Pigmented lesions Flashcards
elderly mixed black and white man pt [morgan freeman]
multiple
tan/brown macules [gradully enlarges and elevated]
less than 2 cm in size
In the sun a lot [but not sure] and possible mutation of FGFR3
seen on: skin of face, trunk, and extremites
seborrhic keratosis
morgan freeman is black happens 30% of the time so aka
________
clinically descibe the lesion
sharply demarcated:
- fissured
- pitted
- verrucous
but may be smooth
seborrheic keratosis is
ACQUIRED ______ proliferation
basal epidermal cells
benign
3 histofeatures of seborrheic keratosis
1) Hyperkeratosis
2) acanthosis
3) **numerous pseudocytes **
what are pseudocytes
keratin filled invaginations
-surrounding the pseudocytes are basaloid in appearance
tx for seborrheic keratosis
no tx, usually esthetic purposes
lq nitrogen and curettage [just like actinic keratosis]
seborrheic keratosis is not malignant in potential exception for
_____ _____ sign
leser trelat sign
waht is leser trelat sign
sudden apperance numerous seborrheic keratosis and pruritus [pus] associated with
internal malignancy
hyperpigmented **MACULE of the skin **
ephelis [freckles]
1st decade of life
round oval
sharply demarcated
light brown lesion [intensifies with sun]
ephelis
region of increased melanin production
strong genetic predilection
blonde hair blue eyed
red hair green eyed
less than 3 mm in size
ephelis
ephelis NOT like lentigo simplex for 2 reasons
1) not as dark
2) no elongation of rete ridges
ephelis is not like MELANOCYTIC nevus
not elevated
histofeatures of ephelis
1) stratisfied sq epithelium
with abundant melanin
deposition in the basal cell layer
true or false
ephelis is not an increase in melanocyte and in fact can be reduced
2) no tx
true
true, use sunblock
what 2 diseases can be PREVENTED with sunscreen
ephelis
actinic lentigo
olderly white with lesion on skin, dorsum of hand, arm
5 mm - 1 cm
BBM [benign brown macule] from chronic UV light
actinic lentigo = senile lentigo = age spot = liver spot
clinical features:
Well demarcateed
uniformly brown and tan macules
irregular borders
actinic lentigo
actinic lentigo NO CHANGE IN COLOR with intensity of UV light just **unlike which pigmented lesion **
ephelis
waht is the tx for actinic lentigo
no tx unless esthetics:
cyrotherapy
laser
pulsed light therapy
topical
sunblock for prevention
how often does actinic lentigo reoccur
rare
BUT NEW LESIONS CAN ARISE FROM ADJ SKIN ANYTIME
what is actinic lentigo
BBM
benign brown macule
with chronic UV light damage to skin
people with freckles are more likely to develop actinic lentigo
true
what is Addison’s Disease
adrenal cortical insuffeciency
addisons disease
diffuse _____ leads to
geranized brown pigmentation
sun exposed skin
hypermelanosis
B Blk M
multiple circumscribed
dark brown/ black macule
covered with intact mucosa
true or false
oral mucosal lesion typically
1st sign of addisons disease
true
what is the treatment of ORAL lesions from addisons disease
no tx
diagnosis of addisions disease:
1)
2)
hx
elevated plasma levels of ACTH
tx of regular addisons disease
corticosteriod replacement thearpy
what 2 diseases does NOT change with color intensity in sun exposure
which dsiease does change color intensity with sun exposure
does not change color:
1) actinic lentigo
2) lentigo simplex
does change:
ephelis
what is lentigo simplex
BCMH
benign cutanenous melanocytic hyperplasia
usually affects children
unknown cause and not on sun exposed skin
TF
darker than ephelis
true
lentigo simplex is associated with _____ _____syndrome
Peutz Jeghers syndrome
4 histofeatures of lentigo simplex
1) increased # of benign melanocytes
in the **basal cell epidermis **
2) encrustations of rete ridges
3) lots of melanin:
- melanocytes
- basal keratinocytes
4) melanin incontinence
melanin incontinence
melanophages in papilary dermis
waht is the tx for lentigo simplex and
is it malignant
no tx
not malignant
what is Peutz Jeghers syndrome
Autosomal disease
freckle like lesions that affect:
- hands
- perioral skin
- oral mucosa
Jejunum and ileum affected with intestinal polyps [intestinal polyposis] predespostion for GI adenocarcinoma
clinically features of Peutz Jeghers syndrome
1) muliple circumscribed
tan/brown macules
covered by intact mucosa
2) affects:
labial and buccal mucosa, tongue, and palate
1 histofeature of Peutz Jeghers syndrome
benign overgrowth
intestinal glandular epithelium
supported by **core smooth muscle **
TF
epithelial **atypia **is NOT a prominent feature of Peutz Jeghers syndrome
true
unlike the polyps of Gardner Syndrome
tx of Peutz Jeghers syndrome
MONITOR
in tuss us ceptions or tumor formation
[genetic counseling]
TF
melasma more commonly affect people with darker complexion
true
what is the treatment of melasma
sunblock with zinc oxide and titanium dioxide
waht 2 pigmented lesions is not due to sun exposure
- lentigo simplex
- oral melanotic macule
who is mostly affected in oral melanoma acanthoma
african american
women
smooth, darkly pigmented MACULE in the buccal mucosa
is oral melanoacanthoma common
how do you make sure its not maligantn
rare
incisonal biopsy
cafe au lait spot is similar to waht disease
albright syndrome
youll see ___ ___ macules in cafe au lait spot
flat brown macules
1.5cm OR GREATER diameter
6 or more flat brown macules [cafe au lait spot] can be given this diagnosis
neurofibromatosis
cafe au lait spot is ___ % in indiv
10%
how fast does oral melanoacanthoma gro
enlarges within **months very alarming **GROWTH RATE
whih pigmented lesions have to be biopsied to rule out early melanom
- oral melanotic macule
- oral melanoacanthoma
- acquired melanocytic neuvs
TF
lesions of acquired melanocytic nevus can arise at birth and throughout life
- will regress by mid life
true
true
what % of newborns have congenital melanocytic nevus
1%
can acquired melanocytic nevus be distinguished from congential melanocytic nevus micoscopically
- waht are the differnces
- no cant be distinguished
- congential melanocytic nevus is LARGER in DIAMETER
what pigmented lesion up until this point has 3 - 15% undergoing malignant transformation to melanom
congential melanocytic nevus
large congenital nevi 2 things
- has 3 - 15% malignant transformation to melanoma
- called bathing trunk and garment nevus
what pigmented lesions has
BR/ BLK **plaques with rough surfaces **
congential melanocytic nevus
waht is
Blue melanocytic nevus
melanin producing lesion
blue nevus
melanin are ____ to the surface
blue color of this melanin producing lesion is explained by _______ _____
deep
Tyndall effect
waht is the tyndall effect
interaction of light
with
particles
in colloidal suspension
well circumscribed
deep blue macule
of the palatal mucosa
blue nevus
histofeature of blue nevus
- melanin seen in **spindle shaped melanocytes **
- deep in LAMINA PROPRIA and PARALLEL to surface epi
heavily pigmented spindle shaped cells
blue nevus
tx for blue nevus
biopsy
make sure its not early melanoma
waht is melanoma
MN MO
malignant neoplasm of melanocytic orgin
from
1) benign melanocytic lesion
2) de novo melanocytes
waht is the major caustive factor of
melanoma
damage from UV radiation
TF
**acute **sun damage is GREATER CAUSTIVE importance
than
**chronic **sun damage
true
what are the 5 risk factors of melanoma
- light hair and skin
- indoor job
- burns easily
- hx with painful and blistering sunburn in childhood
- hx with DCN = dysplastic congential nevus
TF
3rd most common skin cancer is melanoma
most deaths caused by skin cancer is melanoma
true
true
melanoma has a high mutation in _____
BRAF gene
[ras - raf - erk] signaling pathway
waht are the ABCDE of melanoma
A - assymetry
B - border irregularity
C - color variation
D - diameter is greater than 6mm
E -evolving
Lentigo Maligna melanoma
1) precursors: lentigo maligna and **hitchinson’s freckle **
2) mid face of old white people
3) exclusively to sun exposed skin
4) melanoma in situ
5) purely radial growth phase
radial growth phase
superficial spreading of melanoma
most common
Histofeatures of lentigo maligna melanoma
superifical spreading
1) radial growth phase
2) atypical melanocytes **ALONG THE BORDER **
of basilar portion of epidermis
3) indi melanocytes invading higher levels of epithelium
acral lentiginous melanoma
1) most common among Af Amer
2) most common oral melanoma
histofeatures of acral lentiginous melanoma
aytpical melanocytes **WITHIN basilar **portion of epidermis
invasion into SUPERFICIAL LAMINA PROPRIA
_____ of _____
important for
histopathological evaluation
of cutaneous melanoma
depth of invasion
histopathologic evaluation
why is the depth of invasion important
for histopatholgical evaluation
correlation with prognosis
true or false
prognosis for oral melanoma is extremely poor
true extremely poor
____ system of measurement
_____ classification
which one is more accurate
clark system of measurement
breslow classification [more accurate]
clark system of measurement
assigns a level to the lesion
2) depends on the deepest anatomic cutaneous region
invaded by the tumor
breslow classifcaiton
more accurate
measures the distance:
TOP of granular cell layer
to DEEPEST
WORST PROGNOSIS:
Bans
BACK
POSTERIOR ARM
LATERAL NECK
SCALP
5 background info of vitiligo
- **de pigmentation **of broad areas of the skin
- 1% incidence
- family tendency
- onset any age, esp 10 -30 yo
- maybe autoimmune
3 clinical features of vitiligo
- stress
- injury
sun exposure
TF
thyoid disease is common among vitiligo pt
- except for thyroid carcinoma
true
true
___ ___ slight increase with vitiligo pt
DM
Addisons diease
histofeature of vitiligo
NO MELANOCYTES
present in the skin
Pityriasis [tinea] versicolor is caused by
fungus [malassezia furfur] found on normal skin
4 reasons conversion of saprophyic -> morphologic form
1) genetic predilection
warm, humid evn
immunosuppressed malnutrition
cushing’s disease
clinically waht does pityriasis versicolor look like
scaly skin macules
[obvious with pt tan in the summer]
scaly skin macules that can be
HYPOpigmented
HYPERpigmented
HYPOpigmented scaly skin macules:
- tyrosinase
- inhibition of enzyme in melanin synthesis pathway
HYPERpigmented scaly skin macules:
fungus induces MELANOSOME ENLARGEMENT
2 histofeatures of tinea versicolor
- short cigar butt hyphae
- KOH spores with short mycelium = sphagetti and meatball
diagnosis of tinea versicolor is
confirming KOH examination
tx of pityriasis [tinea] versicolor
oral treatments:
1) itraconazole
2) fluconazole
TF
itraconazole and fluconazole DOES NOT PREVENT high rate of reoccurance
true
