Mucosal lesions

Question 1

Transition areas from normal skin to mucosa

Answer 1

eyelids
lips
gingiva, tongue, buccal mucosa
genital region
anal region

Question 2

Histology of mucosa and mucocutaneous transition zone

Answer 2

• Progressive reduction in stratum corneum from several keratotic layers to none.
• . No granular, nor a horny layer - exception - dorsum of the tongue and hard palate.
• . Underlying connective tissue, called lamina propria is similar in composition and structure to the dermis of the skin.

Question 3

Histology of interface between mucosal epithelium and connective tissue in cheek, labial, and alveolar mucosa.

Answer 3

• . relatively flat interface between mucosal epithelium and connective tissue with short papillae and wide rete ridges
• . thin keratinized epithelium of the transition zone between the skin and labial mucosa. (vermilion) with long connective tissue papillae containing numerous superficially located capillaries, which contribute to clinical red appearance of this structure.

Question 4

Histology of vulvar and glans

Answer 4

• vulvar vestibule has non-keratinized superficial layer, indistinct lower layers composed of loosely packed, polygonal cells and a basal layer.
• glans and inner surface of prepuce are lined with variably keratinized squamous epithelium.

Question 5

Melanocytes in the mucosa found in …

Answer 5

the basal layer
(variation between and within individuals. Pigmentation related to melanocyte activity is rarely seen in light skinned individuals.)

Question 6

Benign mucosal lesions

Answer 6

• Melanocytic macule
• Acquired melanocytic nevus
• Congenital nevus
• Hemangioma/angiokeratoma
• Adenoma
• Fibroma
• Amalgam (tattoo)

Question 7

Melanocytic macule dermoscopy

Answer 7

homogenous brown color

Lines, dots or structureless

Question 8

Melanocytic macule histopath

Answer 8

basal hyperpigmentation of epithelium without significant hyperplasia of melanocytes

Question 9

Melanocytic macule syndromes

Answer 9

Laugier-Hunziker

Peutz-Jeghers

Question 10

Acquired melanocytic nevus Dermoscopy

Answer 10

homogenous brown colour - more brown
rarely grey and black colours
lines, dots, clods and structureless
more lines and dots

Question 11

Congenital nevus Dermoscopy

Answer 11

Typically homogenous brown colour
Clods
Structureless areas

Question 12

Angioma Dermoscopy

Answer 12

Red and blue colours
Clods
Structureless areas
Possible white lines (Fibrosis)

Question 13

Amalgam “tattoo” Dermoscopy

Answer 13

Blue, grey and white colours
Structureless areas.
May be difficult to distinguish from malignancy - need clinical context - relationship to amalgam

Question 14

Components of amalgam

Answer 14

Mixture of silver, tin, mercury, copper, zinc

Question 15

Molluscum contagiosum Dermoscopy

Answer 15

White colour
Clods (white) with structureless areas at periphery
possible crown vessels at periphery in advanced cases

Question 16

Herpes labialis Dermoscopy

Answer 16

Yellow and or light brown colours
Structureless areas
Possible erosion/ ulceration

Question 17

Papilloma Dermoscopy

Answer 17

One or multiple white clods

+/- white lines at periphery

Question 18

Lichen sclerosis Dermoscopy

Answer 18

Hallmark is whitish streaks + structureless areas
+/- zones of reddish and bluish colours, representing hemorrhagic areas.
Streaks
Structureless areas

Question 19

Lichen sclerosis inflammatory, Dermoscopy

Answer 19

Structureless areas
Red and blue colours = hemorrhagic areas
Lines, streaks

Question 20

Papilloma is thought to be associated with …

Answer 20

HPV infection.

Question 21

Oral papilloma, presentation.

Answer 21

Papules or exophytic nodules with numerous finger-like surface projections.

Question 22

Melanoma, early, Dermoscopy features

Answer 22

lines, dots, clods, structureless

low degrees of colour variegation (brown, red, grey, black, red, purple, white)

Question 23

Melanoma, invasive, Dermoscopy features

Answer 23

lines, dots, clods, structureless

high degrees of colour variegation

Question 24

Bowen’s disease Dermoscopy features

Answer 24

Peripheral dots and structureless areas with red, grey or black colours.
Black dots at periphery represent vessels arranged in linear fashion.

Question 25

Bowenoid papulosis - features

Answer 25

Low grade SCC in situ
Associated with HPV
Younger males
Behaves in benign fashion

Question 26

Bowenoid papulosis - macroscopic

Answer 26

Multiple slight elevated papule, red-violet to brown black in colour.

Question 27

Bowenoid papulosis - Dermoscopy

Answer 27

Lines and structureless areas

Brown, grey and black colours

Question 28

Diagnostic model presented by IDS

Answer 28

presence of blue, grey or white colour
with or without presence of structureless areas
should raise suspicion of malignancy

Question 29

Diagnostic modes IDS: Sensitivity and specificity

Answer 29

100

82

Question 30

Indication for biopsy

Answer 30

1. Presence of blue, grey or white colours,
   Esp if associated with structureless areas.
2. Unclassifiable mucosal lesion with hx of change.
3. Patient > 45 years with unknown hx, and or unclassifiable lesion.

Question 31

Indication for follow up.

Answer 31

1. Newly detected or changing lesions without blue, grey or white colours.
2. Patient < 45 with unknown history and unclassifiable lesion.