Pigment Lesions Flashcards
if a mole is small and been there since childhood…is it likely to be melanoma?
NO
what do congenital nevus look like?
dome shaped with mammillated and hypertrichosis
what is hypertrichosis?
increase in hairiness
what does it mean for congenital moles to be mammillated?
they have small protuberances
if congenital nevus is bigger than 20 cm…what are we worried about?
melanoma
what tool helps evaluate a pigmented lesion in the clinic?
dermatoscope
when do you usually get acquired nevi?
in first two decades of life
if acquired nevi appear after 50 yo what are we concerned about?
melanoma
how do nevi change over time with age? is this normal?
often change from brown at young age to a pink or skin color in older age…completely normal
name the ABCDEs of evaluating a mole
asymmetry border color diameter evolving
how big are melanomas usually?
greater than 6 mm
how does color appear in melanomas?
usually different throughout the nevi
what is an atypical nevi?
nevus with different colors or fried egg appearanc
are atypical nevi precancerous? what should you tell patient to do with these?
not pre cancer…but patients should monitor because at higher risk for melanoma
why cant you just remove all atypical nevi and prevent melanoma?
because melanoma can occur from the regular normal skin too so removing all of them does not decrease the risk
how many nevi are needed for atypical mole syndrome?
more than 50 and usually appear in puberty
if you are worried about a pigmented lesion…what should you do?
biopsy the entire lesion
what is the most important prognostic indicator in melanoma?
Breslow depth
what percent of melanomas have familial or genetic basis?
10%
what two genes do we know are common for melanoma?
CDKN2A and CDK4
where do most melanomas occur? where else can they occur?
sun exposed areas…anywhere else even genitalia
how do melanomas usually appear? describe them
pigmented papule plaque or nodule
what is breslows depth?
for melanoma eval…is depth between the granulosa tissue and the deepest part of the tumor
name the five types of melanoma
superficial spreading nodular lentigo maligna acral lentiginous amelanotic
what is the most common type of melanoma? describe it
superficial spreading…horizontal growth of tumor
which type of melanoma grows vertically?
nodular
which type of melanoma grown on sun spots?
lentigo maligna
which type of melanoma is common in asians and AAs?
acral lentiginous type
what is the amelanotic type of melanoma?
pink appearance so can be confused with psoriasis and SCC/BCC and dermatitis
if breslow depth is less than 0.8 mm then what do you do?
surgical excision and follow up
if breslow depth is greater than 0.8 mm then what do you do?
surgical excision, eval of sentinel lymph nodes and follow up
what is the common pathway involved in melanomas that can targeted with therapy?
MAPK pathway
what two inhibitor types can be used to target the MAPK pathway in melanoma?
BRAF inhibitor
MEK inhibitor
name the BRAF inhibitor for melanoma
vemurafenib and dabrafenib
name the MEK inhibitor for melanoma
trametinib
name the three immune checkpoint spots that can be targeted with therapy for melanoma
CTLA4
PD1
PDL1
