Pathology Report - Dermatopathology, Right Jawline Shave Biopsy

A. Skin, right jawline, shave biopsy: Superficial epidermal necrosis with paucicellular dermal mixed inflammation and hemorrhage. See microscopic examination for comment. B. Skin, right jawline, shave biopsy for direct immunofluorescence: Negative direct study.

A. The specimen is examined on 15 H&E-stained levels as well as with a special stain for fungus (PASF) and a tissue Gram stain. The tissue is exhausted from the block. There is abrupt superficial epidermal necrosis involving the majority of the sampled epidermis. The basal layer epidermis appears viable. The granular layer is focally eroded; however, other areas of the granular layer are intact. No acantholytic keratinocytes are found. No intraepidermal or subepidermal vesicle is identified in this sample. In the dermis there is a paucicellular perivascular and interstitial inflammatory infiltrate of lymphocytes, histiocytes and neutrophils. No eosinophils are found. Extravasated red blood cells are present, but leukocytoclastic vasculitis is not present. There is no suppurative folliculitis, granulomatous inflammation or interface dermatitis. The special stains for organisms are negative as is the direct immunofluorescence study (part B). The histopathologic features are not specific. The possibility of an irritant contact dermatitis is considered. Clinical correlation is necessary. B. Cryostat sections of frozen tissue are stained with fluoresceinated antibodies against specific immunoglobulins (IgG, IgA and IgM) as well as complement component C3. The positive and negative controls are valid. The H&E stained section shows skin in which epidermis and dermis are clearly identified. There are no specific deposits of immunoglobulins or complement component C3 identified in the epidermal intercellular spaces, basement membrane zone, papillary dermis or dermal blood vessels.