malignant Flashcards
MC melanoma, 30-40s, upperback MandW, legs in women, HALLMARK IS HAPHAZARD COMBO OF MANY COLORS, nodules appear when lesion is greater than 2.5 cm? dx
superficial spreading melanoma
at 2.5 cm marks the beginning of the vertical phse and the end of radial growth. then it gets ulceration and scaling and plaquelike elevation
fried egg appearnace
what are the 3 of 5 things needed to diagnose dysplastic nevus?
diamter >5mm
ill defined borders
irregular margin
varying shades in lesion
presence of popular + macular components
what does a becker’s nevus not contain?
nevus cells
often confused w/ malignant melanoma on extermities and dorsum of hands, but delvops in early chilhood and remains unchanged? dx trx
blue nevus
removal
treatment for large congenital melanocytic nevus?
removal still has high incidence of malignant melanoma
when might a halo nevus occur?
w/o trigger or after sunburn: auto-immune
patient presents w/ patchof hair and brown macule on shoulder. they have ipsilateral breast or limp hypoplasia, scoliosis, and spina bifida occulta. DX trx
becker’s nevus syndrome
hair shaved, laser treatment for hair or pigmentation
malignant melanoma MC wehre for men and women
back: men
arms and legs: women
what is the most imporant histological determination of malignant melanoma?
breslow depth
treatment for halo nevus
nothing in teens, but excise if parents want or atypia suspected
adults: wood’s lamp: look for vitiligo, bx if suspect malignant melanoma
treament for medium congenital melanocytic nevi (1.5-20cm)?
remove after puberty
what is seen on biopsy of melanocytic nevus (mole)?
nest of nevus cells, coarse granules, no dendrites, in dermo-epidermal jxn
what is the tyndall effect and what is it associated w?
the tyndall effect is brown pigment absorbs the longer wavelengths of light and scatter’s blue light
mongolian spots
pt. has short stature, gonadal dysgenesis, web neck, cubitus valgus and lymphedema at birht, DX and what lesion might they have?
turner’s
halo nevus
treatment for small (<1.5 cm) congenital melanocytic nevi? (grows w/ child)
leave alone and observe
what greatly increases risk of malignant melanoma?
- personal hx, fam hx, >76-100 moles
- previous nonmelanoma skin cancer
- congenital nevus (>20 cm)
- hx of melanoma
- immunosuprresion
what is the treatment for nevus spilus?
nothing the malignant potential is rare
treatment for mongoloian spots?
nothing, but make sure that to annotate
treament for melancytic nevus (mole)?
>100 follow at 6-12 months,
ABCDE
biopsy if suspect
what is treatment for a dysplastic nevus?
excisional bx
pt education on self exam and sun: use hairdryer
baseline pics. w/ follow up 6-12 mos
screen family members
refer to ophthalmoligc exams
MC spot for becker’s nevus?
unilateral upper back, shoulder, upper arm, submammary
where is a halo nevus never located?
palms or soles
what melanoma has lateral growht phase and is typically in older patients 60-70s. on face MC, slow growht, and has complex pattern of brown to black macular pigmentation and blue-black nodules?
lentigo maligna melanoma
what melanoma is commonly misdiagnosed? looks like a blood blister, ulcerates and bleeds and has rapid growth. MC found in 40-60y/o males? only vertical gowth no radial growth
nodular melanoma
patient presents w/ discoloration in the eye. it’s an asian female. You know that is blue and black pigmentation in the 1st and 2nd branch of the trigeminal nerve. dx. trx
nevus of ota
laser to lighten
monitor for glaucoma
moderately increased risk of malignant melanoma?
atypical nevi w/ no fam hx
- nevi 51-100, 26-50
- chronic tanning w/ UVA or PUVA for psoriasis
what is the ABCDEF for DPP?
age
brown or black band
change
digit
extension onto cuticle or where hang nail might develop
fam or persona hx of unusual moles
when should you be worried about a congenital melanocytic nevi?
>= 5% bsa, >20 cm
ALL NEVUS CELLS IN DERMIS, dome shaped MC, but can be verrucous, pedunculated, sessile, has hair, common in adults.
dermal melanocytic nevus
melanocytic nevus that is flat or slightly elevated. <.5-.8 cm. light brown to black and uniform. located in the epidermis and epidermis-dermal jxn. may develop into compound. MC in chilhood?
junctional nevi
what is the other name for spitz nevus?
benign juvenile melanoma
what is the most important prognostic factor in lesins >1mm thick?
systemic lymph node involvement
what is the management for malignant melanoma
excisoinal bx
punch bx
NO SHAVE
f/up: self exam
f/u: 3-4 months for 1 year, then q 6 mos therafter
may have white periphery, halo nevus. slightly elevated to dome shaped w/ nest into the upper dermis. Hairy or non hairy.
compound nevus
brown, black macule on lower lip mc in young women. NO CHANGE w/ sun exposure. dx trx
labial melanotic macule
cryotherapy or laser if desired
what is the other name for nevus spilus?
speckled lentiginous nevus
MC in adolescence at birth or early infancy. hairless oval or irregular shaped brown macule, w/ dotted darker spots?
nevus spilus, speckled lentiginous nevus
what is the ugly duckling method
one is darkier and larger than the others
one is small, but lack pigement
one lesion on the back. check for changes
what is the treatment for spitz nevus that MC occurs SUDDENLY in children on the head, neck, and lower extremities? dx trx
spitz nevus
biopsy
what melanoma is on the palms, sole, terminal phalanges and mucou membranes. has a tendency to remin flat? and has hutchinson sign (under nail plate)? dx prognosis?
acral lentiginous
very poor prognosis
MC DPP
moderate incresae risk for MM?
repeated blistering sunburns 2/3
freckling
fair skin/inability to tan
red or blond hair
atypical nevus
acute risk is more risk than recurrent exposure
where does most MM arise?
areas covered by clothing
other names for dysplastic (atypical) nevus?
clark nevi
