Dermoscopy of atypical lesions Flashcards
Name the possible clinical characteristics in an ‘atypical’ or ‘dysplastic’ naevi. How many are required to make it dysplastic/atypical.
Diameter >5 mm
Ill-defined borders
Irregular margin
Varying shades in the lesion
Papular and macular components
*3 clinical characteristics are required.
1-What are the best clues to indicate hystological atypia in dysplastic/atypical naevis?
2- What are the 6 possible structures in atypical naevi?
3-What morphological feature also indicates atypical naevus?
1-Clues appear to be related to structural features and pigment distribution. Frequently a patient with multiple atypical naevi has a predominance of one type.
2-Reticular
Globular
Homogeneous
Reticular/homogeneous
Globular/homogeneous
Reticular/globular
NB: Presence of all three types of structure is very suggestive of melanoma. It has also been shown that naevi showing complex dermoscopic pattern are more prevalent in patients who develop melanoma, i.e., naevi in which there are network, globules +/- structureless areas.
3-Combined macular and papular components are common features of atypical naevi.
Name the lesion and the structural pattern:
Atypical naevi
Globular & Reticular pattern
Name the lesion and the structural pattern:
Atypical naevi
Globular & Homogenous pattern
Name the lesion and the structural pattern:
Atypical naevi
Globular & Homogenous pattern
Name the lesion and the structural pattern:
Atypical naevi
Reticular & Homogenous pattern
Name the lesion and the structural pattern:
Atypical naevi
Reticular & Homogenous pattern
Name the lesion and the structural pattern:
Atypical naevi
Homogenous pattern
Name the lesion and the structural pattern:
Atypical naevi
Globular pattern
Name the lesion and the structural pattern:
Atypical naevi
Reticular pattern
Explain the distribution types of pigmentation (6):
1-Uniform
2-Central hypopigmented annular type
3-Eccentric hypopigmented type
4-Central hyperpigmented type (darker skin types)
5-Eccentric hyperpigmented type (‘Bolognia naevus’)
6-Multifocal hyper-/hypopigmented type
Name this naevi and describe it’s distribution of pigmentation:
Atypical naevi
Asymmetrical pigmentation
Name this naevi and describe it’s distribution of pigmentation:
Atypical naevi
Multifocal pigmentation
Name this naevi and describe it’s distribution of pigmentation:
Atypical naevi
Multifocal pigmentation
Name this naevi and describe it’s distribution of pigmentation:
Atypical naevi
Eccentric Hyerpigmentation
Name this naevi and describe it’s distribution of pigmentation:
Atypical naevi
Eccentric Hyerpigmentation
Name this naevi and describe it’s distribution of pigmentation:
Atypical naevi
Central Hyerpigmentation
Name this naevi and describe it’s distribution of pigmentation:
Atypical naevi
Uniform Hypopigmentation
Name this naevi and describe it’s distribution of pigmentation:
Atypical naevi
Central Hypopigmentation
Describe the terms Compound naevus and Combined naevus:
- Compound naevus is a benign melanocytic naevus in which melanocytes are found in both the epidermis and dermis.
- Combined naevus is used when the dermal component is a deeply pigmented blue naevus.
Apart from pattern structures and pigment distribution, what are 3 other dermatological features which may indicate atypical naevi?
1-Dermoscopic regression structures (white scar-like areas and grey peppering)
2-Irregular vascular pattern
3-Grey-blue areas
Name this lesion and the prominent feature indicating it’s name?
Atypical naevus, due to grey-blue areas
Name this lesion and the prominent feature indicating it’s name?
Atypical naevus, due to areas of regression
Name this lesion and the prominent feature indicating it’s name?
Atypical naevus, due to the presence of irregular vascular pattern
Name this lesion and the prominent feature indicating it’s name?
Atypical naevus, due to the presence of grey peppering (can indicate regression)
Describe a Spitz Naevi and the several dermatological patterns that have been associated with it.
Spitz naevi present as evolving lesions and tend to be pink (classic) or black (pigmented or Reed type). They often arise in children and eventually involute. They may be clinically, dermoscopically and histologically difficult to distinguish from melanoma.
*Dermoscopic patterns described for Spitz naevi include:
Globular: central grey or bluish pigment surrounded by large peripheral globules
Starburst: central grey or bluish pigment surrounded by radiating peripheral streaks or globules
Reticular: superficial dark network
Homogeneous
Atypical: irregular blotches, globules and streaks
Describe some changes seen in benign moles that are unrelated to malignancy:
- Naevi with peripheral globules may frequently be observed to expand and lose their globules over a period of months.
- Uniform darkening in colour may be observed after sun exposure.
- Naevi may darken during pregnancy.
- The number of milia-like cysts in dermal naevi may vary.
- Naevi fade and disappear slowly in many adults, particularly after the age of 50.
- Trauma may result in inflammation, scabbing and crusting, which resolves within a few weeks.
- Naevi may recur if inadequately excised e.g. by shave biopsy.
Describe the changes seen in this melanocytic naevi and whether you think a biopsy is required.
Naevi with peripheral globules may frequently be observed to expand and lose their globules over a period of months.
Naevi fade and disappear slowly in many adults, particularly after the age of 50.
-Biopsy not required.
Describe the changes seen in this melanocytic naevi and whether you think a biopsy is required.
Scab on a melanocytic naevi. Trauma may result in inflammation, scabbing and crusting, which resolves within a few weeks.
-Biopsy not required.
Describe the changes seen in this melanocytic naevi and whether you think a biopsy is required.
Repigmentation in a scar. Naevi may recur if inadequately excised e.g. by shave biopsy.
-Biopsy not required.
Describe the changes seen in this melanocytic naevi and whether you think a biopsy is required.
Uniform darkening in colour may be observed after sun exposure.
-Biopsy not required.
Describe the changes seen in this melanocytic naevi and whether you think a biopsy is required.
The number of milia-like cysts in dermal naevi may vary.
Naevi fade and disappear slowly in many adults, particularly after the age of 50.
-Biopsy not required.
Describe the changes seen in this melanocytic naevi and whether you think a biopsy is required.
Uniform darkening in colour may be observed after sun exposure.
Naevi may darken during pregnancy.
-Biopsy not required.
Describe the changes seen in this melanocytic naevi and whether you think a biopsy is required.
Changing s_hape, size or structure of flat atypical naevi_ are more worrying. About 10 to 15% of these will prove to be melanoma. If changes are mild, it may be reasonable to review the dermoscopy in 3 months.
There should be a low threshold for excision in changing atypical naevi that are elevated, because of rapid growth and relatively poor prognosis of nodular melanoma.
-Biopsy IS required.
Describe the changes seen in this melanocytic naevi and whether you think a biopsy is required.
Changing s_hape, size or structure of flat atypical naevi_ are more worrying. About 10 to 15% of these will prove to be melanoma. If changes are mild, it may be reasonable to review the dermoscopy in 3 months.
There should be a low threshold for excision in changing atypical naevi that are elevated, because of rapid growth and relatively poor prognosis of nodular melanoma.
-Biopsy IS required.
Describe the changes seen in this melanocytic naevi and whether you think a biopsy is required.
Changing s_hape, size or structure of flat atypical naevi_ are more worrying. About 10 to 15% of these will prove to be melanoma. If changes are mild, it may be reasonable to review the dermoscopy in 3 months.
There should be a low threshold for excision in changing atypical naevi that are elevated, because of rapid growth and relatively poor prognosis of nodular melanoma.
-Biopsy IS required.
Describe the changes seen in this melanocytic naevi and whether you think a biopsy is required.
Changing s_hape, size or structure of flat atypical naevi_ are more worrying. About 10 to 15% of these will prove to be melanoma. If changes are mild, it may be reasonable to review the dermoscopy in 3 months.
There should be a low threshold for excision in changing atypical naevi that are elevated, because of rapid growth and relatively poor prognosis of nodular melanoma.
-Biopsy IS required.
Describe the changes seen in this melanocytic naevi and whether you think a biopsy is required.
Naevi appears to fade and disappear slowly. This occurs in many adults, particularly after the age of 50.
-Biopsy not required.
