Melanoma Flashcards
Atypical pigment network is a melanoma specific structure
True
Atypical pigment network Angulated lines Negative pigment network Streaks Crystalline structures Atypical dots and globules Off-centre blotch or multiple asymmetrically located blotches Regression structures Blue-white veil overlying raised areas Atypical vascular structures Peripheral tan structureless areas
Angulated lines is a melanoma specific structure
True
Atypical pigment network Angulated lines Negative pigment network Streaks Crystalline structures Atypical dots and globules Off-centre blotch or multiple asymmetrically located blotches Regression structures Blue-white veil overlying raised areas Atypical vascular structures Peripheral tan structureless areas
Negative pigment network is a melanoma specific structure
True
Atypical pigment network Angulated lines Negative pigment network Streaks Crystalline structures Atypical dots and globules Off-centre blotch or multiple asymmetrically located blotches Regression structures Blue-white veil overlying raised areas Atypical vascular structures Peripheral tan structureless areas
Streaks I.e. pseudopods and radial streaming is a melanoma specific structure
True
Atypical pigment network Angulated lines Negative pigment network Streaks Crystalline structures Atypical dots and globules Off-centre blotch or multiple asymmetrically located blotches Regression structures Blue-white veil overlying raised areas Atypical vascular structures Peripheral tan structureless areas
Crystalline structures is a melanoma specific structure
True
Atypical pigment network Angulated lines Negative pigment network Streaks Crystalline structures Atypical dots and globules Off-centre blotch or multiple asymmetrically located blotches Regression structures Blue-white veil overlying raised areas Atypical vascular structures Peripheral tan structureless areas
Atypical dots or globules is a melanoma specific structure
True
Atypical pigment network Angulated lines Negative pigment network Streaks Crystalline structures Atypical dots and globules Off-centre blotch or multiple asymmetrically located blotches Regression structures Blue-white veil overlying raised areas Atypical vascular structures Peripheral tan structureless areas
Off centre blotch or multiple asymmetrically located blotches is a melanoma specific structure
True
Atypical pigment network Angulated lines Negative pigment network Streaks Crystalline structures Atypical dots and globules Off-centre blotch or multiple asymmetrically located blotches Regression structures Blue-white veil overlying raised areas Atypical vascular structures Peripheral tan structureless areas
Regression structures I.e. white scar-like depigmentation, blue-grey granularity, peppering is a melanoma specific structure
True
Atypical pigment network Angulated lines Negative pigment network Streaks Crystalline structures Atypical dots and globules Off-centre blotch or multiple asymmetrically located blotches Regression structures Blue-white veil overlying raised areas Atypical vascular structures Peripheral tan structureless areas
Blue-white veil overlying raised areas is a melanoma specific structure
True
Atypical pigment network Angulated lines Negative pigment network Streaks Crystalline structures Atypical dots and globules Off-centre blotch or multiple asymmetrically located blotches Regression structures Blue-white veil overlying raised areas Atypical vascular structures Peripheral tan structureless areas
Atypical vascular structures is a melanoma specific structure
True
Atypical pigment network Angulated lines Negative pigment network Streaks Crystalline structures Atypical dots and globules Off-centre blotch or multiple asymmetrically located blotches Regression structures Blue-white veil overlying raised areas Atypical vascular structures Peripheral tan structureless areas
Peripheral tan structure less areas is a melanoma specific structure
True
Atypical pigment network Angulated lines Negative pigment network Streaks Crystalline structures Atypical dots and globules Off-centre blotch or multiple asymmetrically located blotches Regression structures Blue-white veil overlying raised areas Atypical vascular structures Peripheral tan structureless areas
Atypical pigment network is characterised by increased variability in the width of the network lines, their colour and distribution. The hole sizes also have increased variability.
True
Angulated lines create a zig-zag pattern or coalesce to create polygonal structures I.e. rhomboids
True
Negative pigment network are serpiginous interconnecting hypopigmented lines which surround irregularly shaped pigmented structures that resemble elongated curvilinear globules.
It can be seen diffusely throughout the lesion or focally and asymmetrically within the lesion
Streak (pseudopods) are finger-like projections with small knobs at their tips
Whereas radial streaming are the same structures without knobs
Streaks (radial streaming) are finger-like projections
Whereas pseudopods are the same structures with small knobs at their tips
Streaks (I.e. pseudopods and radial streaming) are radial projections located at the periphery of the lesion which extend from the tumour to the surrounding normal skin
Irregular, asymmetrical and focally distributed streaks are highly suggestive of melanoma
Crystalline structures are shiny white linear streaks often parallel to each other
Also known as shiny white streaks/lines
Atypical dots and globules (globules larger than dots) are round structures which may be black, brown, blue/grey/white in colour, usually multiple and of differing sizes, shapes, colours
Often at periphery of lesion
Off-centre blotch are dark brown to black homogenous areas with varying hues of pigment, usually asymmetrically/focally towards periphery of the lesion or present as multiple blotches
Eccentric peripheral hyperpigmentation is often found in melanoma
Regression structures consist of peppering and scar-like areas often asymmetrically located and involve >50% of the lesion in melanoma
True
Blue-white veil overlying raised areas is a confluence blue pigmentation of varying hues with an overlying white ground glass haze
Tend to be asymmetrically located or diffusely present throughout the lesion
Atypical vascular structures is defined by:
Dotted vessels over milky red background Serpentine vessels (linear and irregular vessels) Corkscrew vessels (usually in modular melanoma, desmoplastic melanoma, melanoma mets) Polymorphous vessels (2 or more vessel morphologies)
Peripheral tan structureless areas is a structureless light brown area at the periphery of the lesion and encompassing >10% of a lesion’s area
True
Amelanotic melanomas have atypical vascular structures (dotted, serpentine) and crystalline structures (shiny white streaks/lines)
Vascular structures (dotted, serpentine, corkscrew) are the main and most commonly observed structure, and may be the only clue for the diagnosis of melanoma, particularly amelanotic nodular melanoma
Hypomelanotic melanomas may also have peripheral tan structureless areas
True
On Dermoscopy, pure nodular melanomas do not have any pigment network, pseudo-network or regression structures
Pigmented nodular melanomas have blue-white veil, crystalline structures, irregular blotches, atypical dots and globules, pink or black colours
Some nodular melanomas may present with pseudo-lagoons
These are red lacunae-like structures that are not separated by septae (as is the norm for haemangiomas), and have vessels through them
Desmoplastic melanoma can be subclassified into pure vs mixed desmoplastic melanoma
Pure desmoplastic melanoma is less likely to have regional lymph node involvement , and has a more favourable outcome
Mixed desmoplastic melanoma is associated with higher locoregional recurrence
Desmoplastic melanoma most commonly have the following me;anima specific feature:
Atypical vascular structures Regression structures Blue-white veil Atypical globules Atypical pigment network Crystalline structures
The most common non-desmoplastic melanoma associated with mixed desmoplstic melanoma is lentigo maligna
It is because of this association it is recommended that all suspected lentigo maligna lesions be palpated to ensure there is no subcutaneous firmness associated with them
Negative pigment network occurs in Spitz naevi and melanoma arising in naevi
T
Angulated lines on the face are called rhomboidal structures and are highly suggestive of lentigo maligna
Angulated lines outside the face are called polygons and are highly suggestive of lentiginous melanoma on chronically sun exposed sites (synonymous with lentigo maligna, a specific term for the face)
Occasionally one can see white globules with melanocytic nests with balloon cell changes
T
Irregular globules distributed eccentrically at the periphery of a tan to pink papulonodule should raise the suspicion of a BAP-1 inactivated melanocytic tumour
T
When streaks are located symmetrically around the entire lesion, they favour a Reed naevus
When streaks are located asymmetrically, they favour a superficial spreading melanoma
Homogenous blue pattern can be seen in
Blue naevi
Combined naevi
Pigmented nodular melanoma
Primary or metastatic melanoma
When evaluating a blue lesion, the clinical history is paramount
Stable and longstanding lesions - favour blue naevus
New lesion in patient with history melanoma - raises concern for metastatic melanoma
T
Comma vessels
Intradermal naevus (monomorphous) Melanoma (polymorphous)
