Melanocytic Lesions

Question 1

dermatologic term for freckles

Answer 1

ephelis

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

Question 2

How do ephilies come about ?

Answer 2

harmless lesions that appear upon exposure to sunlight

Question 3

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

Answer 3

actinic lentigines

*also called age spots or liver spots

Question 4

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

Answer 4

actinic lentigines

Question 5

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

Answer 5

melonotic macule

Question 6

is there a change with sun exposure with melanotic macule?

Answer 6

no

Question 7

what could the presence of a melanotic macule represent?

Answer 7

post-traumatic melanosis

Question 8

what is the histo of maleanotic macules?

Answer 8

• 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

Question 9

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

Answer 9

excised for cosmetic purposes and tissue submitteed for microscopic purposes

Question 10

what is the tx for melanic macules on intraoral sites

Answer 10

excised to rule out early melanoma

Question 11

path term for a mole

Answer 11

acquired melanocytic nevus

Question 12

probably the most common of all human “tumors”

Answer 12

acquired melanocytic nevus

Question 13

how many acquired melanocytic nevi does an average caucasians have?

Answer 13

20

Question 14

when do acquired melanocytic nevi develop?

Answer 14

first year of life through the forth decade

Question 15

where do acquired melanocytic nevi develop?

Answer 15

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

Question 16

what type of acquired melanocytic nevi are the first stage?

Answer 16

junctional (appear flat and usually are dark in color)

the other stages are compound and intradermal

Question 17

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

Answer 17

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

Question 18

where do intradermal nevi (stage 3) come from?

Answer 18

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

Question 19

actinic nevi larger than _____ are reason for concern

Answer 19

6mm

Question 20

actinic melanocytic nevus are ususally where in the oral cavity

Answer 20

• infrequently in oral cavity

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

Question 21

what is the tx for acquired melanocytic nevi?

Answer 21

• 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)

Question 22

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

Answer 22

congenital melanocytic nevi

Question 23

what are the size categories for congenital melanocytic nevi?

Answer 23

small is less than 15 mm

large is greater than 15 mm

Question 24

do congential melanocytic nevi have hair?

Answer 24

yes

Question 25

what is a large congenital nevus also called?

Answer 25

garment nevus or bathing trunk nevus -due to the extensive involvement of the patients skin

Question 26

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

Answer 26

low (1%) for small nevi | 2-3% for large nevi

Question 27

what is the tx for congential melanocytic nevus?

Answer 27

- close clinical follow up - staged excision for large - excision for small

Question 28

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

Answer 28

blue nevus

Question 29

why do blue nevi appear blue?

Answer 29

tyndall effect (depth of the melanin pigment)

Question 30

when do blue nevi usually appear?

Answer 30

forth decade of life

Question 31

how big are blue nevi?

Answer 31

less than 1 cm

Question 32

what is the histology of a blue nevus?

Answer 32

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

Question 33

what is the tx of blue nevus?

Answer 33

- simple excision - excellent px - recurrence is rare - malignant ransformation is rare

Question 34

malignancy of melanocytic differentiation

Answer 34

melanoma

Question 35

how common is melanoma

Answer 35

3rd most common skin cancer

Question 36

melanoma is what percent of skin cancers?

Answer 36

5% BUT it is 75% of deaths due to skin cancer (very deadly)

Question 37

are males or females more likely to get melanomas?

Answer 37

females under age 40 males over age 40 overall, slight male predominance

Question 38

what re the risk factors of melanoma?

Answer 38

- 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]

Question 39

what are the melanoma ABCDE's?

Answer 39

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

Question 40

what are the growth phases of melanoma?

Answer 40

radial - spreads laterally | vertical - extends deeper into the connective tissue

Question 41

what is the precursor of melanoma?

Answer 41

lentigo maligna (hutchinson's freckel)

Question 42

what are the 4 types of melanomas?

Answer 42

- lentigo maligna melanoma - superficial spreading melanoma - nodular melanoma - acral lentiginous melanoma

Question 43

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

Answer 43

lentigo maligna

Question 44

where does lentigo maligna usually occur?

Answer 44

facial skin -large macular lesion with irregular borders and uneven pigmentation

Question 45

what % of melanomas are lentigo melanomas?

Answer 45

5%

Question 46

when do lentigo melanomas occur?

Answer 46

15 years before the vertical growth phase -nodularity in previously flat lentigo maligna signals vertical growth phase

Question 47

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)

Answer 47

superficial spreading melanoma

Question 48

what do superficial spreading melanomas begin as?

Answer 48

macule or plaque

Question 49

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)

Answer 49

nodular melanoma

Question 50

what % of melanomas are nodular melanomas?

Answer 50

15%

Question 51

type of melanoma that affects palms, soles, and oral mucosa. | -most common clinicopathologic type of melanoma in persons of color

Answer 51

acral lentiginous melanoma

Question 52

what % of melanomas are acral lentiginous melanomas

Answer 52

8%

Question 53

what does acral lentiginous melanomas begin as?

Answer 53

darkly pigmented macule with irregular borders -mucosal melanoma is more aggressive than cutaneous melanoma

Question 54

what is ORAL acral lentiginous melanoma?

Answer 54

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

Question 55

what is the tx of melanoma?

Answer 55

- 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)

Question 56

what does the px of melanomas depend on?

Answer 56

DEPTH OF INVASION! - .75mm - 96% 10ys - .76 - 1.69mm - 89% 10ys - 1.7 - 3.59mm - 67% 10ys - over 3.6mm - 26% 10ys

Question 57

what is the px for ORAL melanoma?

Answer 57

POOR -10-25% 5ys may be due to difficulty in achieving wide surgical margins and early metastisis