Advances in Dermoscopy Flashcards
From Dermoscopy Masterclass
Describe how the classification of white lines has changed wrt BCC
They are thicker than white lines in melanoma.
Therefore described as white shiny strands
OR
white shiny blotches
(White lines are common in BCC. May be present in > 30% )
Describe how the classification of white lines has changed wrt Melanoma
They are thinner than white lines in BCC.
Therefore described as
white shiny streaks or white shiny lines.
What are May globules in BCC
White clods
Rare - only around 3% BCC
Eccentric/ scattered. Cf white clods in sebaceous hyperplasia.
What is the earliest sign of melanoma in an acquired nevus.
Irregular hyperpigmented areas
Scattered brown or black color
What percentage of melanomas develop de novo?
> 70%
close to 70%
What percentage of melanomas develop on a pre-existing nevus?
< 30%
close to 30%
What is the primary clue to nevus associated melanoma?
(Small/ medium CMN)
Inverse network.
(Brown globules surrounded by white color. )
What is the secondary clue to nevus associated melanoma?
(Small/ medium CMN)
Grey polygonal lines developing inside the nevus.
Inverse network, evenly distributed is found in which type of nevus?
Spitzoid nevus
What are the 3 types of spitzoid nevi?
- Starburst
- dotted vessels
- globules with reticular depigmentation (inverse network)
What are the two pathways to melanoma associated nevus?
- Develops within the nevus.
- Develops adjacent to the nevus.
Why is dermoscopy not helpful in the diagnosis of melanoma in giant congenital nevi?
Melanoma develops deep in the dermis.
A symmetrical lesion with peripheral rim of globules (symmetrical) should be interpreted according to the age of the patient. True/False?
False
In a large database 100% of lesions that meet these criteria are benign.
Features distinguishing melanosis from melanoma of genitals. Name 4.
Age
Flat vs raised
Pattern
Color
Features associated with melanosis of genitalia. Name 3
Young age
Flat lesion
Parallel lines
Features associated with melanoma of genitals
Older age
Raised lesion’
Structureless
Blue and red color
Revision. Features of lentigo maligna on the face. List 4.
- Gray dots/clods
- Asymmetric follicular openings
- angulated lines (rhomboid structures)
- Obliteration of the follicles.
Imiquimod as adjuvant therapy for lentigo maligna. What is the cure rate?
95%
Imiquimod as adjuvant therapy for lentigo maligna. What is the strength/ duration of therapy.
5% 7 days per week for up to 7 weeks.
Is radiotherapy an effective alternative treatment for lentigo maligna. Yes/No
Yes
Approach to Acral lesions
- Is there a clear parallel furrow pattern throughout the lesion?
If not: - Is the lesion >= 7 mm? Then excise
- Is there asymmetry of structure and color? Then excise.
Ddx of parallel ridge pattern
- Melanoma
- Subcorneal hemorrhage
What is a reasonable follow up interval for an acral lesion?
3/12
What is a reasonable follow up time for a nail lesion?
6-12/12
Approach to assessing melanonychia striata. Name the important steps.
- Is this is hemorrhage
- Is only one nail involved, or multiple nails.
- If only one nail involved involved, assess the color of the band. Brown or Grey.
- If the band is brown, distinguish nevus from melanoma.
Approach to assessing melanonychia striata. What is the significance of grey bands?
Benign lesion
Lentigo of nail plate
Reactive pigment
Approach to assessing melanonychia striata. What is the significance of brown bands?
Associated with melanocytic tumors.
Approach to assessing melanonychia striata. What are the features of melanoma.
Irregular bands of pigmentation. (Irregular spacing of bands and variation of color)
Hutchinson’s sign. (Pigmentation of peri-ungual skin/ proximal nail fold)
Micro-Hutchinson sign. Pigmentation see only with dermoscope.
Hutchinson’s sign is suggestive of melanoma with one exception.
Congenital nevus of the nail in a child.
WRT melanonychia striata, what is the significance of triangular shape of nail band.
The nevus is growing.
WRT melanonychia striata, what is the significance of wide band. (> 50%)
Very likely to be a melanoma.
(Except CMN)
What is the only nevus that does not result in coloration of the nail plate itself.
Blue nevus.
This arises deep in the dermis.
Name 4 causes of gray band in the nail.
- Nail Lentigo
- Ethnic pigmentation.
- Drugs.
- Laugier-Hunziker
What is the differentia diagnosis when only 1 nail is pigmented. Name 4 conditions.
- Nevus,
- melanoma,
- lentigo,
- reactive pigmentation.
When is amputation required for nail melanoma
Lesions thicker than 1 mm.
Tendency is for more conservative management.
Are acral and nail melanoma easy to diagnose pathologically at an early stage.
No.
The pathologist may report atypical nevus or atypical melanocytic proliferation.
Is follow up of nail melanoma a reasonable strategy?
Yes
Owing to limitations of histopathology in the setting, 9 month follow up is a reasonable option.
What percentage of patients with “ugly mole” syndrome will develop melanoma over time?
3%
What percentage of patients with “ugly mole” syndrome will develop melanoma over time if they have had a prior melanoma?
10%
Which patients are appropriate for digital dermatoscopic monitoring? Name 5 categories.
- Patients with > 60 melanocytic nevi.
- Patients with CDKN2A mutation. (Independent from the total nevus count.)
- Patients with > 40 melanocytic nevi, and personal history of melanoma.
- Patients wth > 40 melanocytic nevi and red hair and/ or MC1R mutation.
- Patients with > 40 melanocytic nevi and organ transplant.
