S11C30P25-3: Many of the nuclei in this epidermal defect contain inclusions. All the nuclei of the multinucleated cell above the center of the field contain inclusions. Some of the degenerating cells show nuclear pyknosis and a perinuclear vacuole. The cytoplasm is condensed at the periphery of the dying cells (dyskeratosis). Lymphocytes and histiocytes are sprinkled among the keratinocytes.

S11C30P25-4: The epidermal patterns identify the site as acral skin. Rete ridges are elongated. To the left, both the basal unit and the superficial unit of the epidermis are hyperplastic. A zone of necrosis on the right, involving the superficial unit, separates the viable epidermis from the more normal kertinized debris along the surface of the skin. Many of the necrotic keratinocytes have pale, or vacuolated cytoplasm. There are irregular defects (necrolysis), mostly at the interface between the viable and necrotic portions of the epidermis. Lymphoid cells loosely infiltrate the necrotic superficial unit. There are scattered necrotic keratinocytes, with some in clusters, in the basal unit of the epidermis. Centrally, one rete ridge shows clusters of necrotic keratinocytes (blue arrows). The papillary dermis is edematous. There are loose infiltrates of lymphoid cells in the perivascular spaces (hand-foot-mouth disease).

S11C30P25-5: Focally, there are cytolytic and dyskeratotic changes at the dermal-epidermal interface. There are scattered cytopathic changes. In the central rete ridge,  necrotic keratinocytes are clustered.

S11C30P25-6: Some of the nuclei of keratinocytes contain intra-nuclear inclusions (blue arrows). A cell to the right of the irregular defect shows acidophilic bodies in the cytoplasm. The acidophilic bodies are compatible with cytoplasmic inclusions. Scattered cells show individual cell necrosis with pyknosis of nuclei and increased cytoplasmic acidophilia.