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Dermatology > BENIGN & MALIGNANT MELANOCYTIC LESIONS > Flashcards

BENIGN & MALIGNANT MELANOCYTIC LESIONS Flashcards

1
Q

what is a congenital naevi + how common are they

A

lesion present at birth - 1% of newborns

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2
Q

what is an example of highly malignant naevi

A

giant ‘bathing trunk’ naevi

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3
Q

what is the mongolian blue spot

A

benign congenital lesion due to melanocytes in dermis common in asian ethnicities

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4
Q

what is an acquired naevi

A

naevi appearing around adolescence - changes with age

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5
Q

what are the types of acquired naevi and what do they look like

A 
junctional - macular and dark 
intradermal - raised and skin colour 
compound - warty 
halo - naevus with hypopigmented area surrounding it
blue  - black/blue naevus
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6
Q

what does an asymmetrical naevus look like

A

asymmetrical

differently pigmented

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7
Q

what are asymmetrical naevi associated with

A

familial or due to excessive sun exposure in childhood

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8
Q

whats the prevalence of asymmetrical naevi

A

2-5%

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9
Q

when do asymmetrical naevi have a higher risk of melanoma

A

> 50 yrs

family history

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10
Q

whats in incidence of malignant melanoma for men and women in the UK

A
  1. 8/100,000 for men (0.0078%)

12. 3/100,000 for women (0.0123%)

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11
Q

what are risk factors for melignant melanoma

A

fair skin
excessive skin exposure in childhood - especially if multiple severe sunburns in childhood
family history
immunosuppresion
multiple atypical moles
>3 blistering sunburns under 20 yrs old
previous PUVA/immunosuppression/dysplastic naevi
large number of atypical/dysplastic naevi/large congenital naevi

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12
Q

whats the most important prognostic factor for malignant melanomas

A

breslow thickness - histological distance from deepest melanoma cells to stratum granulosa of the epidermis

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13
Q

what are the data ranges for risk for breslow thickness

A

<0.76mm - low risk

>1.5mm - high risk

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14
Q

apart from breslow thickness what are other poor prognostic factors for malignant melanoma

A

lesions on head and neck
being male
older age group
ulceration

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15
Q

what are sinister features of a lesion that make you suspicious of malignancy

A 
change in size 
irregular shape 
irregular colour 
greater than 1cm diameter 
itch 
bleeding/ulceration
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16
Q

where in the epidermis do melanomas begin

A

basal cell layer

17
Q

what is in situ melanoma and what is another name for it

A

all malignant cells are confined to epidermis - lentigo maligna

18
Q

what are the subtypes of melanoma and the % they account for

A 
superficial spreading - 70% 
lentigo maligna melanoma 4-15% 
acral lentiginous - 5%
nodular melanoma - 5% 
amelanotic - 4%
desmoplastic - <4%
19
Q

what subtype of melanoma is more common in those with darker skin

A

acral lentiginous

20
Q

where is superficial spreading malignant melanoma usually found

A

legs of women, trunks of men

21
Q

how do superficial spreading malignant melanoma grow

A

initially horizontally in superficial layer of skin, then after a variable amount of time it will grow vertically

22
Q

in what population do you usually see lentigo maligna melanomas

A

elderly patients, they also tend to have features of sun damage

23
Q

what do lentigo maligna melanomas arise from

A

long standing lesions from lentigo melanomas

24
Q

where do acral lentiginous melanomas tend to grow

A

extremities - palms/soles of feet

25
Q

whats acral lentiginous melanomas relationship with sun exposure

A

not thought to be related

26
Q

how does nodular melanoma grow

A

no horizontal spread, purely vertical spread

27
Q

how does nodular melanoma look

A

round, uniformly black, dome-shaped, well-demarcated border, occasional ulceration

28
Q

whats the differential for benign and malignant pigmented lesions

A 
seborrheic wart 
pigmented BCC
dermatofibroma
pyogenic granuloma 
atypical mole
29
Q

whats the 5-year survival depending on Breslow thickness

A

5-year survival using Breslow thickness:

in situ - 100%
<1mm - 95%
1-3mm - 70%
>3mm - <40%

30
Q

whats the management for malignant melanoma

A

wide local excision - using 1-2cm peripheral margin
lymph node excision for regional metastases
no specific treatment for distant metastases

31
Q

whats the best advice for reducing sun exposure

A

high factor SPF (for UVB) AND high star rating (UVA)
Wear hat/covering clothes
avoid sun at midday

Dermatology (12 decks)

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