Module 2: Chaos and Clues

Question 1

Excluding seborrheic keratosis

Answer 1

Multiple orange or yellow clods
Multiple white clods
Thick curved lines
Well demarcated border
Multiple grouped similar lesions
If in doubt bx

Question 2

Which clue is most sensitive for melanoma on face

Answer 2

Grey color

Question 3

Which clue is most specific for melanoma on face

Answer 3

Dot vessels
then grey circles
then pigmented circles

Question 4

Exceptions to decision algorithm

Answer 4

changing lesions in adults
nodular or small lesions with any clue
Head/neck pigmented circles or dermatoscopic grey
Acral parallel ridge patterns (can be symmetrical)

Question 5

Polarizing specific white lines

Answer 5

BCC
Melanoma
Spitz nevus
Dermatofibroma

Question 6

Where to look for dot vessels in melanoma?

Answer 6

Flat sections

Question 7

Do you get dot vessels in BCC?

Answer 7

Few, but not a pattern.

Question 8

Do you get serpentine vessels in SCC?

Answer 8

No

Question 9

What is significance of looped vessels?

Answer 9

Raised lesion = invasive

Question 10

List vessel structures

Answer 10

Dot, Clod
Line, Looped
Curved, Sepentine
Helical, Coiled

Question 11

List vessel patterns

Answer 11

Random, Clustered
Serpiginous, linear,
Central, Radial
Reticular, Branched

Question 12

Priority pigment vs vessel

Answer 12

Pigment takes priority over vessel

Question 13

Nail matrix melanoma

Answer 13

Lines of varying width interval and color

Question 14

GET BLACK LOLLIPOPS - most to least sensitive

Answer 14

Grey or blue structures
Eccentric structureless areas
Thick lines reticular

Black dots or clods peripheral

Lines radial OR pseudopods, segmental
Lines white
Lines parallel ridges

Polymorphous vessels
Polygons

Question 15

Tyndall effect

Answer 15

Air particles scatter light which becomes visible to observer.
Short wavelength light (blue) is scattered 16x more than long wavelength light (red). Sky therefore appears blue.

Question 16

Chaos and clues has been designed to

Answer 16

assess all pigmented lesions
detects any type malignancy
no need to decide if melanocytic
applied at exam speed

Question 17

C+Clues Algorithm

Answer 17

Chaos, look for 1 of 9 clues.
If 1 of 9 clues biopsy unless can make unequivocal diagnosis.
Exception - consider bx anyway

Question 18

RPA

Answer 18

Pattern + colours + clue = diagnosis

Question 19

5 basic structures

Answer 19

line 
pseudopod
circle
clod
dot

Question 20

5 type of lines

Answer 20

reticular
branched
parallel
radial 
curved

Question 21

Define line

Answer 21

2 dimensional continuous object L&raquo_space;W

Question 22

Define Pseudop

Answer 22

line + bulbous end

Question 23

Define circle

Answer 23

curved lines sensible equidistant from central point

Question 24

Define clod

Answer 24

well circumscribed solid object > dot. Any shape and colour.

Question 25

Define Dot

Answer 25

Too small to have discernable side and shape

Question 26

Define Structureless

Answer 26

Area with no basic structure predominating

Question 27

C+C sens and spec and malignancy

Answer 27

90.6 and 62.7

Question 28

Eccentric structureless area ...

Answer 28

any colour except skin if white usually regressioim red = increased blood flow coloured - dense chaotic melanon deposition

Question 29

Lines reticular exclude

Answer 29

BCC and SCC

Question 30

could a new lesion be a nevus at 40

Answer 30

unlikely

Question 31

could a new lesion be a nevus at 50

Answer 31

no

Question 32

polygons definition

Answer 32

geometric polygonal shape complete or incomplete bounded by straight lines or a straight pigment interface, meeting at angles, larger than the holes of single follicles and larger by far than holes bounded by reticular lines.

Question 33

Pigmented circles are .......% specific for melanoma

Answer 33

76

Question 34

Grey circles are .... % specific for melanoma

Answer 34

83

Question 35

Grey colour is ... % specific for melanoma

Answer 35

31