Exam 2-Pigmented Lesions

Question 1

We are focusing on pigmented lesions that are secondary to melanin production… It is important clinically to determine whether lesions are _______ or ________.

Answer 1

isolated or generalized

Question 2

Nevi (common mole) - nevus cells migrate form _______ to skin and occasionally mucous membranes

Answer 2

neural crest

Question 3

What type of nevus? present at birth, about 1% of newborns, larger (“garmet nevus”)

Answer 3

congenital

Question 4

The average person with congenital nevi has about ____ of them..

Answer 4

15

Question 5

______ nevus: flat macule, nevus cell in basal epithelium at “junction” of epithelium and connective tissue

Answer 5

junctional nevus

Question 6

A junctional nevus is a the junction of what?

Answer 6

basal epi and conn tiss

Question 7

Which Nevus type? nodule ± hair, nevus cells in dermis or lamina propria

Answer 7

intradermal nevus

Question 8

What type of Nevus? nodule, combination of junctional and intradermal

Answer 8

Compound Nevus

Question 9

What type of Nevus? dendritic nevus cells deep within connective tissue

Answer 9

BLUE NEVUS

Question 10

What is a reactive proliferation of intraepithelial dendritic melanocytes?

Answer 10

Melano-A-canthoma

Question 11

Which race is affected most and where in the body with a Melano-A-canthoma?

Answer 11

Blacks…cheeks (they go away with removal of the irritant)

Question 12

What is a localized overproduction of melanin, not an increase in number of cells?

Answer 12

an EPHELIS (a freckle)

Question 13

What activates the formation of an ephelis?

Answer 13

sun exposure

Question 14

What are “age spots”, “liver spots” from chronic UV damage - Are these seen intraorally??

Answer 14

Actinic or senile LENTIGO?

Question 15

senile lentigo (liver spots) are present in WHAT % of elderly?

Answer 15

90%!!

Question 16

_______ macule: tan to brown flat macule, like a big freckle but not sun related

Answer 16

Melanotic macule

Question 17

Melanotic macule affect males or females more?

Answer 17

females 2:1

Question 18

Where is the most common location for Melanotic macule?

Answer 18

lower lip (33%)

Question 19

Please rank the frequency of the 3 most common skin cancers?

Answer 19

1.basal cell carcinoma 2.Squamous Cell Carcinoma 3.Malignant Melanoma

Question 20

likelihood of a Caucasian today developing melanoma during their lifetime is

Answer 20

less than 1 in 100

Question 21

Sites of Malignant Melanoma: _____% H&N, ____% extremities,

Answer 21

25% H&N, 40% extremities,

Question 22

Interesting!! Acute sun damage (burns, blistering) probably more important than chronic exposure in the development of _________

Answer 22

malignant melanoma

Question 23

What are the ABCD’s of malignant melanoma?

Answer 23

Asymmetry, Borders, Color, Diameter

Question 24

What is the magic diameter for red flagging a malignant melanoma?

Answer 24

larger than 6mm

Question 25

___-___% of melanomas have radial growth phase

Answer 25

75-80%

Question 26

About 70% of cutaneous melanomas are ________ spreading melanoma…they are more likely found in the ______ area, but do have a ____% of being Head and Neck

Answer 26

superficial…trunk…28%

Question 27

Which type of melanoma? 15% of cutaneous melanomas…30% in H&N…Very short or non-existent radial growth..Produce exophytic, pigmented nodules but rarely no pigment (amelanotic)

Answer 27

Nodular melanoma

Question 28

Which melanoma? 5-10% of cutaneous melanomas ↑↑ age, on sun exposed areas of face extremely long radial growth phase (lentigo maligna/Hutchinson’s freckle) which may last 15-20 years ultimately develops nodules/vertical growth

Answer 28

LENTigo maligna melanoma

Question 29

small subset affecting palms, soles, subungual and mucous membranes = _________

Answer 29

acral lentigoinous melanoma

Question 30

_____ melanoma: Most have radial growth (>50%) and many similar to acral lentiginous melanoma WHERE ARE THE MOST COMMON LOCATIONS???

Answer 30

Oral…palate and maxillary gingiva!!

Question 31

Treatment of Melanoma: Excision (resection) with minimum of ___cm margin along with dentinal ________ dissection, and lastly adjunctive ___________, radiation and immunotherapy

Answer 31

1cm…lymph node… chemotherapy

Question 32

WHAT IS THE MOST IMPORTANT FACTOR for determining survival form malignant melanoma?

Answer 32

DEPTH OF THE INVASION

Question 33

Overall survival for malignant melanoma is ___% for 10 years

Answer 33

79%

Question 34

Oral melanomas much WORSE prognosis,

Answer 34

20%

Question 35

Multifocal Pigmentation can be caused by drugs. What type of drug most commonly causes it?

Answer 35

antimalarials

Question 36

Multifocal Pigmentation-Which disease??? Adrenocortical insufficiency triggers hypothalamus to stimulate anterior pituitary to produce ACTH

Answer 36

Addison’s disease

Question 37

Multifocal Pigmentation: Which syndrome?? Autosomal dominant skin and mucosal freckles, intestinal polyps (small bowel) (very low rate of malignant…degeneration but will produce symptoms of obstruction)….oral & perioral freckles, ↑ lips and cheeks

Answer 37

Peutz-Jeghers Syndrome

Question 38

Multifocal Pigmentation: Any condition characterized by WHAT TYPE OF spots?

Answer 38

cafe au lait

Question 39

Where is the most likely location for smoker’s meanosis? Secondary?

Answer 39

palate, gingiva