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AU'18 Oral Path II > Melanocytic Lesions - part 2 > Flashcards

Melanocytic Lesions - part 2 Flashcards

1
Q

what percent of melanoma lesions are cutaneous?

A

91%

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2
Q

what are the high risk sites of melanoma?

A

BANS: back, arms, neck and scalp

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3
Q

what percent of high risk sites affected by melanoma is head and neck?

A

25%

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4
Q

other than cutaneous, what other sites can melanoma affect?

A

muscosa, ocular and other

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5
Q

how do you describe a melanocytic lesion?

A 
ABCDE's:
Asymmetry
Border irregularity
Color variegation
Diameter >6 mm (size of pencil eraser)
Evolving - enlarging or changing color
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6
Q

what are the growth phases of melanoma?

A
  1. radical

2. vertical

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7
Q

radial growth phase

A

spreads laterally

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8
Q

vertical growth phase

A

extends deeper into the CT

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9
Q

what is the precursor for melanoma?

A

lentigo maligna

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10
Q

what are the clinicopathologic types of melanoma?

A
  1. lentigo maligna melanoma
  2. superficial spreading melanoma
  3. nodular melanoma
  4. acral lentiginous melanoma
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11
Q

lentigo maligna (Hutchinson’s freckle)

A

melanoma in-situ

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12
Q

melanoma in-situ

A

melanoma in a purely RADIAL growth phase

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13
Q

type of people affected by lentigo maligna

A

older individuals with fair complexion

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14
Q

clinical feature of lentigo maligna

A

large macular lesion with irregular borders and UNEVEN pigmentation

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15
Q

how long does it take before vertical growth phase develops?

A

~15 years

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16
Q

what signals a previously flat lentigo maligna to enter the vertical growth phase and lentigo maligna melanoma?

A

nodularity in a previously flat lentigo maligna

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17
Q

histopathologic of lentigo maligna melanoma

A

nests of malignant melanocytes in epithelium and superficial CT

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18
Q

what is the most common type of melanoma?

A

superficial spreading melanoma

19
Q

what does superficial spreading melanoma begin as?

A

a macule or plaque

20
Q

clinical features of superficial spreading melanoma

A

starts off as a macule or plaque and exhibits classic clinical features (A, B, C, D’s and E)

21
Q

superficial spreading melanoma sites

A
  1. interscapular area of men

2. back of legs on women

22
Q

histopathologic of superficial spreading melanoma

A
  1. clusters of atypical melanocytes along basal layer and dropping into CT
  2. melanocytes invading epidermis producing pigment
23
Q

T/F: nodular melanoma is a rapidly growing nodule

A

true, almost immediate vertical phase and little if any radial growth

24
Q

clinical features of nodular melanoma

A
  1. usually deeply pigmented

2. amelanotic

25
Q

amelanotic

A

melanocytes so poorly differentiated they can no longer produce melanin

26
Q

what is the most common form of oral melanoma?

A

acral lentiginous melanoma

27
Q

what is the most common form of melanoma in persons of color?

A

acral lentiginous melanoma

28
Q

what type of melanoma is more aggressive than the cutaneous form?

A

acral lentiginous melanoma

29
Q

what are the sites for acral lentiginous melanoma?

A
  1. palm of hands
  2. soles of feet
  3. subungual (under nails)
  4. mucous membranes
30
Q

clinical features of CUTANEOUS acral lentiginous melanoma

A
  1. dark, may see color variegation
  2. irregular margin
  3. macule which develops into nodule
31
Q

clinical features of ORAL acral lentiginous melanoma

A
  1. dark, may see color variegation
  2. can be amelanotic
  3. irregular margin
  4. macule which develops into nodule
  5. ± ulceration
  6. ± pain, usually if ulcerated
  7. soft to palpation
  8. cervical lymph node metastasis
32
Q

T/F: there is a female predilection for ORAL acral lentiginous melanoma

A

false, male predilection

33
Q

what age groups are primarily affected with ORAL acral lentiginous melanoma?

A

5th-7th decade

34
Q

which site is commonly affected by ORAL acral lentiginous melanoma?

A

hard palate/maxillary alveolar mucosa

35
Q

how does ORAL acral lentiginous melanoma appear on radiographs?

A

appears as irregular radiolucency or mixed lesion

36
Q

treatment for melanoma

A
  1. surgical excision 1-2 cm margin for cutaneous lesions (lymph node dissection if needed)
  2. genotype-directed immunotherapy
  3. chemotheraphy, radiation have little impact but may be used
  4. close clinical follow-up
  5. SPF products
37
Q

what is the prognosis of a ≤ 0.75 mm invasion?

A

96% 10 year survival

38
Q

what is the prognosis of a > 3.6 mm invasion?

A

26% 10 year survival

39
Q

who has a better prognosis for melanoma?

A
  1. younger than 50

2. female

40
Q

which cutaneous site has a worse prognosis for melanoma?

A

trunk, head and neck (esp. scalp and neck)

41
Q

T/F: melanoma has worse prognosis if the lesion was cutaneous rather than mucosal

A

false, worse for mucosal than cutaneous

42
Q

why is the prognosis for oral melanoma poor?

A

because of difficulty achieving wide surgical margins and early metastasis

43
Q

routes of metastasis for melanoma

A
  1. lymphatics

2. blood via brain, liver, bone

AU'18 Oral Path II (31 decks)

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