Chapter 122 Benign Neoplasias and Hyperplasias of Melanocytes Flashcards
The term _________ is used to describe the presence of melanocytic cells in epidermal nests [defined as_________________ in direct contact (also known as _____)], within the dermis, or in other tissues
melanocytic neoplasia
three or more melanocytic cells
thèque
The term _____________ is used to indicate increased melanocytes confined to the basal layer of the epidermis
melanocytic hyperplasia
The vast majority of CNNs noted at ____ are small and singular, and no __________
According to other studies, the prevalence of CNN appears to be slightly higher in ______________
birth
gender predilection
nonwhites compared to whites
CNNs:
This is presumably due to a mutation (_____) that occurs in a progenitor cell that results in the abnormal extensive accumulation of ______ along migration pathways during normal development.
CNNs in Eyelids:
it may be presumed that the nevomelanocytes migrated into this location sometime during or after eyelid fusion but before the eyelids split which is ______
often NRAS
melanocytic cells
before 24 weeks / 6th uterine month
CNN:
rare relatively large nevomelanocytic nevi (____ cm) that appear for the first time__________, according to parental observations and corroborated by photographs (__________)
disproportionate growth, especially _____mos, or change in a nonuniform manner is of concern for possible _______
> 1.5 cm
between 1 month and 2 years of life
tardive congenital nevi
after 6 months
melanoma
CNN:
Lesions attaining a diameter of _______ are likely to be congenital, atypical melanocytic nevi, or melanoma
Arbitrary size criteria have also considered small (___cm), medium (____cm), and large (____cm)
Giant –> defined as a lesion ___________ if it occurs on the head and neck (and twice that area for other anatomic sites), ______ or ________ in adults (or smaller if it involves a major anatomic area)
1.5 cm or more
<1.5
1.5–19.9
≥20
as large as the patient’s palm
30% of the body surface, or 900 cm2
CNN:
Dermoscopy may reveal a _____ or _____ pattern and may be useful in the identification of small foci of _______
CNNs of the head, neck, or posterior midline, and/or the presence of multiple satellite lesions associated with large CNN may be complicated by underlying _______________
reticular pattern or globular/cobblestone
melanoma
cranial and/or spinal leptomeningeal melanocytosis
CNN:
Tumors indistinguishable from _______________________ may develop in association with giant varieties of CNN
Malignant degeneration of large CNNs may be
associated with the relatively sudden appearance of ____________________
neurofibroma in the absence of von Recklinghausen neurofibromatosis
a dermal or subcutaneous nodule, very dark pigmentation, itching, pain, bleeding, or ulceration
CNNs are characterized by the presence of nevomelanocytes in the epidermis as______________ and/or nevomelanocytes in the dermis, which are present as ____________________
Nevomelanocytic type CNN:
CNNs are more likely than acquired nevi to have nevomelanocytes in the_________________ and to be associated with_______________ structures
well-ordered thèques
sheets, nests, cords, and/ or single cells
lower two-thirds of the reticular dermis
appendageal and neurovascular
neuroid type of giant CNN:
melanocytic elements take on the appearance of____________________ (lames foliacée), a palisaded arrangement of cells around a cellular mass of homogeneous material (_________), and sheathing of nerves by neuroid tissue (neuroid tubes)
spindle cell &/or epithelioid cell type of giant CNN:
may have atypical cellular and architectural features, making differentiation from _________ extremely difficult
blue (dermal melanocytic) type of giant CNN:
heavily pigmented ___________ or intermixed with nevomelanocytes in the reticular dermis or deeper tissues. There may be some biologic overlap with___________ and __________
Wagner–Meissner corpuscles
Verocay body
melanoma
spindle-shaped melanocytic cells alone
nevus of Ito/Ota and Mongolian spot
CNN:
The cumulative 5-year risk has been calculated to be ________% in patients with congenital nevi that involve ______ of the body surface
Melanoma may develop in large CNNs at any time, but the diagnosis of melanoma was established in the ________ in approximately one-half of published cases in which patients ultimately developed melanoma in association with giant CNN
2.3% and 5.7
over 5%
first 3–5 years of life
CNN:
excision of large CNNs should be considered as early as possible, but it is probably prudent to wait until____________ to reduce surgical and anesthetic risks
Unlike surgical excision,_____________ do not address the malignant potential of CNN; nevomelanocytes may still be left behind in the dermis, and the cosmetic results associated with destructive therapy are unpredictable.
after the first 6 months of life
dermabrasion and other modes of destructive therapy
Nevus spilus:
More commonly, the lesion becomes evident during ________________
The tan macular background pigmentation ranges from _____in diameter. Although nevus spilus may occur anywhere, lesions have been noted primarily on the ____________.
infancy or early childhood
less than 1 cm to greater than 10 cm
torso and extremities
Nevus spilus:
The tan background pigmentation usually consists of increased numbers of melanocytes in a _______________ pattern
nevus spilus lesions are presumed to ___________, although it is possible that some elements within the nevus spilus or even the entire nevus spilus itself could regress with time
lentiginous epidermal
persist throughout life
majority of common acquired nevi appear to develop during the_________ decades of life, although some lesions may appear in the first 3–6 months of life
Acquired nevi may be attacked by the patient’s immune system, resulting in the development of a _______
second and third
halo nevus
common acquired nevi :
the _____ mutation that is present in the majority of common acquired (including atypical) nevi appears to be polyclonal
In these patients (eruptive nevi), there is the abrupt appearance of numerous similar appearing nevi often in the setting of________ or _______
B-RAF
immunosuppression or chemotherapy
common acquired nevi :
growing lesion in an older adult has a greater risk of being ______
Spontaneous and concurrent development of scattered nevomelanocytic nevi often similar in appearance has been termed _________
melanoma
eruptive nevi
common acquired nevi :
halo nevus may be associated with acquired and CNN as well as with_____________ and ________
melanoma and nonmelanocytic tumors
common acquired nevi:
More elevated and less pigmented lesions tend to have a prominent_________ nevus component, whereas flatter and darker lesions have a more prominent__________ or _______ component and a less prominent dermal component
intradermal
junctional melanocytic or nevomelanocytic
common acquired nevi:
(Dermoscopy) In general, these lesions reveal a ______ or _______ pattern. On the palms or soles, a parallel-furrow, _____ or ____ pattern may be present. Nonuniform patterns and parallel-ridge patterns are worrisome for _______
(halo nevus)
Any nevus in any anatomic site may be involved, but the _________ is involved most commonly. Lesions are usually asymptomatic.
reticular or globular
lattice, or fibrillar
melanoma
posterior torso
common acquired nevi:
A second process that may provide some insight into factors involved in melanocytic interactions with the immune system is a process that results in the development of an eczematous dermatitis presenting as a red halo around nevi (_____, ______)
For patients with eruptive nevi, there may be findings suggestive of a _________ or _____. For patients with halo nevi, the most common associated condition is _____, occurring in 18% to 26% of patients
halo dermatitis, Meyerson’s nevus
blistering disease or immunosuppression.
vitiligo
common acquired nevi:
Epidermal nevomelanocytes are arranged in ______ surrounded by a smooth perimeter of epidermis, and the epidermis is separated from nevomelanocytes by a _____________
Melanin-laden macrophages are usually apparent in the ________________ of nevi, their number usually proportional to degree of melanin production
nests
retraction artifact
superficial papillary dermis
common acquired nevi:
Intradermal nevi that have few or no junctional nests frequently have a __________ relatively free of nevomelanocytes just below the epidermis
Nevomelanocytes in the deep dermis may be disposed within a collagenous framework that is loose, pale, and wavy in formations called ________, similar to a neurofibroma
grenz zone
neuroid tubes
common acquired nevi:
balloon cell nevus ->In addition to clear cells with single basophilic nuclei, ______ and ________ are seen frequently.
Most ____________ are found in association with a benign compound nevus (acquired or congenital)
multinucleated balloon cells and multinucleated giant cells
combined blue nevi
common acquired nevi:
_____________ (pseudomelanoma) is the name given to recurrent lesions after incomplete removal of a benign nevomelanocytic nevus
________ and _________, present occasionally in nevi, also may be related to degeneration or regression
Recurrent melanocytic nevus
Psammoma bodies and amyloid bodies
common acquired nevi:
Shrinkage clefts may resemble _____ or ______, prominent in the _________ and particularly in areas with hemorrhage
______ and ______ in dermal (deeper) cells may help confirm a benign diagnosis
lymphatics or vascular spaces
midportion of nevi
Low Ki67 activity and loss of HMB45
common acquired nevi:
acquired nevi evolve through a life cycle, first becoming apparent after _____ in the vast majority of cases, peaking in number during the second and third decades of life, and then disappearing by the_________________
infanc
seventh to ninth decades
common acquired nevi:
______, ______ and _______ may occur more frequently in individuals with halo nevi
______ nevi -> link the initiating event to a blistering skin disease, systemic immunosuppression, chemotherapy, or treatment with “biologics.”
Atypical nevi, melanoma, and vitiligo
eruptive
common acquired nevi:
Complete removal of nevi is best accomplished by _____.
Sensible UVR exposure includes confining outdoor activities to the early morning or late afternoon/evening, and avoiding the most intense UVR fluence occurring _______________
excision
2 hours either side of high noon.
Blue nevi:
Multiple blue nevi may be associated with ____, ______, and mucocutaneous myxomas
A specific mutation in the ______ has been identified in blue nevi
lentigines, cardiac myxoma
[Carney complex/LAMB syndrome (lentigines, atrial myxomas, mucocutaneous myxomas, and blue nevi)]
GNAQ gene
Blue nevi:
Nevus of Ota and Ito may share similar underlying defects to blue nevi and are also often acquired (in early childhood, _____________) but are far more extensive, encompassing a portion of _____ (_______) and _____ (_____ and ____)nerve distributions, respectively.
often before age 1 year or around puberty
trigeminal (ophthalmic and maxillary)
brachial (posterior supraclavicular and lateral cutaneous)
Blue nevi:
The blue–gray color of blue nevi is an optical effect of blue light backscatter from the skin over the dermal melanin (_________)
half the reported cases present on the dorsa of ______
The large plaque blue nevus (pilar neurocristic hamartoma) may occasionally be associated with a background of ___________
Tyndall effect
hands and feet
lentigo simplex
Blue nevi:
Deep penetrating nevi are darkly pigmented, blue–black papules or nodules, mostly on the _____________________, 2–9 mm in diameter, and occurring predominantly in the first four decades of life, including childhood
Cellular blue nevus differs from the common blue nevus in that it is usually larger, more elevated, more ______ and occasionally associated with _____________.” Complicating the picture is the fact that ______ may develop in a cellular blue nevus
head and neck or upper extremities
aggressive locally
lymph node “benign metastasis
melanoma
Blue nevi:
In common blue nevi, dermal melanocytes appear as_____________ grouped in irregular bundles admixed with melanin-containing macrophages, associated with ______________ in the middle or upper reticular dermis,
Pathology of the plaque-like blue nevus (pilar neurocristic hamartoma) reveals a peripilar grouped arrangement of mostly____________, patterns of a common blue nevus and dermal melanocytosis (Mongolian spot), and presence of abnormal (granular) melanosomes
melanin-containing fibroblast- like cells
excessive fibrous tissue
spindle cells containing varying amounts of melanin
Blue nevi:
Epithelioid blue nevi have been reported in association with ________ or in isolation
A major complication of blue nevi is the potential risk of _____. This risk appears to be highest for ______ blue nevi.
cardiac myxoma
melanoma
cellular
Blue nevi:
Sudden appearance of a blue nodule, ______ of a preexisting blue nodule, a ________ blue nodule, or a relatively large blue nodule or plaque greater than _____ in diameter should be considered for histopathologic examination
expansion
congenital
10 mm
PIGMENTED SPINDLE CELL NEVUS:
There is a preference for the lower extremity especially the ____, with the _____ being the next most common site
lesions are uniformly dark, with a sharp interface with surrounding skin often exhibiting streaks/pseudopods and giving the lesion a _____________
thigh
back
**Female patients outnumber male patients
starburst appearance
PIGMENTED SPINDLE CELL NEVUS:
PSCN consists of vertically oriented fascicles of spindle-shaped, pigment-producing _________; some pagetoid upward migration may be present, but the lesion can be distinguished from melanoma by uniform _____, uniform _________, and distinctive pattern of growth.
these lesions should be excised with ________ margins of normal skin
melanocytes
nuclei
cellular detail
3–5 mm
Spitz nevus:
Amplifications of _____ and _____ and activating mutations of _____ have been noted in a subset of Spitz nevi
duration of solitary Spitz nevus before presentation is usually less than ________
chromosome 11p and H-RAS
H-RAS
9 months
Spitz nevus:
most common variety of Spitz nevus is solitary, ____, ____, ____, firm, and dome-shaped
__________ often occur in the early years of life within a background of congenital (sometimes acquired) macular pigmentation (_______) or occasionally within a hypopigmented plaque.
asymptomatic, pink or red, hairless,
Agminated Spitz nevi
nevus spilus
Spitz nevus:
Unlike ordinary nevi and melanomas, melanocytic cells in Spitz nevi are ____ - ________ ________, with prominent mononuclear or multinucleated giant cells in the epidermis and/or dermis
Coalescent eosinophilic globules (______), periodic acid-Schiff-______ and diastase-______ (resembling colloid bodies), have been reported in 60% of Spitz nevi
large—often twice the size of epidermal basal keratinocytes
Kamino bodies
positive
resistant
Spitz nevus:
Based on patients with eruptive Spitz nevi, it is clear that ___________ can occur
Complete excision with a ________ clear margin of normal skin is generally sufficient treatment for Spitz nevi
spontaneous regression
3–5 mm
Nodal nevi:
Nevomelanocytes can be identified in lymph nodes with a frequency ranging from________% in lymphadenectomies not related to melanoma and up to 22% in regional nodes removed because of melanoma
The first theory is that during development, nevomelanocytes _______ in developing nodal tissues
The second theory suggests that there may be _______ from the cutaneous lesion to the lymph node
0.3% to 7.3%
get trapped
passive transfer
Nodal nevi:
Lack of proliferative markers _____ and possibly high levels of _____ immunohisto- chemical markers support a benign diagnosis
(Ki67)
p16
Lentigo simplex:
The increased density of melanocytes in lentigines is presumably due to an underlying developmental or intrinsic defect in _________
Lentigo simplex may appear as ___________ and may occur anywhere on skin or mucous membranes
melanocyte homeostasis
early as the first decade
Lentigo simplex:
__________ may occur as an isolated phenomenon without known familial aggregation and first appear at birth, during infancy, or during adulthood.
Generalized lentigines
Lentigo simplex: In Moynahan (LEOPARD) syndrome, lentigines occur on \_\_\_\_\_\_\_ and \_\_\_\_\_\_\_\_ , including genitalia, conjunctiva, oral mucosa, palms, and soles.
In Peutz–Jeghers syndrome, lentigines are almost always present on the _________
both sun-exposed and sun-protected sites
oral mucosa.
Lentigo simplex:
Lentigines in the myxoma syndrome (LAMB) occur mainly on the ____ and _____ as tan to black macules
Lentigines in Laugier– Hunziker pigmentation occur on the__________________, on fingertips and nail matrix
face and genitalia
buccal and labial mucosa of the mouth
Lentigo simplex:
_________________ may be required to differentiate agminated lentigines from nevus spilus
____, ____ and ____ histochemistry may be useful to demonstrate increased number of melanocytes confined to the basal layer and lacking junctional nest formation
Wood’s lamp examination
Mart-1, Mel-5, and DOPA
Lentigo simplex:
Cosmetic removal may be achieved with
_____ or other destructive approaches such as ________.
cryotherapy
Q-switched laser
**There is a theoretical risk of malignant transformation of any variety of melanocytic hyperplasia or dysplasia using any type of laser
Solar lentigo:
they are present in 90% of white people over ______ of age
Lentigines may be induced by photochemotherapy [psoralen and UVA light (PUVA) lentigo], occurring in 40% to 50% of patients an average of _______ after starting therapy,
60 years
5.7 years
Solar lentigo:
Lesions similar in gross and microscopic appearance to solar lentigo, _________, may occur in children and young adults.
They may appear within the first ______ of life, tend to aggregate in families,
freckle (ephelis)
5 years
Solar lentigo:
Single exposures of experimental UVB radiation (_____ mm) that is _______ times the minimal erythema dose induces “freckling” in susceptible individuals
Phototoxic doses of PUVA may lead to the development of lentigines ____ months later
320
six to ten
6–8
Solar lentigo:
In xeroderma pigmentosum (XP), in which patients have an increased sensitivity to UVR, hyperpigmented macules develop on light-exposed skin within the first ______ of life, and these lesions demonstrate hyperplasia of variably atypical epidermal melanocytes (i.e., __________)
5 years
atypical lentigines
Solar lentigo:
When examined by dermoscopy, solar lentigines reveal a uniform ________
Freckles are common on the _____ and often first noted in _______, presumably developing after significant sun exposure and are said to__________ when sun exposure is discontinued
reticular network
central face
early childhood
fade or even disappear
Solar lentigo:
The presence of solar lentigines is a risk factor for ____, ____, _____
Solar lentigines reveal elongated epidermal _______ with club-shaped or bud- like extensions, frequent branching and fusing of rete ridges, a thinned or ________ between rete ridges, and increased numbers of _________ without nesting.
melanoma, basal cell cancer, and squamous cell cancer
rete ridges
atrophic epidermis
epidermal melanocytes
Solar lentigo:
Electron microscopy -> Compared with melanocytes in sun-protected skin, melanocytes in solar lentigo reveal increased activity manifested by marked _______ (suggesting increased _____ activity),
DOPA reactivity
tyrosinase
Solar lentigo:
Pathologic features of PUVA-induced lentigo include increased numbers of melanocytes in elongated ________, with large________
melanosomes in keratinocytes of PUVA lentigines are often______ instead of ________ as in solar lentigines
epidermal rete ridges
cell bodies
large and single
small and compound
Solar lentigo:
____ and ___ histochemical studies may be useful to demonstrate increased number of melanocytes confined to the______ and a lack of __________ formation
Mart-1 and DOPA
basal layer
junctional nest
Solar lentigo:
PUVA lentigines may persist ______ or longer after therapy is discontinued
_______ or other superficial destructive techniques (such as ________) may be an option if the lesion is clearly benign, but lesions may recur after therapy
1–2 years
Cryotherapy
Q-switched laser
Solar lentigo:
______ supplementation needs to be considered for patients practicing UVR protection and avoidance
Vitamin D
