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Atopic dermatitis > Melanoma features based on anatomical site > Flashcards

Melanoma features based on anatomical site Flashcards

Understand unique melanoma features based on anatomical location

1
Q

What is the single most important dermoscopic feature for early lentigo maligna detection?

A

Asymmetric pigmentation of follicular openings

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2
Q

According to Tschandl et al., what dermoscopic pattern indicates malignancy in lesions?

A

Circle-within-circle (isobar sign)

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3
Q

What are the additional criteria described by Pralong et al. for lentigo maligna diagnosis?

A
  1. ‘Target-like pattern’, 2. ‘Darkening at dermoscopic examination’, 3. ‘Red rhomboidal structures’, 4. ‘Increased density of the vascular network’
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4
Q

Which dermoscopic criteria are most useful for rare, amelanotic (non-pigmented) lentigo maligna variants?

A

‘Red rhomboidal structures’ and ‘Increased density of the vascular network’

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5
Q

What type of facial lesions may display ‘regression structures’ like peppering and ‘white scar-like depigmentation’?

A

Lentigo maligna

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6
Q

What approach has been proposed for diagnosing lentigo maligna by recognizing seven benign features?

A

Inverse approach

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7
Q

What features are commonly observed in thick scalp melanomas on dermoscopy?

A

Blue-white veil, irregular pigmented blotches, unspecific pattern

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8
Q

In thick scalp melanomas, which pattern is frequently demonstrated in nodular melanomas?

A

Unspecific pattern

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9
Q

What dermoscopic features are associated with scalp melanoma disease progression?

A

Atypical network, regression in thin melanomas; blue-white veil, irregular pigmented blotches in thick lesions

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10
Q

What is the ‘BB’ rule aimed at increasing the dermoscopic diagnostic accuracy of pigmented nodular melanoma?

A

The combination of blue and/or black pigmented areas

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11
Q

Why is dermoscopy considered essential for accurate melanoma diagnosis?

A

Dermoscopy is essential for accurate and early melanoma diagnosis, as per international guidelines.

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12
Q

What are the key points about lentigo maligna melanoma on the facial skin?

A

Lentigo maligna melanoma is common on facial skin with distinct dermoscopic criteria around hair follicles.

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13
Q

What are the unique dermoscopic characteristics of lentigo maligna on facial skin?

A

Dermoscopic features include perifollicular grey dots, rhomboidal structures, and pigmented blotches.

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14
Q

How do lentigo maligna and lentigo maligna melanoma lesions typically appear on the face?

A

They present as irregularly pigmented macules or patches on facial skin.

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15
Q

What makes diagnosing facial melanoma challenging with the ‘ABCDE rule’?

A

The ‘ABCDE rule’ is not applicable for facial melanomas like lentigo maligna.

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16
Q

Where are lentigo maligna/lentigo maligna melanoma lesions most commonly found on the head and neck for men and women?

A

They are commonly found on the cheek and central face area in women and on the scalp, ear, and neck in men.

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17
Q

What are the key points regarding mucosal melanoma?

A

Mucosal melanoma is rare, diagnosed late, and can develop in various mucosal areas.

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18
Q

How is mucosal melanoma clinically visualized?

A

Initially as a brown to black macule that progresses to a nodule or plaque.

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19
Q

What dermoscopic features characterize mucosal melanoma?

A

Multicomponent, structureless patterns with blue, grey, or white colors.

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20
Q

What increases the difficulty in diagnosing mucosal melanoma?

A

Around 1/5 are amelanotic, complicating correct diagnoses.

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21
Q

What are the limitations in dermoscopy of mucosal melanoma?

A

Limited data due to rarity, difficulties in examination, and probe limitations.

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22
Q

What is the significance of multiple colors in mucosal melanoma?

A

Associated with melanoma diagnosis, especially with structureless distribution.

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23
Q

How can mucosal melanoma be differentiated from benign lesions?

A

Presence of blue, grey, or white colors with a structureless pattern.

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24
Q

What pattern is common in mucous membrane melanoma?

A

Multicomponent or polymorphous pattern with multiple structures.

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25
Q

What are some dermoscopic features common to mucosal and cutaneous melanomas?

A

Asymmetry of structures, multiple colors, irregular vessels, and milky-red areas.

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26
Q

What are some dermoscopic features of melanoma on the lower limbs?

A

Prominent or delicate network, hypo-pigmentation with dotted vessels, diffuse light pigmentation.

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27
Q

Where are most melanomas located in women?

A

Lower limbs.

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28
Q

What is the most common site of melanoma in women?

A

Lower limbs.

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29
Q

What are the additional associated features of melanoma on the lower limbs?

A

Polygons/angulated lines, regression, dermoscopic islands.

30
Q

What is the Hutchinson’s sign in nail melanoma?

A

Periungual spread of pigmentation, visible in adults, suggestive of malignancy.

31
Q

What is the most common clinical presentation of nail melanoma?

A

Longitudinal band of melanonychia.

32
Q

Where do nail melanomas generally occur?

A

Fifth to seventh decades of life, both in fingernails and toenails.

33
Q

What is the Hutchinson’s sign associated with in adults?

A

Nail melanoma.

34
Q

What is the significance of Hutchinson’s sign in adults?

A

Suggests a suspicious clinical diagnosis of nail melanoma.

35
Q

What dermoscopic features are associated with a melanoma diagnosis if the total score is ≥4?

A

Presence of multicomponent or polycircular pattern, irregular globules, blue-whitish or white veil, ≥3 colours, irregular vessels, and palpable, unilateral or unifocal lesion.

36
Q

Describe the dermoscopy features of thin or in situ vulvar melanomas.

A

Structureless areas, grey areas, irregular black-brown dots, and blue-white structures.

37
Q

What dermoscopic characteristics are commonly observed in conjunctival melanoma?

A

Dark brown, black, and grey color, dots in a structureless pattern, prominent feeder linear vessels, multiple patterns and colors, asymmetry, irregular dots and globules, regression structures, and blue-white veil.

38
Q

How is acral melanoma defined anatomically?

A

Melanoma located on glabrous (hairless) skin of the extremities.

39
Q

What is the typical dermoscopic feature of acral melanoma?

A

The parallel ridge pattern (PRP), characterized by a band-like pigmentation along the rete ridges.

40
Q

In which populations is acral melanoma most common?

A

Dark-skinned people (Asian, African, and Hispanic populations).

41
Q

What are specific dermoscopic features for melanoma on the trunk?

A

Regression structures and shiny white lines for the upper back, negative pigment network for the abdomen.

42
Q

Describe the dermoscopic features of superficial spreading melanoma of the trunk.

A

Asymmetric with regression, irregular globules, pigment blotches, blue-white veil.

43
Q

What is the dermoscopic appearance of nevus-associated melanoma?

A

Inverse network and regression, dermoscopic island possible.

44
Q

How do melanoma and nevus remnants appear when coexisting?

A

Reported at histopathological examination, melanoma usually SSM subtype, thicker in congenital NAMs.

45
Q

What are some dermoscopic criteria associated with nevus-associated melanoma?

A

Negative pigment network, globules, streaks, sometimes blue-white veil.

46
Q

Where can nodular melanomas (NMs) be found on the body?

A

Any part, including the trunk.

47
Q

What are traditional dermoscopic features of pigmented NMs?

A

Blue-black color, irregular dots and globules, crystalline structures, vessels.

48
Q

How are amelanotic NMs characterized?

A

Diagnostic dilemma, lack typical pigmentation.

49
Q

What vascular patterns are seen in pink melanomas?

A

Predominant central vessels, hairpin vessels, milky red-pink areas, polymorphic vessels.

50
Q

What did a recent study highlight about tumour thickness and vascular patterns?

A

Tumour thickness strongly influences the vascular pattern on dermoscopy.

51
Q

What is the BB rule used for?

A

To differentiate thick lesions like BCC, SCC, angiomas, blue nevi, and seborrheic keratoses.

52
Q

Describe the dermoscopic features of amelanotic nodular melanomas.

A

Milky-red background, irregular vessels, suggestive of malignancy.

53
Q

What are the key dermoscopic characteristics to differentiate BCCs and SCCs from pigmented nodular melanomas?

A

Presence or absence of vascular patterns, streaks, brown globules, and structureless brown areas.

54
Q

How are nevus-associated melanomas typified dermoscopically?

A

By dermoscopic island, negative pigment network, globules, and streaks.

55
Q

What are the main dermoscopic clues for pigmented nodular melanomas?

A

Blue and black color under the BB rule.

56
Q

Describe the dermoscopic features of superficial spreading melanoma (SSM) on the trunk.

A

Irregular hyperpigmented areas, prominent skin markings in thin lesions, multicomponent pattern, asymmetry, blue-grey veil.

57
Q

What is the most common histologic subtype of melanoma on the trunk?

A

Superficial spreading melanoma (SSM).

58
Q

What is the BRAFV600E mutation associated with in melanomas of the trunk?

A

Almost half of the confirmed SSM cases.

59
Q

When does the vertical growth phase typically begin in melanomas?

A

After the slow and progressive horizontal growth phase.

60
Q

What dermoscopic findings are common in thin trunk melanomas?

A

Multicomponent pattern, asymmetry, blue-grey coloration.

61
Q

What are typical dermoscopic features associated with invasive acral melanoma?

A

They include parallel ridge pattern (PRP), irregular diffuse pigmentation, and irregular brown to black dots/clods.

62
Q

What is the clinical three-step algorithm for surgical excision of acquired acral melanocytic lesions?

A

The algorithm recommends excision for lesions with non-typical dermoscopic pattern, diameter ≥7 mm, and patient age >50 years.

63
Q

How does the BRAAFF dermoscopic scoring system improve acral melanoma diagnostic accuracy?

A

It includes positive patterns like PRP and irregular blotches, with negative predictors such as parallel furrow and fibrillar pattern.

64
Q

What does the presence of an irregular fibrillar pattern in acral melanoma indicate?

A

It indicates an asymmetric and irregular arrangement of fibrillar pigmentation with varying size and color of fibrils.

65
Q

What dermoscopic features characterize amelanotic acral melanoma?

A

Microscopic remnants of pigmentation and a polymorphous vascular pattern including milky-red areas, irregular vessels, and hairpin vessels.

66
Q

Why may the overall sensitivity of the clinical three-step algorithm for acral melanoma be low?

A

It may be low due to misclassification of fibrillar pattern as high-risk and the frequency of small multicomponent diagnoses.

67
Q

What is the color range of the background band in nail melanoma?

A

Grey to brown to black.

68
Q

Describe the characteristics of irregular lines in nail melanoma.

A

Variable colors, thickness, interrupted, and cross into each other.

69
Q

What features are significantly associated with nail melanoma observed with onychoscopy?

A

Brown colored background and irregular longitudinal lines.

70
Q

What is the ‘Micro-Hutchinson’s sign’ visible by dermoscopy?

A

Parallel ridge pattern and irregular diffuse pigmentation.

71
Q

What are the indicative features of nail melanoma according to onychoscopy?

A

Presence of dots/globules of brown-black color, width of the band >2/3 of the nail plate, and nail plate dystrophy.

72
Q

What is the significance of nail plate dystrophy in onychoscopy?

A

It is an indicator of invasive melanoma.

Atopic dermatitis (5 decks)

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