Pigment Lesions

Question 1

if a mole is small and been there since childhood…is it likely to be melanoma?

Answer 1

NO

Question 2

what do congenital nevus look like?

Answer 2

dome shaped with mammillated and hypertrichosis

Question 3

what is hypertrichosis?

Answer 3

increase in hairiness

Question 4

what does it mean for congenital moles to be mammillated?

Answer 4

they have small protuberances

Question 5

if congenital nevus is bigger than 20 cm…what are we worried about?

Answer 5

melanoma

Question 6

what tool helps evaluate a pigmented lesion in the clinic?

Answer 6

dermatoscope

Question 7

when do you usually get acquired nevi?

Answer 7

in first two decades of life

Question 8

if acquired nevi appear after 50 yo what are we concerned about?

Answer 8

melanoma

Question 9

how do nevi change over time with age? is this normal?

Answer 9

often change from brown at young age to a pink or skin color in older age…completely normal

Question 10

name the ABCDEs of evaluating a mole

Answer 10

asymmetry
border
color
diameter
evolving

Question 11

how big are melanomas usually?

Answer 11

greater than 6 mm

Question 12

how does color appear in melanomas?

Answer 12

usually different throughout the nevi

Question 13

what is an atypical nevi?

Answer 13

nevus with different colors or fried egg appearanc

Question 14

are atypical nevi precancerous? what should you tell patient to do with these?

Answer 14

not pre cancer…but patients should monitor because at higher risk for melanoma

Question 15

why cant you just remove all atypical nevi and prevent melanoma?

Answer 15

because melanoma can occur from the regular normal skin too so removing all of them does not decrease the risk

Question 16

how many nevi are needed for atypical mole syndrome?

Answer 16

more than 50 and usually appear in puberty

Question 17

if you are worried about a pigmented lesion…what should you do?

Answer 17

biopsy the entire lesion

Question 18

what is the most important prognostic indicator in melanoma?

Answer 18

Breslow depth

Question 19

what percent of melanomas have familial or genetic basis?

Answer 19

10%

Question 20

what two genes do we know are common for melanoma?

Answer 20

CDKN2A and CDK4

Question 21

where do most melanomas occur? where else can they occur?

Answer 21

sun exposed areas…anywhere else even genitalia

Question 22

how do melanomas usually appear? describe them

Answer 22

pigmented papule plaque or nodule

Question 23

what is breslows depth?

Answer 23

for melanoma eval…is depth between the granulosa tissue and the deepest part of the tumor

Question 24

name the five types of melanoma

Answer 24

superficial spreading
nodular
lentigo maligna
acral lentiginous 
amelanotic

Question 25

what is the most common type of melanoma? describe it

Answer 25

superficial spreading…horizontal growth of tumor

Question 26

which type of melanoma grows vertically?

Answer 26

nodular

Question 27

which type of melanoma grown on sun spots?

Answer 27

lentigo maligna

Question 28

which type of melanoma is common in asians and AAs?

Answer 28

acral lentiginous type

Question 29

what is the amelanotic type of melanoma?

Answer 29

pink appearance so can be confused with psoriasis and SCC/BCC and dermatitis

Question 30

if breslow depth is less than 0.8 mm then what do you do?

Answer 30

surgical excision and follow up

Question 31

if breslow depth is greater than 0.8 mm then what do you do?

Answer 31

surgical excision, eval of sentinel lymph nodes and follow up

Question 32

what is the common pathway involved in melanomas that can targeted with therapy?

Answer 32

MAPK pathway

Question 33

what two inhibitor types can be used to target the MAPK pathway in melanoma?

Answer 33

BRAF inhibitor

MEK inhibitor

Question 34

name the BRAF inhibitor for melanoma

Answer 34

vemurafenib and dabrafenib

Question 35

name the MEK inhibitor for melanoma

Answer 35

trametinib

Question 36

name the three immune checkpoint spots that can be targeted with therapy for melanoma

Answer 36

CTLA4
PD1
PDL1