S6C9P3-1: To the right, the patterns are typical of pemphigus vulgaris, but the dermal papillae are elongated. The defect is clearly supra-basilar. To the left of the area showing the typical patterns, another dimension has been added; the papillae are even more elongated and not all of the defects are clearly supra-basilar. In some areas, especially in irregular patterns along the papillae, the defects are above the basal layer. In fact, in areas (as evaluated by a definition of the distinctions between the basal and superficial units of the epidermis) the defects are at the interface between the superficial and the basal units. This division becomes apparent when emphasis is placed on the character of the epithelium forming the roof of the bulla; the roof has the characteristics of a hyperplastic superficial unit. It is perhaps too convenient to merely dismiss the variations in the location of the defects as having a relationship to the age of the lesion. In the latter approach, a lesion, as it advances in age, might manifest partial, and irregular, regeneration of epithelium to produce a multilayered floor, rather than a single row of basal cells. I think it more likely that in some examples, injury in the supra-basilar and in the intermediate zone of the epidermis is concomitant. Patterns of this type might be characterized as acantholysis in two tiers (perhaps three tiers) and additionally qualified as a hypertrophic variant (the latter qualification gives recognition to the increased mass of cells above the basal layer). I suppose some observers might characterize the changes as bouts of acantholysis, in squences, with the most superficial cleft at the interface between the granular layer and the keratin layer to be characterized as the oldest insult. On the other hand, a lesion of this type might provide documentation of the antigenic heterogenicity of the epidermis with different surface antigens at three levels of the epidermis (level 1 at the interface between the basal layer and the overlying cellular component; level 2 at the interface between the basal unit and the superficial unit; and level 3 near the interface between the granular layer and the keratin layer).

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S6C9P3-2: In this field of the same lesion as S6C9P3-1, acantholysis affects cells of the granular layer;  the acantholytic cells are dyskeratotic (their cytoplasm is condensed and shows increased acidophilia). In this area, the changes are of a type seen in pemphigus foliaceus (the lesion is stratified in regard to levels of acantholysis and this is the superficial level).

S6C9P3-3: This example might also qualify as a hypertrophic variant. The striking hyperplasia of the epidermis provides a psoriasiform quality. Inflammatory infiltrates are prominent in the dermis. Acantholysis is prominent on the left. In other sites, the clefting is mostly suprabasilar and most focal. Lesions of this type probably have a relationship to examples that clinically would have a vegetating quality.

S6C9P3-4: At a higher magnification, the spotty clefts are not purely  suprabasilar. The dermal infiltrates are lymphoplasmacytic. The epidermal hyperplasia might be characterized as a form of immunostimulation.

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