S9C20P12-1: The epidermis is hyperplastic; it shows features common to acral sites, particularly in the keratin layer. The epidermal pattern is psoriasiform, but the granular layer is prominent. There are mild perivascular infiltrates in the dermis. Below the boundary defined by the red arrows, the connective tissue shows closely spaced collagen bundles in parallel arrays; the connective tissue in this area appears less cellular than in the neighboring dermis (acrosclerosis). The fibrosing reaction in lesions of acrosclerosis is often rather subtle. The interpretation of such patterns is complicated by the normal anatomic patterns of this site; in normal acral skin, there are areas in which aponeurotic-like components blend with the lower margin of the dermis.

S9C20P12-2: In this area of a lesion of acrosclerosis, vessels have thickened walls (PAS stain with hematoxylin counterstain). Sclerosis of vessels in this anatomic site occurs with advancing age even in the absence of acrosclerosis. The vascular changes in this area are of questionable significance.

S9C20P12-3: The vascular changes in this lesion of acrosclerosis qualify as arteriolosclerosis. The vessel identified by blue arrows has a thickened wall and narrowed lumen; it is hyalinized. The one outlined by red arrows shows a thickened wall and a narrowed lumen.

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