Dermatopathology. Christine J. Ko

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Figure 4(C) Eyelid skin has a thin epidermis with dermal vellus hairs (red arrow) and skeletal muscle (black arrow)

Figure 4(D) Axilla

       The epidermis is undulating, often with basilar melanin pigment. There are apocrine glands in the deep dermis

Table 2(see page 22) shows a differential of “normal”‐appearing skin. Some entities, like vitiligo, require special stains (i.e., a melanocytic marker).

Figure 5(A) Argyria

       There are fine black granules in the basement membrane of hair follicles and eccrine glands

       Black granules are also deposited on elastotic fibers, so‐called “pseudo‐ochronosis”

      Source: Case courtesy of James E. Fitzpatrick, MD.

Figure 5(B) Ichthyosis vulgaris

       This example from an older patient has solar elastosis in the dermis

       There is hyperkeratosis above an attenuated granular layer

      Source: Case courtesy of Jeff D. Harvell, MD.

Figure 5(C) Tinea versicolor

       Yeast and hyphal forms in the stratum corneum

Figure 5(D) Urticaria

       Urticaria can appear “normal” at low power, particularly when inflammation is sparse

       There are perivascular and interstitial lymphocytes and eosinophils

Table 2 Some entities to consider for a gestalt impression of “normal” skin.

“Normal” skin	Look for
Argyria	Flecks of black material around eccrine glands; elastic fibers may be discolored (Figure 5A)
Ichthyosis vulgaris	Hyperkeratosis above hypogranulosis or absent granular layer (Figure 5B)
Macular amyloidosis	Amorphous, smooth pink globules in the papillary dermis Pigment incontinence
Scleredema	“Square”/rectangular biopsy shape Increased space +/‐ mucin between collagen bundles
Tinea versicolor	Spores and pseudohyphae in the stratum corneum (Figure 5C)
Urticaria	Mixed inflammation (interstitial and perivascular) (Figure 5D)