2. DEFINITENESS OF PURPOSE Your progress toward success begins with a simple fundamental question… Where am I going…? 17 Success Principles:

Dermatopathology: Session 3 Synthesis & SAQ Dr. Shashidhar VM A/Prof. & Head of Pathology

Normal Skin: (Thin)

Prominent granular layer Thick Skin: Stratum Lucidum

Dermatopathology: MD3020 curriculum Acute Inflammations: Urticaria, Acute Eczema, Erythema Multiforme. Chronic Inflammations: Psoriasis, Chronic Eczema, Lichen planus. Infections Bacterial (Impetigo), Fungal(tinea) & Viral(warts). Blistering Diseases Pemphigus, Pemphigoid, Dermatitis herpetiformis. 5. Neoplastic: Benign: Nevi, Actinic Keratosis, Seborrheic Keratosis. Malignant: BCC, SCC, Melanoma.

INFLAMMATORY DISORDERS Urticaria Acute Chronic Lichen Eczema Eczema Sclerosis Dermal Infl Epidermal Infl Hyperplasia Hyperkeratosis Acute Inflam. Chronic Inflam. Ep. Hyperplasia Psoriasis Lichen..

BLISTERING DISEASES Subcornial. Suprabasal. Subepidermal. PEMPIGUS FOLIACESOUS PEMPIGUS VULGARIS BULLOUS PEMPHIGOID

Nevi types & Pathology: (Genetic) somatic mutations in epidermal melanocytes that promote increased melanogenesis on exposure to UV-A and UV-B rays, the dopa reaction is increased, leading to the production of larger melanosomes. Melanocytes are not increased in number.

Melanoma Staging: Clark’s levels

5. SELF DISCIPLINE Self discipline is doing what you are supposed to be doing for the moment. It is employing the “DO IT NOW” philosophy 17 Success Principles:

Dermatopathology: Self Assessment Quiz

19y boy, lesions following viral fever and sore throat. ? diagnosis Verruca plana Tinea corporis Steven Johnson Sy. Erythema multiforme Psoriasis

16y girl, itchy, lesion on wrist 3 days following wearing new bracelet. ? diagnosis Urticaria Acute eczema Chronic eczema Tinea corporis. Erythema multiforme

84y male, scalp lesions. Diagnostic feature? Spongiosis. Acanthosis. Dermal edema. Solar elastosis Parakeratosis

84y m, What is shown by light Green arrow? Spongiosis Acanthosis Keratin plug Solar elastosis Parakeratosis

41y male, swollen lips and an intensely itchy generalised rash 24hour. Most likely diagnosis ? Acute eczema Tinea versicolor Psoriasis Urticaria/hives Acute eczema.

41y male, swollen lips and an intensely itchy generalised rash 24hour. Characteristic microscopic feature ? Spongiosis Acanthosis Parakeratosis Dermal edema Lymphocytes

31y fem, rash 6 days at blood collection site Diagnosis? Tinea corporis. Psoriasis. Impetigo. Contact dermatitis. Actinic keratosis

What is shown by Black arrow? Hyperkeratosis Acantholysis. Acanthosis parakeratosis Spongiosis

82y male, lesions on the hand & ear.?Diagnosis Actinic Keratosis Basal cell carcinoma Malignant Melanoma Squamous cell carcinoma Solar elastosis

48y female, large blisters. Biopsy Images ? Diagnosis Bullous pemphigoid Pemphigus Dermatitis herpetiformis Pustular Psoriasis Sebhorrheic keratosis.

28y male, Asymptomatic lesions 3 weeks. diagnosis? ? Contact dermatitis Impetigo Erythema multiforme Tinea versicolor Multiple Nevi

81y male, surfing enthusiast. Lesions on the cheek since 3 years. Slowly increasing. ? Diagnosis Seborrheic keratosis. Contact dermatitis. Tinea Barbae Impetigo (staph.) Actinic keratosis.

21y male, Lesions on the face since 4 weeks. Slowly increasing, Itchy but no pain. ? Likely Diagnosis Seborrheic keratosis. Contact dermatitis. Tinea Barbae Impetigo (staph.) Actinic keratosis.

Case: Itchy lesion A 68-year-old man has a 10-month history of an intermittent, itchy rash over popliteal fossae. This settles with a topical steroid and worsens with scratching. Between episodes the skin is normal. He occasionally has a similar eruption on his left chest but has had no rashes anywhere else.

What is the most likely diagnosis? Pemphigus vulgaris Tinea pedis Contact dermatitis Psoriasis Chronic eczema

71y fem, recurrent blisters. ?diagnosis Erythema multiforme Contact dermatitis Dermatitis herpetiformis Bullous pemphigoid Pemphigus vulgaris

Case of asymptomatic mole: A middle-aged man presented with a scaly spot on his nose. This proved to be a solar keratosis and was treated with liquid nitrogen. However, general examination revealed a lesion over his lower back. He had been aware of it for several years and had not noticed any obvious change of appearance.

Likely diagnosis? Dysplatic nevus Blue nevus Seborheic keratosis Melanoma Benign mole

3 year child, lip licking. Likely diagnosis? Impetigo Contact dermatitis Tinea corporis Psoriasis Pemphigus

13y girl, Biopsy stained with PAS. Diagnosis? Impetigo Contact dermatitis Tinea infection. Psoriasis Lichen slcerosis

83y female, Lesion on face, 2 years. Diagnosis? SCC Amelanotic melanoma. Keratoacanthoma BCC Nodular melanoma.

78y, Male, lesions since 16 years on exposed surface. slowly increasing, mild itching. Psoriasis Contact dermatitis Basal cell carcinoma Squamous carcinoma Actinic keratosis

28y, Male, recurrent small itchy vesicles. Lesions exacerbate following eating whole meal bread.?Diagnosis Blister Erythema multiforme Contact dermatitis Dermatitis herpetiformis Eczema Actinic keratosis

What is shown by Red arrow? Spongiosis Acanthosis Dysplasia Solar elastosis Parakeratosis

82y, Male, asymptomatic lesion slowly growing since 2 years. Urticaria Erythema multiforme Squamous carcinoma Contact dermatitis Basal cell carcinoma

Pigmented growing lesion - ? diagnosis Basal cell carcinoma Malignant melanoma Squamous cell carcinoma Seborrheic keratosis Blue dermal nevus

Slowly enlarging hard plaque on the scalp of a 86y man. Diagnosis? Basal cell carcinoma. Malignant melanoma. Squamous cell carcinoma. Seborrheic keratosis. Actinic keratosis.

Slowly enlarging hard plaque on the scalp of a 86y man. Feature shown by arrow A? A C B Hyperkeratosis Parakaeratosis Epidermal dysplasia Acanthosis Dermal inflammation

78y male, slowly growing lesion - ?diagnosis Basal cell carcinoma Malignant melanoma Squamous cell carcinoma Seborrheic keratosis Molluscum contagiosum

82y Fem, tense blisters. ? Diagnosis Pemphigus vulgaris Toxic Epidermal necrolysis. Bullous eczema. Bullous Pemphigoid. Dermatitis Herpetitis.

82y male, lesion on nose since 4 months. Squamous cell ca Organizing Haematoma Basal cell carcinoma Melanoma Sebhorrheic keratosis.

66y male with lung Ca. multiple new lesions 3wk: Melanoma Blue Nevi Dysplastic nevi Seborrheic keratosis Basal cell carcinoma

Two teenagers, lesion around pubic area Itchy, oozing since 3wks. Impetigo. Tinea cruris. Psoriasis. Seborrheic dermatitis. Contact dermatitis.

81y male, surfing enthusiast. Lesions on the cheek since 3 years. Slowly increasing. ? Microscopic feature Hyperkeratosis. Parakeratosis. Dermal inflammation. Epidermal atrophy. Solar elastosis.

18y female, Lesion on the cheek since 3 weeks. Slowly increasing. ? Diagnosis KOH prep Psoriasis. Acute Eczema. Chronic Eczema. Tinea corporis. Actinic keratosis.

6y male. Lesion on face, 3m. ? Diagnosis Impetigo Psoriasis. Acute Eczema Chronic Eczema Actinic keratosis.

28y fem, Lesion leg 5 days. ? Diagnosis Impetigo Psoriasis. Acute Eczema Chronic Eczema Actinic keratosis.

86y, painless nodule since 4 years. SCC. Melanoma. Seborrheic keratosis. Condyloma. BCC.

16y, Itchy lesions 4m. Impetigo. Tinea versicolor. Contact dermatitis. Eczema. Kaposi sarcoma.

Study Tips: Preparation: Read Lecture notes, attend lecture*. Read Robbins Pathology (Basic). Make short notes for each condition, Etiology, Pathogenesis List 3* clinical & 3* microscopic features (images) List common complications & A line about prognosis. Success tips: Discuss Cases & Q&A with friends. Books, clinics, online, friends..! (http://www.dermnetnz.org) Every time you see a lesion, become the dermatologist…!

“ We are what we repeatedly do. Excellence, then, is not an act, but a habit ” Aristotle Worth reading the book: “7 habits of highly effective people” by - Stephen R. Covey