Module 5: Melanocytic Nevi Flashcards

1
Q

New classification of nevi based on Dermoscopy

A
cobblestone pattern
globular p
reticular p
homogenous blue p
starburst p
not specific p
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2
Q

New classification - pigment distribution

A
Uniformly pigmented
Central hyper pigmented
central hypo pigmented
eccentric hyper pigmented
eccentric hypopigmented
multifocal hyper/ hypo pigmented
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3
Q

New classification - color

A
Light brown
Dark brown
Red
White
Blue 
Black 
Grey
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4
Q

2 main categories of melanocytic nevi

A

Congenital

Acquired

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5
Q

Categories of congenital nevi

A

Large
Medium
Small

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6
Q

Categories of acquired nevi

A

Junctional, compound, dermal
Spitz
Blue
Other

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7
Q

Incidence of congenital nevi

A

Likely 1% or lower

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8
Q

Risk of melanoma in CN?

A

Small - medium 0-5% lifetime risk

Giant 5-15%

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9
Q

Origin of melanoma in CN

A

Dermis

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10
Q

Congenital nevis, dermoscopic features

A
  1. Asymmetry
  2. Pattern
    a. Multicomponent
    b. Globular (cobblestone)
    c. reticular
    d. Homogenous
  3. Pigmentation
    a. Uniform
    b. Hypo/ hyper-pigmented
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11
Q

Congenital nevis, additional dermoscopic features

A

Hypertrichosis
Perifollicular hyper/ hypo-pigmentation
Vessels

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12
Q

Definition giant congenital nevus

A

> 20 cm adult
6 cm birth
9 cm birth, head

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13
Q

Management giant congenital nevus

A
  1. MRI to r/o neurocutaneous melanosis
  2. Early surgery if appropriate
  3. Follow up examination every 6 months.
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14
Q

Management small/ medium congenital nevi

A
If suspicious features excise
If change in lesion excise
if difficulty with documentation excise
If unable to do full excision do partial excision of suspicious area. 
If unable to excise follow  up.
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15
Q

What is histopathological correlate of globular pattern?

A

Nests of melanocytes at the Dermoscopy-epidermal junction and dermis

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16
Q

What is dermoscopic hallmark of nevi in childhood?

A

Globular pattern

17
Q

What types of nevi contain globular pattern?

A

Small congenital
compound
dermal

18
Q

Arguments for common histiogenetic background globular nevi

A
  1. Histopath features of small CMN, compound nevi, dermal nevi often indistinguishable.
  2. All 3 types characterized by same morphologic pattern
  3. Histopathologic studies report on high number compound or dermal nevi in early childhood and late adulthood.
19
Q

New classification globular nevi

A
  1. Previously characterized as small congenital nevi, compound nevi +/- dysplasia, dermal nevi.
  2. Development dt endogenous pathway
  3. Life-long persistence
20
Q

What is hallmark of Nevis in adults with development at puberty

A

Reticular pattern

21
Q

Reticular pattern, histopath correlation

A

proliferation of malanocytes along elongated retentions ridges

22
Q

In what type of nevi is reticular pattern typically seen?

A

Junctional nevi +/- dysplasia

23
Q

Association between nevus and skin type

A

ST I. Light brown, central hypo-pigmentation
ST II. Light brown, multi-focal hyper/ hypo-pigmentation
ST III. Light brown, multi-focal hyper/ hypo-pigmentation
ST IV. Dark brown, central hyper-pigmentation.

24
Q

Reticular nevi pathway

A

“True” AMN
Development in early adolescence, exogenous pathway (UV induced), disappearance later in life dt involution and or regression.

25
Q

New classification reticular nevi

A
  1. Previously categorized as acquired melanocytic nevi, junctional nevi +/- dysplasia.
  2. Development dt exogenous pathway.
  3. Involution.
26
Q

Starburst pattern histopath correlation

A

vertically arranged well defined junctional melanocyte nests with signs of maturation in deeper parts

27
Q

Starburst pattern hallmark of …

A

Spitz and Reed nevi

28
Q

Starburst pattern represents …

A

transitory pattern in evolution of pigmented Spitz nevi

globular > starburst > homogenous > involution

29
Q

New classification Starburst nevi

A

Previoiusly pigmented spitz or reed nevus
Development ? endogenous
Evolution

30
Q

New classification site related nevi

A

Parallel pattern - aural nevi
Band like pattern- sublingual nevi
Pseudo network pattern - facial nevi
Globular reticular grey blue pattern - mucosal nevi

31
Q

New classification nevi with special features

A
Combined nevus
Halo nevus
Hemosiderotic target nevus (traumatized nevus)
Meyerson nevus 
Recurrent nevus
32
Q

New terminology dysplastic (Clarke) nevus

A

large acquired nevus

> 5 mm