A 67-year-old woman presents to her primary care physician for evaluation of persistent skin lesions on her upper extremities for the past 2 weeks. She states that the lesions begin as blisters before popping and becoming painful erosions. Her past medical history is significant for cystinuria treated with penicillamine. On physical examination, she has numerous bullae and erosions on her upper extremities, with similar erosions on her oral mucosa. The bullae are Nikolsky sign positive.
Which of the following best describes the most likely histologic appearance of this patient’s lesions?
- A) Acantholysis with “tombstoning” of basal keratinocytes
- B) Acanthosis and hyperkeratosis with koilocytic nuclear change
- C) Acanthosis with persistence of nuclei in the stratum corneum
- D) Nests of basal cells with peripheral palisading
- E) Thickening of the stratum spinosum