Exam 2- Blue, Brown, Gray, and Black Lesions Flashcards
What is the most common location of physiologic pigmentation?
Attached gingiva most common location
Can be seen anywhere (even tips of fungiform papillae on dorsal tongue)
T/F Physiologic pigmentation falls into the developmental category. It is defined by an increase in production of melanin by melanocytes
(Normal Number of Melanocytes).
True
How do you diagnose and tx physiologic pigmentation?
Established clinically because a biopsy is not conclusive without clinical correlation
No tx
Name the Pathology: Oral and Perioral freckles that first present during childhood and adolescence.
Lips and Cheeks
Skin and mucosal freckles.
Multiple gastrointestinal hamartomatous polyps
Peutz-Jeghers Syndrome
What category does Peutz-Jeghers Syndrome fall into?
Developmental
T/F Hamartomatous polyps have the same risk of transformation to colorectal cancer as adenomatous polyps.
False
Peutz-Jeghers Syndrome increases the risk of malignancies for _______, _________, ________, and _______.
GI, Pancreas, Breast, Ovarian
T/F Peutz-Jeghers Syndrome is an autosomal dominant disease.
True
How would you diagnose and tx Peutz-Jeghers Syndrome?
Family history
Genetic Testing
Oral/perioral biopsy not supportive
Oral and perioral pigmentation persists throughout life and does not require tx.
Lifelong monitor for development of neoplasia.
What category does amalgam tattoo fall under?
Injury
Note the differential would be Neoplasm
Describe an amalgam tattoo appearance
Black, blue, or gray
Macule
Gingiva, alveolar mucosa, and buccal mucosa most common
How do you diagnose an amalgam tattoo?
Radiograph - may appear as a dense radiopacity
Biopsy- it must be distinguished from melanocytic neoplasia
If can’t
Don’t get confused with Intentional Tattoos
No tx necessary
What is the etiology of smokers melanosis?
Increase in production of melanin, normal number of melanocytes, protective response against noxious chemical in tobacco smoke
T/F Men are affected with a higher frequency of smoker melanosis.
False - females
Give the clinical presentation of smoker melanosis.
Anterior facial mandibular gingiva most common
Multiple brown macules
How do you diagnose smokers melanosis?
Correlate clinical presentation with smoking history and medical history
Biopsy if any doubt
Biopsy not diagnostic for smokers melanosis, but can rule out neoplasia.
T/F Pigmentation Associated with smoker melanosis can disappear after smoking cessation
True
_________ __________ pigmentation is different for different medications. Some chelate with ______ or ________ and deposit in _____ _____. Some stimulate __________ to produce melanin.
Drug related pigmentation is different for different medications. Some chelate with iron or melanin and deposit in lamina propria. Some stimulate melanocytes to produce melanin.
What are the medications known to cause drug related pigmentation?
(Mighty Ants Try Climbing Every Hill)
Minocycline
Antimalarials (chloroquine, hydroxychloroquine, quinidine, quinacrine)
Tranquilizers (chlorpromazine)
Chemotherapeutic agents (imatinib)
Estrogen
AIDS medications (zidovudine/AZT)
What are the 4 antimalarials?
chloroquine, hydroxychloroquine, quinidine, quinacrine
What is the tranquilizer talked about for drug related pgimentation?
Chlorpromazine
What is the AIDS medication talked about for drug related pigmentation?
zidovudine/AZT
What is the clinical presentation for drug related pigmentation?
Diffuse, painless, symmetric, bluish-gray macular pigmentation of the hard palate
T/F You must do a biopsy to rule out neoplasia for drug related pigmentation.
False there is no tx
First correlate between initiation of the drug and onset of the pigmentation. Go through medications. Second do a biopsy if there are suggestions of neoplasia.
T/F Drug related pigmentation is an injury.
True
Name the lesion:
increase in melanin and sometimes the number of melanocytes.
Melanotic macule
What are melanotic macule demographics?
2:1 Female predilection
Average age of 42 years old
What is the clinical presentation of melanotic macule?
Solitary, uniformly tan to dark brown
Most common on lower lip
How do you diagnose and tx a melanotic macule?
BIOPSY
- Especially if recent onset, recent enlargement, large size, irregular pigmentation, and unknown duration
- Usually say melanotic macule is less than 6mm if larger DEF biopsy
No tx
Melanocytic nevus is also called a ______.
mole
Name the lesion:
Benign localized proliferation of nevus (melanocytic) cells derived from the neural crest.
Melanocytic Nevus (mole)
What are melanocytic nevus derived from?
neural crest
What’s an average amount of melanocytic nevus to have?
10-40 cutaneous per white adult
Clinical Presentation of melanocytic nevus.
Uncommon intraorally, more common on skin. If intraoral can happen anywhere in the mouth .
Junctional nevus
Compound nevus
Intradermal/intramucosal nevus
Match the correct nevus with the description:
- Brown/black macule
- Brown/tan papule
- Brown/tan papule with papillomatous surface (hair may grow from the center)
- Junctional nevus
- Compound nevus
- Intradermal/intramucosal nevus
How to diagnose and tx melanocytic nevus?
If the nevus is > 6mm def biopsy. If cutaneous use clinical judgment. Always biopsy intraoral nevus.
Monitor for signs of change.
T/F A large percentage of Melanocytic Nevus (“mole”) progress to melanoma.
FALSE only small percentage
Name the lesion: Benign proliferation of dendritic melanocytes usually within CT
Blue Nevus
What type of cells proliferate for a blue nevus?
Dendritic melanocytes usually within CT
What are the demographics of a blue nevus?
Female predilection
Usually in children/ young adults
Clinical presentation of a blue nevus
Macular or dome-shaped, blue or blue-black lesion.
Smaller than _____.
Any cutaneous or mucosal site.
_______ is most common oral location
Macular or dome-shaped, blue or blue-black lesion.
Smaller than 1cm
Any cutaneous or mucosal site
Palate is most common oral location
T/F A blue nevus can be at any cutaneous or mucosal site.
True
How to diagnose and tx a blue nevus?
Biopsy (definitive) and surgical excsion.
T/F There is not tx for a blue nevus.
False- surgical excision a small percentage can progress to melanoma along with melanocytic nevus
Name that lesion:
Malignancy of melanocytic cells
Melanoma
What are the 4 risk factors for melanoma.
- Acute sun damage
- Fair complexion (blonde hair, blue eyes)
- Family history
- Multiple molar, freckling, dysplastic nevi
What are the demographics for melanoma?
5th-7th decade of life
Male predilection
Melanoma
_____% are head and neck
_____% are extremities
<____% are intraoral
25% head and neck
40% extremities
<1% intraoral
What are the most common sites of melanoma even though less than 1% occurs intraorally?
Hard palate and gingiva
Remember the ABCDEs of melanoma.
Asymmetry
Borders irregular
Color variegation
Diameter - greater than 6mm
Evolving
How do you tx melanoma?
Wide surgical excision
Radiation
Immunotherapy
Oral mucosal melanoma has worse prognosis than cutaneous melanoma (<20% 5 year survival)
What is an important prognostic factor for melanoma?
The depth of the invasion
T/F Oral mucosal melanoma has worse prognosis than cutaneous melanoma (<20% 5 year survival).
True
What is the 5 year survival rate for oral mucosal melanoma?
<20%
What category does addisons disease fall under?
Metabolic
Addison disease (adrenal insufficiency)
Increased _____ by anterior pituitary but decreased production of ________ and ____________. Problem with the adrenal gland.
The byproduct is increased production of ______ but don’t know the reason why.
Increased ACTH by anterior pituitary but decreased production of cortisol and mineralocorticoids. Problem with the adrenal gland.
The byproduct is increased production of melanin but don’t know the reason why.
Adrenocortical insufficiency can be secondary to: (5 things)
- Autoimmune adrenalitis
- TB
- Sarcoidosis
- Adrenal hemorrhage
- Metastatic cancer
Name the pathology:
Generalized hyperpigmentation of the skin (bronzing)
Diffuse or patchy, brown, macular pigmentations of the oral mucosa
Systemic symptoms
Weakness, weight loss, irritability, depression, nausea, vomiting, hypotension
Addison Disease (Adrenal Insufficiency)
T/F One of Addison Disease (Adrenal Insufficiency) systemic symptoms may be hypertension.
False hypotension
Systemic symptoms
Weakness, weight loss, irritability, depression, nausea, vomiting, hypotension
How do you diagnose Addisons Disease?
____________ (increase/decrease) serum cortisol
____________ (increase/decrease) plasma ACTH levels
Decrease; Increase
How do you tx Addison’s Disease?
Steroid replacement therapy
Tx of underlying tension
T/F Drug related pigmentation is painful.
False it’s not painful
Where is a melanotic macule most commonly found?
The lower lip
