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Oral Pathology 1/2/16 > Lec 3: Pigmented Lesions > Flashcards

Lec 3: Pigmented Lesions Flashcards

1
Q

What gives lesions color?

A

Blood
melanin
foreign material

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2
Q

Pigmentation Caused By Blood (2)

A

Intrascular: blanches
Extravascular: does not blanch

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3
Q

Diascopy tests for

A

whether a lesion is vascular (inflammatory) or nonvascular (nevus) or hemorrhagic (petechia or purpura).

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4
Q

Hemangioma

A

Not present at birth
Tumor of infancy that has rapid growth and endothelial cell proliferation
Gradual involution

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5
Q

Venus malformation

A

Present at birth and persist through life

Anomalies of blood vessels without endothelial proliferation

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6
Q

Hemangioma treatment

A

Will regress on their own

Systemic corticosteroids may help reduce size

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7
Q

Venus malformation

A

Small lesion: no treatment

Large lesions: sclerosing agent and later resection

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8
Q

STURGE-WEBER ANGIOMATOSIS

A

Born with vascular malformation of face known as port wine stain
Non-hereditary

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9
Q

Leptomeningeal angioimas on ipsilateral cerebral cortex may cause

A

convulsive disorder or mental retardation

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10
Q

port wine stain + meningeal angiomas + seizures + mental retardation

A

STURGE-WEBER SYNDROME

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11
Q

PORT WINE STAIN (NEVUS FLAMMEUS):

A

vascular malformation seen in 0.3-1.0% of newborns

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12
Q

STRUGE-WEBER ANGIOMATOSIS treatment

A

Flashlamp pulsed dye laser can improve esthetics of facial/oral port wine nevi
Mental retardation/epilepsy may require neurosurgical treatment

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13
Q

varix is? common in? loss of what? blanch or non-blanch? common location? treatment?

A

Abnormally dilated and tortuous veins
Common in older adults
Loss of connective tissue tone supporting vessels
Usually blanch, but will not if thrombosis occurs
Common location: sublingual varix
Txt: none needed. May be removed for esthetics

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14
Q

Firm, nontender, blue-purple nodule describes a

A

varix

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15
Q

KAPOSI’S SARCOMA caused by? seen in? appears? occur on? treatment?

A

Vascular neoplasm
Caused by human herpesvirus 8 (HHV-8)
Seen in association with HIV
Painless blue-purple macules/plaques on surface of skin
Oral lesions generally occur on the palate
Treatment: Chemotherapy or Radiation therapy

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16
Q

SUBMUCOSAL HEMORRHAGE is a ? leads to? examples?

A 
Bruise from minor trauma
Leads to extravasated erythrocytes
PETECHIAE 
ECCHYMOSIS 
HEMATOMA
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17
Q

PETECHIAE

A

very small hemorrhages into skin, mucosa, serosa

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18
Q

ECCHYMOSIS

A

blood accumulation greater than 2 cm

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19
Q

HEMATOMA

A

accumulation produces a mass

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20
Q

Keratinocytes histology? most common in? function? amt of cytokeratins increase as?

A

are stratified squamous epithelial cells. Most common cell in epidermis. Function is to produce intermediate filaments called cytokeratins. Amount of cytokeratins increases as the cells move upward.

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21
Q

melanocytes produce

A

melanin

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22
Q

Langerhans cells are

A

antigen presenting

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23
Q

Merkel cells are

A

neuroendocrine cells involved in tactile sensation

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24
Q

Oral mucosa and skin contain __ distinct cell types in surface epithelium

A

4

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25
Q

Children Love Getting Sun Block

A 
Stratum Corneum
Stratum Lucidum
Stratum Granulosum
Stratum Spinosum
Stratum Basale
Dermis
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26
Q

Melanocytes synthesize ____ & inject it into _____

A

melanin; keratinocytes

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27
Q

Melanocytes synthesize melanin pigment in _____.

A

melanosomes

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28
Q

Is melanin more present in keratinocytes or melanocytes?

A

keratinocytes

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29
Q

Number of melanocytes per unit area of skin varies from one part of body to another but is independent of ___. Differences in skin color are due to differences in the _____ .

A

race; number of melanin granules in keratinocytes

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30
Q

Melanin granules accumulate above region of ____ ___to protect genetic material from damage by ____ radiation.

A

keratinocyte nuclei; ultraviolet

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31
Q

Ephelis

A

Freckle

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32
Q

Ephelis–present region of

A

increased melanin production

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33
Q

Ephelis receptor?

A

Melanocortin-1-receptor gene (MC1R)

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34
Q

Ephelis more pronounced after?

A

sun exposure

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35
Q

Oral Melanotic Macule-Brown, mucosal discoloration due to?

A

increased melanin production

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36
Q

Oral Melanotic Macule-shape?

A

FLAT = Not thickened or raised

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37
Q

Oral Melanotic Macule unlike epelis because

A

not related to sun exposure

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38
Q

Oral Melanotic Macule has potential for premalignant?

A

No premalignant potential

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39
Q

Hypermelanosis (in oral melanotic macule and freckle)

A

Hyperactivity of melanocytes

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40
Q

management: Oral Melanotic MaculeSmall unchanging ____ lesions _____ and with ____borders can be followed. Otherwise, biopsy.

A

nonthickened; uniform in color; regular

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41
Q

Melanoacanthoma–exclusive to? Often demonstrate? Management?

A

African Americans; Often demonstrate rapid growth; biopsy to rule out melanoma

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42
Q

ACQUIRED MELANOCYTIC NEVUS is proliferation of

A

nevus cells and melanocytes

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43
Q

nevus refers to

A

malformation of the skin and mucosa

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44
Q

3 types of nevus

A

junctional nevus
compound nevus
intramucosal nevus

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45
Q

Oral Melanocytic Nevus Managment

A

Oral nevus is considered premalignant & should be completely excised

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46
Q

Can melanoma always be distinguished from a nevus from a clinical basis?

A

NO

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47
Q

CONGENITAL MELANOCYTIC NEVUS: seen in __ of newborns

A

1%

48
Q

GIANT HAIRY NEVUS:

A

extensive hypertrichosis within congenital nevus.

49
Q

Giant hairy nevus when very prominent can be called (2)

A

bathing trunk nevus or garment nevus

50
Q

HALO NEVUS: halo is result of

A

nevus cells destruction by immune system

51
Q

BLUE NEVUS–Proliferation of melanocytes deep within the? Seen almost always in the?

A

CT; palate;

52
Q

Second most common nevus in the mouth?

A

Blue nevus

53
Q

MELANOMA OF SKIN–___ neoplasm?

A

malignant;

54
Q

Melanoma of the skin major causative factor?

A

Damage from UV radiation

55
Q

Melanoma of skin- is acute or chronic sun exposure of greater importance?

A

acute

56
Q

Melanoma of the skin-risk factors?

A

Fair complexion and light hair
Tendency to sunburn easily
Indoor occupation with outdoor recreational habits
Personal/family history of melanoma
History of dysplastic or congenital nevus

57
Q

Melanoma–On skin (90%), due to?

A

acute sun damage

58
Q

Most common skin cancers–1-3?

A

1# Basal Cell Carcinoma
2# Squamous Cell Carcinoma
3#Melanoma

59
Q

Where can melanoma occur?

A

anywhere

60
Q

Melanoma Growth Pattern (2)

A

Radial (horizontal) growth phase

Vertical growth phase

61
Q

Melanoma Radial Growth Phase- Melanoma cells are present along the epidermal-dermal junction and grow? can remain in this phase for? does melanoma metastasize during this time?

A

laterally; years; NO

62
Q

Melanoma Vertical Growth Phase–Melanoma cells grow? can cells metastasize?

A

downward into the dermis; YES

63
Q

Melanoma- Four clinicopathologic types exist:

A

Superficial spreading melanoma
Nodular melanoma
Lentigo maligna melanoma
Acral (mucosal) lentiginous melanoma

64
Q

The most common type of melanoma

A

Superficial Spreading Melanoma

65
Q

Superficial Spreading Melanoma can occur in what population?

A

young adults

66
Q

SUPERFICIAL SPREADING: ___ of cutaneous lesions

A

70%

67
Q

SUPERFICIAL SPREADING

A

Macule with variety of colors, may be slightly elevated. Interscapular area of males, back of legs of females

68
Q

Nodular Melanoma–appears? grows? exists in what growth phase?

A

Appears as a dome-shaped, darkly pigmented nodule.
Grows rapidly
Exists in the vertical growth phase from the beginning, thus tends to be deeply invasive.

69
Q

Nodular Melanoma-___% of skin melanomas, 1/3 of these in_____area. No radial growth phase. Usually deeply pigmented, but can sometimes be _____

A

15; head and neck; nonpigmented

70
Q

Lentigo Maligna Melanoma associated with?

A

chronic sun exposure

71
Q

Lentigo Maligna Melanoma occurs most commonly?

A

on the face of older adults

72
Q

-Lentigo Maligna Melanoma typically appears as one or more darkly pigmented nodules arising in a ____

A

solar lentigo

73
Q

The most slowly growing melanoma—may remain in the radial growth phase for years is?

A

Lentigo Maligna Melanoma

74
Q

Solar Lentigo Clinical Features–> 90% of ____? appearance? occurs on? pigmentation is? no change with exposure to?

A

Caucasians over 70 yo;
Brown (nonthickened) macule, larger than a freckle.
Occurs on chronically sun-exposed skin especially cheeks and dorsal surface of hands;
Pigmentation is constant; no change with exposure to UV light

75
Q

LENTIGO MALIGNA: ___% of cases. Develops from _____. Almost exclusive on? growth time?

A

5-10; precursor lesion; sun-exposed skin of fair-complexioned older adults; Very slow radial growth (15y).

76
Q

Acral Lentiginous Melanoma most common in?

A

African-Americans

77
Q

Melanomas of oral mucosa, palms, soles, nail beds.

A

Acral Lentiginous Melanoma

78
Q

Most common in blacks and orally. Develops on palms of the hands, soles of the feet, subungually, and mucous membranes

A

ACRAL (MUCOSAL) LENTIGINOUS

79
Q

Melanoma: Treatment?

A

Treatment is surgical excision.
Radiation therapy is of limited value.
Chemotherapy and immunotherapy are evolving.

80
Q

Melanoma: Prognosis?

A

The most important prognostic indicator is the histologic depth of invasion. Melanomas less than 0.75 mm thick have almost 100% 5-year survival.

81
Q 
Melanoma Survival, 10 years-Breslow Depth of Invasion
0.00 to 0.75mm?		   
0.76 to 1.69mm?		
1.70 to 3.59mm?      	
 > 3.59mm?
A

0.00 to 0.75mm 98%
0.76 to 1.69mm 89%
1.70 to 3.59mm 67%
> 3.59mm 43%

82
Q

Clark Method of Staging-Stage 1?

A

melanoma in situ (no invasion)

83
Q

Clark Method of Staging-Stage 2?

A

tumor in papillary dermis

84
Q

Clark Method of Staging-Stage 3?

A

tumor to junction papillary and reticular dermis

85
Q

Clark Method of Staging-Stage 4?

A

tumor in reticular dermis

86
Q

Clark Method of Staging-Stage 5?

A

tumor in subcutaneous tissue

87
Q

Clark level 1

A

96%

88
Q

Clark level 2

A

96%

89
Q

Clark level 3

A

90%

90
Q

Clark level 4

A

67%

91
Q

Clark level 5

A

26%

92
Q

Melanoma- Areas of poor prognosis:

A 
BANS
Interscapular area of the BACK
Posterior upper ARM
Posterior and lateral NECK
SCALP
93
Q

ORAL MELANOMA begins as?

A

Begins as brown-black macule

94
Q

Clinical Features of Melanoma

A 
ABCDE
Asymmetry 
Border irregularity
Color variation
Diameter greater than 6mm
Evolving
95
Q

Benign and malignant melanocytic lesions may be clinically______ in the oral cavity

A

indistiguishable

96
Q

The only certain method of excluding malignant melanoma is ______.

A

excisional biopsy

97
Q

Melanoma Survival Rates: Oral 5-year?

A

Oral

5-year: 13-22%

98
Q

PHYSIOLOGIC PIGMENTATION occurs due to

A

increased production of melanin

99
Q

Oral pigmentation is similar in intensity to

A

skin pigmentation

100
Q

Gastro-intestinal features where? Intestinal obstruction to due? GI malignancy percentage and age?

A 
Intestinal polyposis (not premalignant)
Intestinal obstruction due to intussusception
GI malignancy: 33% by age of 60
101
Q

Oral lesions seen in 90% of the patients found in? size? appearance?

A

Vermillion zone, labial/buccal mucosa, and tongue

1-4 mm blue-gray macules

102
Q

ADDISON’S DISEASE is brought on by?

A

Insufficient production of adrenal corticosteroid hormones (mineralcorticoids, cortisol)

103
Q

Destruction of the adrenal cortex or pituitary gland dysfunction

A

ADDISON’S DISEASE

104
Q

HOW DOES ADDISON’S CAUSE BRONIZING?

A

Increased adrenocorticotropic hormone (ACTH) stimulates melanocytes (primary, not secondary)

105
Q

HOW DOES SMOKING CAUSE PIGMENTATION OF THE ORAL SOFT TISSUES?

A

Stimulation of melanocyte activity by tobacco

106
Q

MELASMA aka

A

the mask of pregnancy

107
Q

Melasma appearance and location

A

Irregular, symmetric, brown macules on sun-exposed face and lips

108
Q

Melasma may also occur with use of

A

oral contraceptives

109
Q

Drug-Induced Pigmentation (6)

A

Anti-malarial drugs used for systemic lupus
Anti-psychotic: chlorpromazine, clozapine
Medications for AIDS: AZT
Tetracycline associated hairy tongue
Minocyclines (Minocin): discoloration of bone -> discoloration of oral mucosa; also teeth Chemotherapeutic drugs

110
Q

NEUROFIBROMATOSIS-clinical appearance? (4)

A

Multiple “café au lait” freckles
Axillary freckling
Multiple neurofibromas
Lisch nodules

111
Q

Café au Lait Spots similar lesions seen in

A

Polyostotic Fibrous dysplasia

112
Q

Heavy metal pigmentation due to what type of metal?

A

Arsenic, bismuth, platinum, lead, silver and mercury

113
Q

LEAD AND BISMUTH: blue-gray line along gingival margin. Lead =

A

Burton’s line

114
Q

ARGYRIA aka

A

chronic silver intoxication

115
Q

ARGYRIA appearance

A

diffuse greyish discoloration, especially in sun-exposed areas

X-men!!!

Oral Pathology 1/2/16 (11 decks)

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