Pigmented Lesions Flashcards
How late into age do normal moles usually develop and how big are they?
6 mos to late 30s
<6mm (pencil eraser)
How late into life do atypical moles usually develop and how big are they?
6 mos to 20s
> 6 mm but maybe smaller
When do melanomas usually develop in life?
adulthood but can occur in children
What is this lesion?
congenital melanocytic nevus (CMN)
- small, medium, large, giant
- increased risk for melanoma
- raised
- can darken over time
- hypertrichosis common
- surgical resection should be attempted before 6 mos
Hypertrichosis
excessive hair
What is this lesion?
Intradermal Nevus
- melanocytes in the dermis
- common in adults
What are these examples of
Common acquired nevi
Junctional Nevi
- melanocytes located at dermoepidermal junction
- start in childhood as freckle
- can become more raised and lose pigment throughout age
Compound nevi
- features of both junctional and intradermal nevi
- melanocytes in the dermoepidermal junction AND dermis
- raised, uniform, light brown
Nevus Spilus
- presents 1st year of life
- hairless, speckled
- vary in size
- transformation to melanoma is rare
- can biopsy areas that are suspicious
Becker’s Nevus
- common in males
- onset around puberty
- light brown, slightly elevated, verrucous
- hypertrichotic
- no reported malignancy
Halo Nevus
- white border
- children and adults
- located on back usually
- consider biopsy if irregular/suspicious
Spitz Nevus
- acquired, solitary, rapidly growing
- pink/red papulonodule
- difficult to distinguish from melanoma
- usually benign and can convolute, treatment controversial
Blue Nevus
- macule/papule
- usually <1cm
- dark blue, gray/black
- common on scalp and distal extensor extremities
- can resemble melanoma
Actinic Keratosis
- PRE-CANCEROUS
- pink/erythematous papules/thin plaques
- rough, gritty scale
- sun exposed areas, male, age, fair skin
- Tx: Cryo, or refer to derm for Efudex/Aldera, PDT, chemical peel
How many Fitzpatrick skin types are there?
6 (very fair, fair, medium, olive, brown, black)
AK can turn into which cancer?
Squamous cell carcinoma
Squamous Cell Carcinoma In Situ (Bowen’s Disease)
- erythematous, hyperkeratotic
- well demarcated patch/plaque
- can resemble eczema/psoriasis
- Tx: ED & C, cryo, 5-FU/Imiquimod, PDT, surgical excision
Invasive Squamous Cell Carcinoma
- erythematous, scaly papulonodule/plaque with adherent white scale, eroded
- sun explosed areas
- Tx: wide local excision, Moh’s, ED&C, radiation
Basal Cell Carcinoma
- most common skin cancer
- pink pearly papule with central depression, telangiectasias, rolled borders
- common on nose
- slow growing, rarely metastasize
- Tx: dependent on type/location, Moh’s, WLE, ED&C, radiation, 5-FU for superficial, Vismodegib for inoperable/metastasized
Identify the lesion on the left vs on the right
Left: BCC
Right: SCC
What are the ABCDEs
Asymmetry
Border
Color
Diameter
Evolving
What are the subtypes of melanoma
Superficial spreading
Nodular
Lentigo Maligna
Acral lentiginous
Subungual melanoma
Treatment of melanoma
Initial
- WLE
- sentinel lymph node biopsy
Advanced
- immunotherapy
- inhibitors
- radiation/chemotherapy
Melanoma
Kaposi Sarcoma
- often affects those with immunodeficiencies (HIV/AIDS)
- slow growing violaceous patches
- Tx: depends on cause and localization/dissemination
What are the types of sunscreen
Physical (blocks/scatters UV and visible light)
Chemical (absorbs light and re-emits energy as heat)
Superficial spreading melanoma
- excisional biopsy
Nevus spilous
- watch/reassure
Halo Nevus
- watch/reassure (biopsy if concerning)
Becker’s Nevus
- reassurance/cosmetic follow up
Atypical nevus
- punch biopsy
Spitz vs Basal CC
- biopsy or refer to derm
Seborrheic keratosis
Intradermal nevus
Seborrheic keratosis
Nodular Melanoma
- biopsy
Seborrheic keratosis
melanoma
- biopsy
intradermal nevus
melanoma
- biopsy
SCC
- biopsy
SCC
- biopsy
SCC
- biopsy
BCC
- refer to derm (location)
Melanoma
- refer to derm
Blue nevus vs melanoma
- biopsy or refer to derm
