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Skin Diseases |
| A review of the history of dermatopathology is HERE; the history of the American Society of Dermatopathology (ASDP or ASD) is HERE and photos of fonders HERE. There is a massive amount of information about skin
diseases. Most patients with skin disease are first treated by primary care doctors & not to dermatologists until later. Either by greater
savvy or because of referral or because of other recommendations,
stubborn and odd skin problems end up with the skin experts...the
dermatologists. Biopsy and excision specimens of
skin diseases, tumors, and cancers are best handled when they end up with local ("point of service") pathologists. The
most important factor in a patient's behalf as to what lab (pathologist)
is "best" to process and interpret his/her specimen is
that the pathologists really care to do the best for the
patient. Such an attitude assures correct initial handling & processing
of the specimen. Such an attitude is far more likely with a point of service (local) pathologist. If need be, expert consultation on the specimen
can then be quickly obtained by overnight express or telepathology from anywhere
in the USA (or the world, for that matter). |
| Pathology Associates of Lexington, P. A. (operating
out of Lexington Medical Center, West Columbia, S.C.) has "cared" about
skin problems since 1975 and has an unusually full range of excellently
executed routine, specialized, and emergency services available
to doctors and patients: routine histological exams, special histochemical
stains, special immunohistochemical stains (IHC), fluorescent staining
and microscopy (DIF/DFA), and a wide range of serological tests
(ANA thru anti-skin types of antibodies)...almost all "in-house" and
rapidly available...even by way of the ER or ICU...as necessary. |
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- About MELANOMA skin cancer:
- CARDINAL POINTS:
- pathology gross exam
- DX must be correct
- invasive vs. noninvasive: [HERE] regression is a stumbling block
- is it Clark level II vs III? [this & next 2, HERE]
- did you seek & rule out vascular invasion?
- did you seek & rule out perineural space invasion?
- An overview, screening, & melanoma variety definitions/criteria AND node nevi vs. met. melanoma.
- AND, if you have lots of nevi, the new “MoleMapCD™” System of
tracking your moles may be at a site near you (my son worked
with the Columbia, S. C. inventor). And, there is another MoleMap where photos & dermatoscopic photos are taken of a "suspicious mole"
and reviewed & diagnosed via internet by a specialized dermatologist known as a "dermatoscopist". In late 2011, MelApp came out for the iPhone for a photo of your suspicious mole and an app calculation of "riskiness".
- basic melanoma histologic criteria,
tables; template parameters & criteria.
- pathology report parameters
and their prognostic significance.
- the Clark 6-parameter prognosis tables;
use your pathology report to get a general idea of your odds
of cure.
- formula for your personal prognosis
calculation (using your pathology report) with ability
to adjust the survival intervals.
- link to a good site with
on-line info, article links, and staging & prognosis
calculator. (NOTE: We continue to see on-line
advice to use specialist pathologists for diagnoses.
After 26 years in practice, our advice is, rather, to
deal with pathologists [and all other physician service
providers] who "care" and are qualified).
- skin cysts.
- Rough, scaly skin, Keratoderma,
hyperkeratoses, genodermatoses, nail disorders.
- clavus (corn): & dozens of other localized friction & pressure-related callosities (acquired keratoderma [HP14-752]), such as eyeglasses ear callus [HP14-752], jeweler's callus, cherry pitter's thumb, cameo engraver's corn weight lifter's callus, screwdriver's callus, and various callosities of the feet and toes; website file.
- nail photos & names of the abnormality HERE. In a search for fungus thickening of the nails or a thick nail, we may find our exam negative because it is thick due to the common onychauxis (thick nail) due to subtle trauma of a nail by ill-fitted shoes or that tends to "dig in" to the shoe bottom (usually the longest of the non-great, curved toes) to speed up walking, etc. This would be traction (traumatic) etiology). Another "traction" is due to subtle trauma of a nail that tends to "dig in" to the shoe bottom (usually the longest of the non-great, curved toes) to speed up walking, etc. This would be traction (traumatic) etiology). Or it may be due to contact dermatitis, keratosis disorders, or vascular insufficiency.
- hard to cure Palm & foot dermatitis.
- vasculopathies:
- telangiectasia: clinically, extreme cold, chronic liver disease, and chilblain lupus can result in changes in digits suggestive of a systemic disease. Ectasia of venules may also be manifested clinically as discrete telangiectases in conditions as disparate as unilateral nevoid telangiectasia syndrome in pregnancy and CREST syndrome, or it may present itself as diffuse erythema in a localized region, as occurs in acral erythema [AE] (chemotherapy being a case of AE). Venules are simply dilated.
- physical factor etiology lesions: such as simple blood blister (pseudo-angiokeratoma) HERE.
- factitious (self inflicted) skin problems: dermatitis artefacta; think of this when you see odd abscesses, facial pigmentations & odd lesions, odd foreign body granulomata, and odd ulcers/excoriations (neurotic excoriations) or skin necroses, and certain types of hair loss (alopecia)...trichotillomania & traction alopecia.
- cutaneous
sarcoidosis, what to do?
- skin scars:
- alopecia;
an alopecia website.
- Dermatopathology on-line Czech outline
and atlas.
- Medscape's Primary Care (photo) Dermatology
Atlas of skin
disorders by lesion type, body location, and by search engine (access
will require ID and password; another
on-line atlas;
New Zealand Dermatology website, DermNet,
has search categories body area and symptom for patients and doctors.
- A dermatology website.
- A dermatopathology website.
- A podiatric dermatopathology lab site.
- A web site of information on blistering dermatoses.
- chronic cutaneous urticaria [CCU].
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DIF/DFA differential diagnosis
notes:
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Anti-skin antibody testing by IFA...blood (serum) sample
[here].
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Inflammatory dermatoses: [pending]
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diseases in each histological
pigeon-hole category, list [pending].
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as decision trees or flow
charts [pending].
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infectious, notes.
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Miscellaneous:
- special hyperpigmentation:
- pellagra: a more acute case1 has acanthosis & maybe some parakeratosis & can look like zinc-deficiency, late onset "acrodermatitis enteropathica" (which has superficial keratocytes with marked pallor & focal spongiosis) or necrolytic migratory erythema (flaccid bullae & parakeratosis & keratocyte pallor & vacuolation & a sort of superficial necrosis & separation). Chronic is hyperpigmented, symmetrical
dermatosis that looks "cracked" like sunbaked mud
(dermatitis, diarrhea, dementia)...niacin deficiency (J.
SCMA Aug. 2003).
- acanthosis nigricans: Clinically hyperpigmented neck folds, armpits and intertriginous folds; histology reveals non-compact orthohyperkeratosis, papillomatosis, with minimal or no acanthosis or hyperpigmentation, the visually increased pigmentation due to the velvety, fine-calibre papillomatosis "stacking" epidermis vertically up the sides of the closely compacted papillated folds of papillary dermis; due to "benign"...associated
with excessive niacin intake (e. g., to increase HDL cholesterol), & metabolic syndrome (also see PCOS), & some
others; "malignant"...when it heralds an internal
malignancy, especially stomach cancer. Associated syndromes HERE.
- Addison's disease
- hemochromatosis, advanced
References:
- McKee, Calonje, & Granter, Pathology of The Skin... Two volumes, 3rd Ed. 2005.
(posted 2001; latest
addition 12 October 2014) |
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