysis 46, 132, 229
Transepidermal elimination 64
phenomenon of 224
Transepithelial elimination 43
Transient neonatal pustular melanosis 57
Treponematoses 23
Trichilemmal keratinization 188f, 266, 266t
Trichilemmoma 53, 295
multiple 295
Trichoepithelioma 41, 53, 295, 296, 296f, 296t
desmoplastic 51
Trichomalacia 191, 351
Trichotillomania 191, 191f, 351
Triglycerides 23
Tuberculids 229
Tuberculoid 69
granuloma 50, 50f, 242
diagnosis of 50
Tuberculosis 200
verrucosa cutis 35, 282
Tuberous sclerosis, ash leaf macules of 352
Tumors 32, 48, 53, 59, 60, 222, 225, 263, 265, 294, 353
appendageal 288
blood vessels 352
cytoplasmic granules of 307fc
epidermal 265, 286
fibrous 60
giant cell 60
malignant 32
mass 279f, 292
melanocytic 314
neural 305
proliferating trichilemmal 52
sebaceous 53
stage 313
stroma 279f, 296f
trichilemmal 286
types of 260
vascular 308
Tunica media 12f
Tyrosinase 22
Tyson's glands 15
Tzanck cell 34, 110, 112
Tzanck test 110
U
Ulcerative lichen planus 90
Ultraviolet A 179
Unilocular subcorneal pustule 116f
Upper dermis 43, 102
extraordinary edema of 351
Upper respiratory tract 150
Urates 22
stains for 26
Urticaria 46, 80, 82
acute 80
chronic 80
pigmentosa 58, 351
V
van Gieson's stain 27
Varicella zoster 351
Vasculitides 244
Vasculitis 47, 47f, 64, 65f, 69, 82, 134, 146f, 149fc, 200, 242, 256, 351
acute 136
chronic 136
classification of 134
drug-induced 148
granulomatous 136, 143
hypersensitivity 138
large vessel 134, 150fc
lymphocytic 136, 139
necrotizing 136
neutrophilic 136
nodular 145, 146f, 148, 351
small vessel 134
types of 69, 135f, 148
urticarial 138, 148
Vasculopathic reaction 66
Vasculopathy 64, 149fc
diagnosis of 148
occlusive 144
Vasodilatation 72, 95
Veins 12
large 12f
Vellus hair 16, 17t
Venule 11f, 12
Verhoeff-von Gieson stain 27
Verruca
plana 233, 234f
plantaris 233
vulgaris 40, 232, 233f, 286
Verruciform xanthoma 332
Verrucous carcinoma 32, 283, 283f
Verrucous epidermal hyperplasia 349
Verrucous skin lesions 32
Vesiculobullous disorders 249f
Vesiculobullous lesions 119
Vesiculobullous reactions 64
Vessels 8
thrombosis of 351
Villae 46
Villi 116
Viral blister 34, 232f
Viral diseases 224
Viral infections 140, 231
Viral warts 32, 232
Viruses 351
Vitiligo 179, 352
histopathology of 179f
von Kossa stains 25, 48
W
Warthin-starry stain 27, 229
Warty dyskeratoma 34, 40, 271
Warty dyskeratosis 349
Warty lesion, diagnosis of 91fc
Weber–Christian panniculitis 200, 203, 351
Weedon's scheme 64
Wegener's granulomatosis 143, 148
Weigart's stain 27
Wells syndrome 58
Wickham's striae 87
Wind-blown appearance 350
Woringer-Kolopp disease 54, 260
Wounds healing 225
Wucher atrophy 199
X
Xanthogranuloma 327, 329, 331
juvenile 60, 329, 330, 330f
Xanthoma 60
disseminatum 60, 329, 331
hyperlipidemia-associated 332
Xeroderma pigmentosum 214
Y
Yeast 228
Z
Ziehl–Neelsen stain 156t, 166, 239
Zygomycosis 228
×
Chapter Notes

Save Clear


1INFLAMMATORY DISEASES2

Biopsy1

  • Dermatologists have the unique advantage of performing biopsy with minimum of effort. It should be done not only when the clinician wants to know what is going on but also when he does not know what to do. It gives time to think and understand the process! So just do it.
  • A biopsy can by diagnostic (e.g., in inflammatory disorders), therapeutic (e.g., seborrheic keratosis, melanocytic nevi), or prognostic (e.g., leprosy, mycosis fungoides).
  • Every biopsy sample should be accompanied by a detailed clinical information, including differential diagnosis. Perform face, scalp, nail, and mucosal biopsies frequently—do not be hesitant.
  • Remember that any biopsy has four dimensions: Length, breadth, depth, and time. A pathologist sees the first three dimensions. A clinician has the advantage of watching the fourth dimension, i.e., time, as only he can follow-up the lesion. Hence, clinicopathological correlation provides all the four dimensions.
 
COMMANDMENTS OF BIOPSY
  1. There are several types of biopsies: punch, superficial, deep shave, deep incisional complete excision, and curettage.
  2. An ideal lesion for biopsy should not be scratched/traumatized, secondarily infected, or treated by topical and systemic therapies, especially anti-inflammatory drugs.
  3. Always take a deep, large biopsy. Include subcutaneous tissue (Box 1.1).
  4. Shave biopsy should be used when histopathologic changes are expected in the epidermis, such as seborrheic keratoses and verrucae.
  5. Avoid curettage biopsy, except in superficial lesions such as seborrheic keratosis and molluscum contagiosum.
  1. 4Prefer excision biopsies for bullous lesions, panniculitis, granulomas, and scleroderma.
  2. For punch biopsy, usually a 4-mm punch is required for adequate histological study. A 3-mm punch may be preferable for small lesions or biopsies from the face.
  3. Resort to multiple biopsies from multiple sites if there are lesions in different stages of evolution and in case of difficult diagnosis, for example, mycosis fungoides and leprosy.
  4. Lesions can change with time; repeat biopsies in evolving lesions.
  5. Choose an early lesion for biopsy in bullous, ulcers, pustular lesions, and vasculitis.
  6. Choose an established and fully evolved lesion in psoriasis, discoid lupus erythematosus, and leprosy.
  7. In case of scalp lesions, two specimens are ideally needed—one for horizontal section and the other for vertical section. Choose an area with erythema and visible hair shaft in case of scarring alopecia and from the active border of alopecia patch in case of nonscarring alopecia.
  8. Include the surrounding skin for comparison, in morphea, anetoderma, and in situ malignancies.
  9. The specimen should be handled gently and not to be handled with forceps, except at the edges to avoid crush artifact (Figs. 1.1 and 1.2).
  10. Aluminum chloride is preferred over electrocautery or radiofrequency (RF) for hemostasis. RF can lead to artifactual changes (Fig. 1.3).
  11. Put the sample inside a container, prefilled with fixative, without any delay. Mark the container with a patient information tag. Never put the patient information tag on the cap of the container. It may get changed.
zoom view
FIG. 1.1: Crush artifact. Part of epidermis crushed by forceps (4×) (scanner).
5
zoom view
FIG. 1.2: Crush artifact. Part of dermis crushed by forceps (4×) (scanner).
zoom view
FIG. 1.3: Changes after radiofrequency (RF). Seborrheic keratosis removed with RF showing secondary acantholysis resembling Hailey–Hailey disease (10×).
6
 
FIXATIVES
  1. Not all specimens needs to be fixed. few tests are performed even without fixing (Box 1.2)
  2. Always use 10% buffered formalin to avoid artifacts such as formazan pigment and crystal formation. Use adequate amounts—at least 10–20 times the volume of the sample.
  3. Fixation time is 1–2 hours per millimeter thickness of specimen. For a 4-mm skin sample, the usual fixation time is 6 hours. The specimen kept in fixatives for more than 24 hours gets hardened, making section difficult.
  4. Use glutaraldehyde for electron microscopy.
  5. After fixation, routine specimens are processed in an automatic processor, except for the specimens that are to be stained for lipids as xylene is used for extracting lipids.
  6. Use Michael's solution for direct immunofluorescence (specimen stay stable for 2 weeks at room temperature and several months when refrigerated). If this is not available, saline is enough, if you can transport it immediately to the laboratory!!