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Oral Pathology #2 > Melanocytic Lesions > Flashcards

Melanocytic Lesions Flashcards

1
Q

dermatologic term for freckles

A

ephelis

*gives a hint that this person is more suceptible to UV damage

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2
Q

How do ephilies come about ?

A

harmless lesions that appear upon exposure to sunlight

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3
Q

common harmless melanocytic lesions that appear on sun-exposed skin, usually on the face and dorsum of the hands

A

actinic lentigines

*also called age spots or liver spots

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4
Q

completely macular and often multiple and unlike freckles, these dont wax and wane with sun exposure

A

actinic lentigines

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5
Q

common, harmless lesion taht may be seen either on the LIP or INTRAORALLY.
-tan to dark brown , uniformly pigmented, demarcated margins

A

melonotic macule

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6
Q

is there a change with sun exposure with melanotic macule?

A

no

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7
Q

what could the presence of a melanotic macule represent?

A

post-traumatic melanosis

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8
Q

what is the histo of maleanotic macules?

A
  • no evidence of nevus cells or clustering of melanocytes

- inc amount of melanin pigment in the basal layer or within melanophages in the superficial connective tissue

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9
Q

what is the tx for melanotic macules on the vermillion zone?

A

excised for cosmetic purposes and tissue submitteed for microscopic purposes

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10
Q

what is the tx for melanic macules on intraoral sites

A

excised to rule out early melanoma

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11
Q

path term for a mole

A

acquired melanocytic nevus

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12
Q

probably the most common of all human “tumors”

A

acquired melanocytic nevus

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13
Q

how many acquired melanocytic nevi does an average caucasians have?

A

20

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14
Q

when do acquired melanocytic nevi develop?

A

first year of life through the forth decade

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15
Q

where do acquired melanocytic nevi develop?

A

head and neck region and often involute (regress) with aging

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16
Q

what type of acquired melanocytic nevi are the first stage?

A

junctional (appear flat and usually are dark in color)

the other stages are compound and intradermal

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17
Q

where does a compound (stage 2) nevus come from?

A

evolves from a junctional nevus as the patient grows older

  • proliferation of nevus occurs with some of the nevus cells “dropping off” into the superficial connective tissue
  • may see elevation and hair
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18
Q

where do intradermal nevi (stage 3) come from?

A

proliferate to the extent that they are completely contained within the dermal connective tissue
-elevated with a variable degree of pigmentation (many are normal skin colored)

-migrate deeper into the skin

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19
Q

actinic nevi larger than _____ are reason for concern

A

6mm

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20
Q

actinic melanocytic nevus are ususally where in the oral cavity

A
  • infrequently in oral cavity

- located on hard palate or attached gingiva but any site can be affected

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21
Q

what is the tx for acquired melanocytic nevi?

A
  • no tx indicated unless chronically irritated, an esthetic concern or changes in size or color
  • risk of transformation to malignancy is very low (1 in 3,000)
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22
Q

type of melanocytic nevus is present at birth in 1% of newborns

A

congenital melanocytic nevi

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23
Q

what are the size categories for congenital melanocytic nevi?

A

small is less than 15 mm

large is greater than 15 mm

24
Q

do congential melanocytic nevi have hair?

A

yes

25
Q

what is a large congenital nevus also called?

A

garment nevus or bathing trunk nevus

-due to the extensive involvement of the patients skin

26
Q

what is the risk of malignant transformation for congenital melanocytic nevi?

A

low (1%) for small nevi

2-3% for large nevi

27
Q

what is the tx for congential melanocytic nevus?

A
  • close clinical follow up
  • staged excision for large
  • excision for small
28
Q

type of nevus that may affect an cutaneous or mucosal site, inclue oral or conjunctival mucosa
-appear bluish or blue-grey due to the depth of the melanin pigment

A

blue nevus

29
Q

why do blue nevi appear blue?

A

tyndall effect (depth of the melanin pigment)

30
Q

when do blue nevi usually appear?

A

forth decade of life

31
Q

how big are blue nevi?

A

less than 1 cm

32
Q

what is the histology of a blue nevus?

A
  • collection of dendritic melanocytes within the sonnective tissue
  • typically the liesional cells contain abundant melanin pigment
  • no melanic atypia should be seen
33
Q

what is the tx of blue nevus?

A
  • simple excision
  • excellent px
  • recurrence is rare
  • malignant ransformation is rare
34
Q

malignancy of melanocytic differentiation

A

melanoma

35
Q

how common is melanoma

A

3rd most common skin cancer

36
Q

melanoma is what percent of skin cancers?

A

5%

BUT

it is 75% of deaths due to skin cancer (very deadly)

37
Q

are males or females more likely to get melanomas?

A

females under age 40
males over age 40

overall, slight male predominance

38
Q

what re the risk factors of melanoma?

A
  • fair skinned pt, 40-70 years of age
  • history of blistering sun burn early in life
  • indoor occupation, outdoor recreation
  • family history of melanoma
  • personal history of melanoma
  • high risk locations (BANS) [back, arms, neck, scalp]
39
Q

what are the melanoma ABCDE’s?

A 
asymmetry
border irregularity
color variegation
diatmeter greater than 6mm (size of pencil eraser)
evolving - enlarging or changing color
40
Q

what are the growth phases of melanoma?

A

radial - spreads laterally

vertical - extends deeper into the connective tissue

41
Q

what is the precursor of melanoma?

A

lentigo maligna (hutchinson’s freckel)

42
Q

what are the 4 types of melanomas?

A
  • lentigo maligna melanoma
  • superficial spreading melanoma
  • nodular melanoma
  • acral lentiginous melanoma
43
Q

essentially melanoma in a purely radial growth phase “melanoma insitu”
-affects older ppl with fair complexion

A

lentigo maligna

44
Q

where does lentigo maligna usually occur?

A

facial skin

-large macular lesion with irregular borders and uneven pigmentation

45
Q

what % of melanomas are lentigo melanomas?

A

5%

46
Q

when do lentigo melanomas occur?

A

15 years before the vertical growth phase

-nodularity in previously flat lentigo maligna signals vertical growth phase

47
Q

most common (70%) melanoma that occurs in the interscapular area in men and back of the legs in women (15-20% in head and neck region)

A

superficial spreading melanoma

48
Q

what do superficial spreading melanomas begin as?

A

macule or plaque

49
Q

type of melanoma that appears as rapidly growing nodule that almost immediately in the vertical growth phase

  • little if any radial growth phase
  • usually deeply pigmented (may be amelanotic and therefore resembles pyogenic granuloma)
A

nodular melanoma

50
Q

what % of melanomas are nodular melanomas?

A

15%

51
Q

type of melanoma that affects palms, soles, and oral mucosa.

-most common clinicopathologic type of melanoma in persons of color

A

acral lentiginous melanoma

52
Q

what % of melanomas are acral lentiginous melanomas

A

8%

53
Q

what does acral lentiginous melanomas begin as?

A

darkly pigmented macule with irregular borders

-mucosal melanoma is more aggressive than cutaneous melanoma

54
Q

what is ORAL acral lentiginous melanoma?

A
  • male predilection
  • 5th - 7th decade
  • 70-80% are found on the hard palate or max alveolar mucosa
  • pain is uncommon unless it is ulcerated
55
Q

what is the tx of melanoma?

A
  • surgical excision
  • chemo, radiation, immunotherapy have little impact on the disease
  • developments in genotype-directed and immunotherapy have led to prolonged survival

-MOST OF TX IS BASED ON SIZE (remove what you can see plus a border beyond that) (1cm margins)

56
Q

what does the px of melanomas depend on?

A

DEPTH OF INVASION!

  • .75mm - 96% 10ys
  • .76 - 1.69mm - 89% 10ys
  • 1.7 - 3.59mm - 67% 10ys
  • over 3.6mm - 26% 10ys
57
Q

what is the px for ORAL melanoma?

A

POOR
-10-25% 5ys

may be due to difficulty in achieving wide surgical margins and early metastisis

Oral Pathology #2 (4 decks)

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