Melanocytic lesions

Question 1

What is the term for freckles?

Answer 1

Ephelides

Question 2

What is actinic lentigines?

Answer 2

macular “age spots” or “liver spots” that are on your face or back of the hands. They are usually bigger than and don’t wax and wane in the sun like ephelides

Question 3

a patient has uniformly pigmented brown lesions on the lip as well as intraorally that do not change with sun exposure. What is the diagnosis?

Answer 3

Melanotic macule. could represent post traumatic melanosis.

Question 4

what is special microscopically about melanotic macules?

Answer 4

no nevus cells present. Clusters of melanocytes at rete ridge tips. INCREASED amount of melanin pigment of basal layer of connective tissue

Question 5

How do you treat melanotic macules?

Answer 5

vermillion lesions can be excised for esthetics and submitted for examination. IF INTRAORAL, may need to take out to rule out melanoma.

Question 6

What does Harrington call a mole?

Answer 6

Acquired melanocytic nevus. The most common of all human tumors.

Question 7

What are the 3 types of melanocytic nevi?

Answer 7

1. Junctional nevus
2. Compound nevus
3. Intradermal nevus
   These terms are based on where the nevus cells are located microscopically

Question 8

What can you tell me about junctional nevi?

Answer 8

They are the first stage, flat, and dark in color

Question 9

What can you tell me about compound nevi?

Answer 9

They can evolve from a junctional nevus. Their cells begin to “drop off” into the connective tissue and start to become raised lesions. Compound nevi can have hair

Question 10

What can you tell me about intradermal nevi?

Answer 10

They have proliferated until they are completely contained inside the connective tissue. Elevated, and a wide range of colors. Often skin colored.

Question 11

T/F moles can appear inside the mouth

Answer 11

gross but true! it is rare but they mostly occur on the hard palate or attached gingiva. They can be present on any oral site though.

Question 12

what are the indications for tx of melanocytic nevi?

Answer 12

no tx for cutaneous nevi unless 1. esthetic concern, 2. chronically irritated, or 3. has had changes in color

Question 13

What is the risk of nevi turning into melanoma?

Answer 13

low, 1 in 3,000 to 10,000

Question 14

T/F Early oral mucosal malanoma can look like mucosal nevi

Answer 14

True! Biopsy ALL unexplained pigmented oral lesions

Question 15

What percentage of newborns have nevi at birth?

Answer 15

1% have congenital melanocytic nevi. These moles can be large (bathing suit or garment nevi) or small, but most are less than 15cm and can have hypertrichosis (excess hair)

Question 16

what percentage of congenital nevi can turn malignant?

Answer 16

1% for small, 2-3% for larger nevi

Question 17

tx for congenital nevi

Answer 17

excise totally if small, may have to do it in stages if large. Close follow up is necessary

Question 18

where can blue nevi occur and why are they blue?

Answer 18

ANY cutaneous or mucosal surface. Blue color due to depth of melanin (Tyndall effect)

Question 19

Blue nevi has what microscopic appearances?

Answer 19

a collection of dendritic melanocytes within connective tissue with abundant melanin content. Melanocytes appear normal.

Question 20

tx and prognosis of blue nevus?

Answer 20

excise. excellent prognosis and rarely is malignant or recurs

Question 21

The 3rd most common skin cancer is?

Answer 21

Melanoma (BCC most common)

Question 22

malanoma is what percent of skin cancers and causes what percent of skin cancer deaths?

Answer 22

5% but causes 75% of the deaths

Question 23

who gets more melanoma, men or women?

Answer 23

slightly more men. Young women are prone to get it and older men are too

Question 24

what are the risk factors of melanoma and the high risk locations (BANS)?

Answer 24

family hx of melanoma, personal hx of melanoma,

BANS =back, arms, neck, scalp

Question 25

what are the ABCDEs of melanoma?

Answer 25

Asymmetry, Boarder irregularity, Color variegation, Diameter greater than 6mm, Evolving (getting bigger or color change)

Question 26

What are the 4 types of melanoma?

Answer 26

Lentigo maligna melanoma
superficial spreading melanoma
nodular melanoma
acral lentiginous melanoma

Question 27

lentigo maligna grows in what direction?

Answer 27

purely radially “melanoma in situ” (lateral growing)

Question 28

what are the characteristics of lentigo maligna?

Answer 28

a large macular lesion with irregular boarders, uneven coloring. It grows radially, affects older white people on their faces.
Only 5% of melanomas. It usually takes 15 years to advance to vertical growth stage

Question 29

Nodular melanoma characteristics

Answer 29

15% of melanomas. starts almost immediately in the vertical growth phase with little radial growth.
Deeply pigmented or amelanotic (differential dx with pyogenic granuloma)
33% occur in head and neck region

Question 30

what is the most common melanoma?

Answer 30

superficial spreading melanoma is 70% of all melanomas. Happens on men’s backs and women’s legs. 15% in head and neck region. Has classic ABCDEs

Question 31

what is the most common melanoma in black people?

Answer 31

acral lentiginous melanoma (only 8% of all melanomas, but common in darker skin types)

Question 32

acral lentiginous melanoma characteristics

Answer 32

mucosal melanoma is more aggressive than cutaneous.
Oral type happens most often in older males with 70-80% on hard palate or max alveolar mucosa, but pain is uncommon unless ulcerated.

Question 33

tx for melanoma?

Answer 33

excision with at least 1 cm margins

(chemo, radiation, immunotherapy are not effective) but genotype immunotherapy advances look promising

Question 34

what is the prognosis for oral melanoma?

Answer 34

poor. 5 yr survival is 10-25%