Module 8: Melanoma Flashcards
Diffuse reticular/ Patchy reticular - B v M
M - disorganized
Central hypo/ hyperpigmentation - B v M
M - off centre
Non- specific (structureless or featureless or homogenous) - B v M
M - heterogeneous hues or completely structureless
Peripheral globules and central reticular/ central globules and peripheral reticular - B v M
M - disorganized. Included asymmetric starburst
Globular - B v M
M - disorganized
Multi-component (symmetric)
2 component nevus
B v M
M Multi-component - 3 or more structures distributed asymmetrically
MM specific structures - sensitivity, 1-3
Regression structures
Atypical network
BWV
MM specific structures - specificity, 99% (4)
Streaks
Cystalline
BWV
Regression s
MM specific structures - odds ration, 1-4
Peripheral brown structureless
Crystalline
Atypical network
Regression structures
MM specific structures
- Atypical network (included grey angulated lines)
- Irregular Streaks (focal irregular - pseudopods & or radial streaming)
- Negative pigment network
- Crystalline (short white lines)
- Atypical dots and granules
- Atypical (irregular) blotch
- Blue white veil over raised areas
- Regression structures (BWV over flat area, peppering, scar)
- Atypical vessels
- Peripheral tan/ brown structureless areas
Atypical network is associated with ….
Superficial spreading melanoma
Angulated lines - description
Form zig zag pattern and polygonal structures (rhomboids)
Angulated lines Sens and Sp?
Not known but almost always MM
Angulated lines histopath correlation
NYD
Angulated lines most commonly seen
Sun damaged skin of face
Angulated lines also seen
Chronic sun damaged skin upper torso/ extremities
Histopath correlated irregular streaks/ pseudopods?
confluent junctional nests of pigmented melanocytes
confluent junctional nests of pigmented melanocytes associated with what type of growth
radial growth
confluent junctional nests of pigmented melanocytes associated with what type of melanoma …
superficial spreading
definition of negative network
serpiginous interconnecting hypo pigmented lines that surround irregularly shaped pigmented strcutures, which resemble elongated and curvilinear globules.
is pigment network seen with P or NP Dermoscopy?
both
In white benign lesions can you see negative pigment
- Spitz nevus.
2. CMN
Crystalline structures - definition
Short white lines only seen with polarizing Dermoscopy
Crystalline structures - cause
birefringent properties of collagen > polarized light to randomize it polarization rapidly
White reflective structures
- Crystalline (shiny white lines/ streaks) MM, spitz, LPLK
- Shiny white blotches/ patches/ areas (white clods) & strands BCC
- Rosettes AK, SCC, Actinic damaged skin
White reflective structures are predictive of ….
Thicker melanoma
Invasive melanoma
What type of collagen is expressed in malignant but not benign melanocyte tumors
Collagen XVII
Predictor of thicker MM > 0.75
Blue grey areas Vessels Abrupt cutoff > 4 colors Blue white veil > 2 structures
Predictor of thicker MM & +SLNB
Blotch
Ulceration.
Negative predictor of thicker MM & +SLNB
Atypical network
Predictor of thicker MM & distant mets
Shiny white streaks
Milky red areas.
In which non-melanocytes lesions do you see crystalline structures
- DF.
- BCC
- LPLK
Dots defn
Small round structures, diam < 0.1 mm
Black dots =
Pigment in the stratum corneum/ upper epidermis
Brown dots =
small nests at or near the Dermoscopy-epidermal jn
Blue grey dots =
free melanin in dermis or in macrophages
Red dots =
dotted vessels
I brown dot on network corresponds to …
pigment nests within rete
Typical/ regular black or brown dots
Central OR
Situated on network lines, or in holes
Black or brown Dots asymmetrical
Located focally at periphery
Not associated with network lines
Black or brown Dots situated in holes of network known as …
Target globules
Globules defn
Symmetrical, round to oval well dermarcated structure > 0.1mm diamanté’s
Brown globules =
nests at or below DR junction in papillae to upper reticular dermis. (Most common)
Black globules =
heavily melanized nests
Blue globules =
nests in deeper dermis
White globules =
ballon cell nests
Red globules =
vascular structures
Typical/ regular globules
Uniform size, shape, color
Symmetrically distributed throughout lesion or at peripheral or in the centre
Atypical globules
Asymmetrically distributed.
Often aggregated focally.
When reddish in colour, highly suggestive melanoma.
Significance of tiered globules
Atypical pattern
What is a large concentration of melanin in stratum corneum called?
Black lamella
Botch - definition.
Large concentration of melanonin
throughout epidermis +/- dermis
Visually obscures underlying structures.
Typical blotch
Single
Central
Homogenous
Atypical blotch
Peripheral
Asymmetric
> 1
Blue white veil (raised) definition
Focal, irregular, indistinct, confluent, blue pigmentation.
Overlying white ground-glass haze
Pigmentation cannot occupy entire lesions.
Blue white veil histopath
Aggregation of heavily pigmented cells/ melnanin in the dermis. (Blue color)
In combination with compact orthokeratosis.
Blue white veil in nevus
blue hue (not veil)
centrally located
rainy and homogenous
usually only with NPD (orthokeratosis)
Blue white veil in melanoma
Asymmetrical/ focal or diffuse throughout lesion
Differing hues (heterogeneous)
Both with NPD and PD
Regression structures - name them
- Peppering - fine grey particles
- Depigmented area (scar like depigmentation) - structureless area that is white in color. Lighter in color as compared to lesion, and background skin color.
The combination creates blue white veil - on palpation it will be flat.
Peppering in nevus
usually symmetrical
< 10% lesion
uncommon to have scarring
Peppering in melanoma
+/- scarring
asymmetrically located
involves > 50% lesion area
Vascular structures, nodular lesion, nevus
Comma vessels
IDN
CMN
Vascular structures, nodular lesion, melanoma
Dotted Glomerular serpentine/ linear polymorphous milky red
Vascular structures, flat lesions, nevus
Monomorphous dotted “target network” vessels. (In CMN can be polymorphous)
Milky red
Vascular structures, flat lesions, melanoma
Dotted Globular Serpentine/ linear Milky-red (polymorphous)
Peripheral tan/ brown structureless areas - dermatophatology
- Flattening of rete ridges at DEJ
- Melanocytes arranged predominantly as solitary units + less melanin
- Pagetoid scatter of melanocytes
Melanoma specific structures
- Atypical network incl angulated lines.
- Streaks (pseudopods and radial streaming)
- Negative pigment network
- Shiny white lines (Chrysallis/ crustalline)
- Atypical dots and globules.
- Off-centered blotch.
- Peripheral tan structureless area
- Blue-white veil overlying raised areas.
- Regression structures.
- Atypical vascular structures.
