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Introduction Flashcards

1
Q

Sensitivity of naked-eye examination for melanoma detection (dermatologists)

A

65-80%

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2
Q

Overall benefit of dermoscopy in melanoma Dx

A

Dermoscopy improves diagnostic accuracy by 10–27%

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3
Q

Advantages of dermoscopy

A
  • significantly improves the in vivo diagnostic accuracy of melanoma
  • can differentiate most lesions of the skin from melanoma
  • reduces unneeded biopsies
  • Basic instrumentation is affordable
  • easy to use
  • noninvasive technique that allows microscopic visualization of subsurface skin structures not visible to the naked eye
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4
Q

Which are the qualities of a good test?

A
  • Accuracy
  • No adverse effects
  • target disorder dangerous if left untreated
  • effective treatment if diagnosed early
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5
Q

How Can Dermoscopy Help?

A
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6
Q

Primary difference of dermoscopy vs naked-eye skin examination

A
  • visualize structures below the level of the stratum corneum to the depth of the superficial dermis
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7
Q

Why can’t we observe with naked-eye the morphological structures that are located below the stratum corneum?

A
  • Because the refractive index of the stratum corneum is higher than that of air, much of the incident light is reflected off the surface of the skin
  • this diffuse backscattered light overwhelms the retina, and thereby obscures the visualizing of light that is reflected from the deeper layers of the skin
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8
Q

Rationale in using liquid interface in non-polarized dermoscopy(NPD)

A
  • Because there is a closer match of refractive indices within the skin–liquid–glass inter- face, light reflection is decreased, thereby minimizing glare, which in turn makes the stratum corneum appear more translucent
  • This optical setup per- mits the observer to see deeper structures in the skin
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9
Q

Best immersion liquid for dermoscopy?

A

70% alcohol

  • it yielded fewer air bubbles & provided clearer images
  • reduces bacterial contamination
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10
Q

Best immersion liquid for nail dermoscopy & why?

A

US or antibacterial gels

  • gel’s viscosity prevents it from rolling off the convex nail surface.
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11
Q

How to minimize air bubbles in the gel used in dermoscopy?

A
  • store the gel bottles upside down
  • avoid shaking the bottle
  • squeeze out a small amount of the gel before use so as to discard remnant dried gel
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12
Q

What will be the result if we use NPD without a liquid interface?

A
  • The user will simply see a magnified clinical (not dermoscopic) image of the lesion
  • no dermoscopic structures will be discernable
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13
Q

Main technique of polarized dermoscopes

A

Cross-polarization

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14
Q

Main advantages of cross-polarized system

A
  • the 2 polarizers allow the dermoscope to preferentially capture the backscattered light from the deeper layers of the skin
  • eliminates the necessity of a liquid interface
  • does not require direct contact with the skin
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15
Q

Blood vessels & pink color are evident in PD or NPD, why?

A

PD (doesn’t require skin contact)

  • pressure applied from the NPD scope against the skin can compress small blood vessels in a lesion, making it difficult to visualize them
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16
Q

Blue-white color (due to orthokeratosis), Milia-like cyst, Regression are more conspicuous under PD or NPD?

A

NPD

The PD instrument displays the melanin pigment with varying and darker shades of brown and blue compared with NPD

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17
Q

Some of the differences btw the images of PD & NPD are owed to?

A

Contact vs non-contract dermoscopy

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18
Q

Schematic representation of optical properties of light without the use of dermoscopy

A
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19
Q

Schematic representation of optical proper- ties of light during the use of contact NPD with a liquid interface

A
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20
Q

Relative differences btw NPD & PD

A
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21
Q

Schematic representation of optical properties of light during the use of polarized dermoscopy

A
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22
Q

Colors in dermoscopy depend on?

A

Location of melanin in the skin

Melanin is the main chromophore in pigmented skin lesions

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23
Q

Important determinants of the lesion color

A
  • Melanin, the main chromophore in pigmented skin lesions (black to blue colors)
  • Hemoglobin, in RBCs (pink to red colors)
  • Collagen fibers in the dermis ( white color)
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24
Q

If melanin is located in the stratum corneum or immediately beneath it, the lesion would appear ___ on dermoscopy

A

Black

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25
Q

Melanin at the dermoepidermal junction (DEJ) would be perceived as ____, depending on its density

A

light brown to dark brown

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26
Q

Melanin in the dermis results in __?

A

shades of blue to gray

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27
Q

Colors in dermoscopy depending on the location of melanin in the skin

A
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28
Q

The stratum corneum, devoid of blood and melanin, appears ___?

A

Yellow

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29
Q

Areas with sebaceous differentiation can manifest__?

A

yellow hue

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30
Q

Blood vessels and vascular volume are responsible for __?

A

Red and pink hues

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31
Q

White color is due to __?

A

Depigmentation

fibrosis

alterations in the collagen matrix

keratin within cysts

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32
Q

Color of the lesion depending on the location of melanin

stratum corneum

vs

DEJ

vs

papillary dermis

vs

deeper dermis

A

Black (stratum corneum)

–

Brown (DEJ)

–

Gray (papillary dermis)

–

Blue (deeper dermis)

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33
Q

Jet-black color is usually due to?

A

congealed blood

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34
Q

Orange hues are usually due to?

A

serum present in erosions or superficial ulcerations

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35
Q

Basic colors in dermoscopy and anatomic background

A
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36
Q

Define pigment network (reticulation)

A

Grid-like or honeycomb pattern consisting of intersecting pigmented “lines” and hypopig- mented “holes”

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37
Q

Histopathologic correlation of pigment network

A

Melanin in keratinocytes and/or melanocytes along the epidermal rete ridges

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38
Q

What does presence of pigment network mean?

Name the exceptions

A

Presence of a network, indicates with few exceptions that the lesion is of melanocytic origin

Dermatofibroma, accessory nipple, lentigo

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39
Q

Typical vs atypical pigment network

A
  • Typical: regularly meshed, composed of lines relatively uniform in width, homogeneous in color, lines become gradually thinner & fainter in pigmentation at the periphery.

Ass/w nevi (especially junctional)

  • Atypical: irregularly meshed with lines that vary in width and degree of pigmentation, “holes” that are heterogeneous in area and shape, network often ends abruptly at the periphery

Ass/w melanoma,dysplastic nevi

40
Q

Typical or atypical pigment network(pn)?

A

Typical pn

regular homogenous honeycomb-like pigment network thinning out at the periphery

41
Q

Histopathological section of a typical or atypical pigment network(comment)?

A

Typical pn

There is more pigment per unit area overlying the rete ridge and this results in the dermoscopic observation of network lines. There is less pigment per unit area over- lying the supra-papillary plate and this corresponds to the dermoscopic holes in the network

42
Q

Define pseudonetwork

A

In facial lesions, diffuse pigmentation is interrupted by nonpigmented adnexal openings, giving the appearance of a network

43
Q

Define the type of pigment network seen in this nevus

A

Pseudonetwork

Pigment in the epidermis or dermis interrupted by follicular and adnexal openings on the face

44
Q

Define structureless areas

A

Areas with a size >= 10% of the lesion’s surface area that are devoid of any discernible structures, such as globules, network, or regression structures (i.e., scars, peppering, granularity, or blue-white veil over flat areas)

Usually hypopigmented compared with the surrounding lesion, but not in comparison to the surrounding normal skin.

45
Q

Focal structureless area within a lesion

vs

focal tan to light brown structureless areas at the periphery of melanocytic lesion

A

Common finding in benign nevi

vs

ass/w melanoma

46
Q

Histopathologic correlation of structureless areas

A

Flattening of the rete ridge pattern and/or decrease in concentration of eumelanin +/- presence of pagetoid cells

It may also simply be due to a loss of contrast between the holes and lines of the network

47
Q

Type of pigment network, structureless area?

A

Typical regular pn (periphery)

Central structureless area

Black dots upper part of lesion (arrows)

Dx: Compound nevus

48
Q

Describe pn, structureless area in this lesion

A

Central atypical pn

Light brown structureless area periphery

Dx: Thin Melanoma

49
Q

Define blotches

A

Dark brown to black, usually homogenous areas of pigment( >10% of lesion area) that obscures the ability to visualize underlying structures

  • In nevi: homogenous, located towards the center
  • In melanoma: heterogeneous, multiple hues, located off center
50
Q

Describe the principal dermoscopic structure in this lesion

A

Dark central hyper-pigmentation area (blotch) that is obscuring the ability to visualize any underlying structures

51
Q

Define dots

A

Small, round structures of <0.1 mm in dm that:

  • have a red color when corresponding to blood vessels
  • when due to melanin, their color ranges from black, brown, to blue-gray depending on the depth and concentration of the melanin in the skin (Tyndall effect)
52
Q

Dots in nevi vs melanoma

A
  • Nevi: located toward the center of the lesion, +/- overlie network lines
  • Melanoma: not associated with the network, located toward the periphery
53
Q

Define peppering or granularity or blue-white veil over flat (macular) areas

A

Tiny, blue-gray granules

sign of regression, can be seen in melanocytic & nonmelanocytic lesions

  • In nevi: the area of regression usually encompasses <10% of the surface area of the lesion
  • In melanoma: >50% of the surface area
54
Q

Define globules

A

Round to oval structures that may be brown, black, blue-gray, or red with dm >0.1 mm

  • Nests of melanocytes in the dermis
  • Presence of aggregated globules >3 =>melanocytic origin of lesion
  • In nevi: tend to be symmetrical, of similar size, shape, and color
  • In melanoma: randomly distributed, different shape,size, color
55
Q

Major dermoscopic finding in this lesion?

A

Globular pattern

globules display different sizes, shapes and colors, including browns, black, and blue-gray

Dx: Spitz nevus

56
Q

Major dermoscopic finding in this lesion?

A

Globular pattern

globules correspond to nevomelanocytic nests in the dermis

57
Q

Define streaks (pseudopods, radial streaming)

A

Radially arranged, linear projections of dark pigment (brown to black) at the periphery of the lesion that eminate from the tumor and radiate towards normal skin

  • Spitz: streaks are arranged circumferentially around the entire perimeter
  • Melanoma: located focally at the perimeter
58
Q

Major dermoscopic finding in this lesion?

A

Multiple pseudopods at the periphery

Dx: SSM

59
Q

Major dermoscopic finding in this lesion?

A

radial streaming (arrows) in the upper right portion of the lesion

Dx: SSM

60
Q

Define negative pigment network

(aka reverse/inverse network)

A

Serpiginous interconnecting hypopigmented lines that surround irregularly shaped brown structures that resemble elongated and curvilinear globular structures

  • Indicates melanocytic origin of lesion
  • Ass/w: Spitz nevi, melanoma
61
Q

Major dermoscopic findings in this lesion?

(left vs right side)

A

reticular architecture on the left side

negative pigment network on the right side

62
Q

Major dermoscopic finding in this lesion?

A

homogenous architecture in the center

pseudopods distributed symmetrically along its entire perimeter

[Pseudopods (streaks) have a stalk that directly connects to the main tumor body]

Dx: Reed nevus

63
Q

Major dermoscopic finding in this lesion?

A

peripheral rim of globules

globules are not directly connected to the lesion

Dx: Dysplastic nevus

64
Q

Define chrysalis/crystalline

A

White shiny linear streaks that are seen ONLY with polarized dermoscopy

Ass/w: scars, dermatofibromas, BCCs, lichen-planus like keratosis

In melanocytic lesions DD btw: melanoma & Spitz nevi

65
Q

Major dermoscopic findings in this lesion?

A

Multiple chrysalis-like structures (PD) especially in the upper left area

Blue-white veil (regression)

66
Q

Major dermoscopic finding in this lesion?

A

Chrysalis-like structures

Dx: Melanoma

67
Q

Define regression structures

A

White, scar-like depigmentation

often combined with or adjacent to blue-gray areas or peppering

DD: Melanoma (!!!), Lichen planus - like keratosis, Nevi

68
Q

Define blue-white veil over palpable/raised areas

A

Irregular, confluent blue pigmentation with an overlying white “ground glass” haze

  • DDx:
  1. Melanoma: Heterogeneous, prominent, asymmetrically shaped
  2. Blue nevi: covers the entire lesion
  3. Seborrheic Keratosis
  4. pBCC
69
Q

Major dermoscopic finding in this lesion?

A

homogenous blue-white veil

encompassing the ENTIRE surface area of the lesion

Dx: Blue nevus

70
Q

Define vascular structures

A

Pink hue (milky red areas) and isolated blood vessels with varying morphologies

  • May be due to ^ vascular volume (vascular blush) or neoangiogenesis
71
Q

Define milia-like cysts

A

Round whitish or yellowish structures that shine brightly

(like “stars in the sky”) under NP

Sometimes are pigmented & resemble globules

Ass/w: SKs(mainly), melanoma/nevi

72
Q

Major dermoscopic finding in this lesion?

A

multiple milia-like cysts,

comedo-like openings and some fissures

Dx: SK

73
Q

Define comedo-like openings

A

“Blackhead”-like plugs on the surface of the lesion

  • Ass/w: SKs, nevi
74
Q

Define ridges & fissures

A

Cerebriform surface resulting in gyri (ridges) and sulci (fissures)

  • Ass/w: SKs
75
Q

Major dermoscopic finding in this lesion?

A

multiple gyri and sulci creating a brain-like appearance

Dx: SK

76
Q

Define fingerprint-like structures

A

Thin light brown lines that do not interconnect to form a meshwork pattern

Feature of lentigo or early seborrheic keratosis

77
Q

Major dermoscopic finding in this lesion?

A

multiple parallel lines resembling finger-prints (dotted area)

and a moth-eaten border (arrows) at the periphery

Dx: SK

78
Q

Define moth-eaten border

A

Concave invaginations of the lesion border

Feature associated with a solar lentigo

79
Q

Define leaf-like areas

A

Brown to gray-blue discrete bulbous structures that often create shapes that resembles a leaf

Highly specific for BCC

80
Q

Define spoke-wheel-like structures

A

Well-circumscribed brown to gray-blue-brown radial projections meeting at a darker brown central hub

Highly specific for BCC

81
Q

Major dermoscopic finding in this lesion?

A

multiple spoke- wheel-like structures

Dx: pBCC

82
Q

Major dermoscopic finding in this lesion?

A

leaf-like areas

Dx: pBCC

83
Q

Define large blue-gray ovoid nests

A

Large, well-circumscribed areas, larger than globules

In the absence of a network are ^ specific for BCC

84
Q

Major dermoscopic finding in this lesion?

A

Multiple blue-gray ovoid nests

Dx: pBCC

85
Q

Define multiple blue-gray non-aggregated globules

A

Round well-circumscribed structures that resemble small ovoid nests

In the absence of a pigment network it suggests: BCC

86
Q

Major dermoscopic finding in this lesion?

A

multiple blue- gray globules.

Dx: BCC

87
Q

Define lacunae

A

Red, maroon, or black lagoons

Seen in angiomas and angiokeratomas

88
Q

Major dermoscopic finding in this lesion?

A

blue black lacunae

Dx: Angiokeratoma

89
Q

Major dermoscopic finding in this lesion?

A

multiple well- demarcated lacunae

Dx: Angioma

90
Q

Histopathologic correlation of

globules

vs

streaks

A
  • Nests of melanocytes in the dermis
  • Confluent junctional nests of melanocytes
91
Q

Histopathologic correlation of

Dots

vs

Peppering

A
  • Aggregates of melanocytes or melanin granules
  1. Black – Upper epidermis , stratum corneum
  2. Brown – DEJ or spinous layer
  3. Gray – Papillary dermis
  • Melanin deposited as intracellular (mostly within melanophages) or extracellular particles in the upper dermis
92
Q

Histopathologic correlation of

pigment network

vs

pseudonetwork

A
  • Melanin in keratinocytes and/or melanocytes along the epidermal rete ridges

vs

  • Pigment in the epidermis or dermis interrupted by follicular and adnexal openings on the face
93
Q

Histopathologic correlation of

structureless areas

vs

regression structures

A
  • Flattening of the rete ridge pattern and/or decrease in concentration of eumelanin with/without the presence of pagetoid cells.

vs

  • Scar-like changes: thickened fibrotic papillary dermis, sparse lymphocytic infiltrates, and variable numbers of melanophages
94
Q

Histopathologic correlation of

milia-like structures

vs

chrysalis/crystaline

A
  • Intraepidermal keratin cysts

vs

  • increased or altered collagen in the superficial dermis (fibrosis)
95
Q

Histopathologic correlation of

comedo-like openings

vs

fingerprint-like structures

A
  • Concave clefts in the surface of the epidermis, often filled with keratin

vs

  • thin, elongated epidermal ridges
96
Q

Histopathologic correlation of

lacunae

vs

vascular structures

A

Dilated vascular spaces

vs

Dilated blood vessels in the papillary dermis

97
Q

Histopathologic correlation of

negative pigmented network

vs

ridge and fissures

A
  • thin elongated rete ridges that are accompanied by large melanocytic nests within widened papillary dermis.

vs

  • Wedge-shaped clefts of the surface of the epidermis often filled with keratin

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