Slide Review: Thick skin and sun damaged skin

Thick and/or sun damaged skin will appear as a translucent layer of cells outside the epidermis. This section shows scabby, sun damaged tissue, so the layer of cells is rough and uneven. In the mid dermis, the grayish/lavender area is most likely actinic elastosis, or the accumulation of abnormal elastic tissue in the dermis, also a result of sun damage.

This next section shows the thick skin found in the palms of the hand or the soles of the feet. Note that even though the image (courtesy of http://www.dartmouth.edu) points out the "thickened layer of squamous cells," it is not referring to SCC. Healthy squamous cells are a normal part of the superficial epidermis. The outermost squamous cells are heavily keratinized, creating a thick layer of dead cells that protects our hands and feet. 

For comparison, here is a section of normal tissue only a thin layer of dead squamous epithelial cells.

Slide Review: Water in the slide

At the end of staining, tissue sections must be fully dehydrated by alcohol before applying Cytoseal. If you rush the process and leave water mixed with the alcohol and glue, the tissue will have strange dark flecks in it. Notice how the tissue in the far lower right corner of this picture is not contaminated as much. The cytoseal was probably dropped directly on that area of tissue.

You will also notice what looks like streams of bubbles. Since cytoseal is toluene-based and toluene is insoluble in water, any water left on the slide will create this cloudy mess of bubbles.

Solution: Recoverslip. Slide off the coverslip. Give the slide a few good swishes in the alcohol, a few drops of glue, and a brand new coverslip. 

Slide Review: Monsel's Solution

Monsel's solution, also known as ferric subsulfate solution, is a styptic agent used to stop bleeding after superficial skin biopsies.  It works by contracting tissue to seal injured blood vessels. Here, we see residual Monsel from a biopsy done several days before Mohs surgery.

Slide Review: Milial Cyst

A milial cyst is a small, keratin filled cyst, often found on the face. This lesion is quite common in women who apply moisturizers, and can also be a complication of facial cosmetic dermatology such as dermabrasion, chemical peels, and laser resurfacing.

The hardened keratin sounds like a grain of sand embedded in the tissue, making a scraping sound at each pass of the blade. 

In these sections, you can see the stratified layers of keratin lining the cyst. 

Slide Review: Tattoo Ink