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Opath > Pigmented lesions > Flashcards

Pigmented lesions Flashcards

1
Q

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

A

seborrhic keratosis

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2
Q

morgan freeman is black happens 30% of the time so aka

________

clinically descibe the lesion

A

sharply demarcated:

  • fissured
  • pitted
  • verrucous

but may be smooth

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3
Q

seborrheic keratosis is

ACQUIRED ______ proliferation

basal epidermal cells

A

benign

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4
Q

3 histofeatures of seborrheic keratosis

A

1) Hyperkeratosis
2) acanthosis
3) **numerous pseudocytes **

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5
Q

what are pseudocytes

A

keratin filled invaginations

-surrounding the pseudocytes are basaloid in appearance

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6
Q

tx for seborrheic keratosis

A

no tx, usually esthetic purposes

lq nitrogen and curettage [just like actinic keratosis]

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7
Q

seborrheic keratosis is not malignant in potential exception for

_____ _____ sign

A

leser trelat sign

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8
Q

waht is leser trelat sign

A

sudden apperance numerous seborrheic keratosis and pruritus [pus] associated with

internal malignancy

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9
Q

hyperpigmented **MACULE of the skin **

A

ephelis [freckles]

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10
Q

1st decade of life

round oval

sharply demarcated

light brown lesion [intensifies with sun]

A

ephelis

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11
Q

region of increased melanin production

strong genetic predilection

blonde hair blue eyed

red hair green eyed

less than 3 mm in size

A

ephelis

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12
Q

ephelis NOT like lentigo simplex for 2 reasons

A

1) not as dark
2) no elongation of rete ridges

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13
Q

ephelis is not like MELANOCYTIC nevus

A

not elevated

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14
Q

histofeatures of ephelis

A

1) stratisfied sq epithelium

with abundant melanin

deposition in the basal cell layer

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15
Q

true or false

ephelis is not an increase in melanocyte and in fact can be reduced

2) no tx

A

true

true, use sunblock

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16
Q

what 2 diseases can be PREVENTED with sunscreen

A

ephelis

actinic lentigo

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17
Q

olderly white with lesion on skin, dorsum of hand, arm

5 mm - 1 cm

BBM [benign brown macule] from chronic UV light

A

actinic lentigo = senile lentigo = age spot = liver spot

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18
Q

clinical features:

Well demarcateed

uniformly brown and tan macules

irregular borders

A

actinic lentigo

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19
Q

actinic lentigo NO CHANGE IN COLOR with intensity of UV light just **unlike which pigmented lesion **

A

ephelis

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20
Q

waht is the tx for actinic lentigo

A

no tx unless esthetics:

cyrotherapy

laser

pulsed light therapy

topical

sunblock for prevention

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21
Q

how often does actinic lentigo reoccur

A

rare

BUT NEW LESIONS CAN ARISE FROM ADJ SKIN ANYTIME

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22
Q

what is actinic lentigo

A

BBM

benign brown macule

with chronic UV light damage to skin

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23
Q

people with freckles are more likely to develop actinic lentigo

A

true

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24
Q

what is Addison’s Disease

A

adrenal cortical insuffeciency

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25
Q

addisons disease

diffuse _____ leads to

geranized brown pigmentation

sun exposed skin

A

hypermelanosis

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26
Q

B Blk M

A

multiple circumscribed

dark brown/ black macule

covered with intact mucosa

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27
Q

true or false

oral mucosal lesion typically

1st sign of addisons disease

A

true

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28
Q

what is the treatment of ORAL lesions from addisons disease

A

no tx

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29
Q

diagnosis of addisions disease:

1)

2)

A

hx

elevated plasma levels of ACTH

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30
Q

tx of regular addisons disease

A

corticosteriod replacement thearpy

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31
Q

what 2 diseases does NOT change with color intensity in sun exposure

which dsiease does change color intensity with sun exposure

A

does not change color:

1) actinic lentigo
2) lentigo simplex

does change:

ephelis

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32
Q

what is lentigo simplex

A

BCMH

benign cutanenous melanocytic hyperplasia

usually affects children

unknown cause and not on sun exposed skin

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33
Q

TF

darker than ephelis

A

true

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34
Q

lentigo simplex is associated with _____ _____syndrome

A

Peutz Jeghers syndrome

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35
Q

4 histofeatures of lentigo simplex

A

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

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36
Q

melanin incontinence

A

melanophages in papilary dermis

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37
Q

waht is the tx for lentigo simplex and

is it malignant

A

no tx

not malignant

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38
Q

what is Peutz Jeghers syndrome

A

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

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39
Q

clinically features of Peutz Jeghers syndrome

A

1) muliple circumscribed

tan/brown macules

covered by intact mucosa

2) affects:

labial and buccal mucosa, tongue, and palate

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40
Q

1 histofeature of Peutz Jeghers syndrome

A

benign overgrowth

intestinal glandular epithelium

supported by **core smooth muscle **

41
Q

TF

epithelial **atypia **is NOT a prominent feature of Peutz Jeghers syndrome

A

true

unlike the polyps of Gardner Syndrome

42
Q

tx of Peutz Jeghers syndrome

A

MONITOR

in tuss us ceptions or tumor formation

[genetic counseling]

43
Q

TF

melasma more commonly affect people with darker complexion

A

true

44
Q

what is the treatment of melasma

A

sunblock with zinc oxide and titanium dioxide

45
Q

waht 2 pigmented lesions is not due to sun exposure

A
  1. lentigo simplex
  2. oral melanotic macule
46
Q

who is mostly affected in oral melanoma acanthoma

A

african american

women

smooth, darkly pigmented MACULE in the buccal mucosa

47
Q

is oral melanoacanthoma common

how do you make sure its not maligantn

A

rare

incisonal biopsy

48
Q

cafe au lait spot is similar to waht disease

A

albright syndrome

49
Q

youll see ___ ___ macules in cafe au lait spot

A

flat brown macules

1.5cm OR GREATER diameter

50
Q

6 or more flat brown macules [cafe au lait spot] can be given this diagnosis

A

neurofibromatosis

51
Q

cafe au lait spot is ___ % in indiv

A

10%

52
Q

how fast does oral melanoacanthoma gro

A

enlarges within **months very alarming **GROWTH RATE

53
Q

whih pigmented lesions have to be biopsied to rule out early melanom

A
  1. oral melanotic macule
  2. oral melanoacanthoma
  3. acquired melanocytic neuvs
54
Q

TF

lesions of acquired melanocytic nevus can arise at birth and throughout life

  1. will regress by mid life
A

true

true

55
Q

what % of newborns have congenital melanocytic nevus

A

1%

56
Q

can acquired melanocytic nevus be distinguished from congential melanocytic nevus micoscopically

  1. waht are the differnces
A
  1. no cant be distinguished
  2. congential melanocytic nevus is LARGER in DIAMETER
57
Q

what pigmented lesion up until this point has 3 - 15% undergoing malignant transformation to melanom

A

congential melanocytic nevus

58
Q

large congenital nevi 2 things

A
  1. has 3 - 15% malignant transformation to melanoma
  2. called bathing trunk and garment nevus
59
Q

what pigmented lesions has

BR/ BLK **plaques with rough surfaces **

A

congential melanocytic nevus

60
Q

waht is

Blue melanocytic nevus

melanin producing lesion

A

blue nevus

61
Q

melanin are ____ to the surface

blue color of this melanin producing lesion is explained by _______ _____

A

deep

Tyndall effect

62
Q

waht is the tyndall effect

A

interaction of light

with

particles

in colloidal suspension

63
Q

well circumscribed

deep blue macule

of the palatal mucosa

A

blue nevus

64
Q

histofeature of blue nevus

A
  1. melanin seen in **spindle shaped melanocytes **
  2. deep in LAMINA PROPRIA and PARALLEL to surface epi
65
Q

heavily pigmented spindle shaped cells

A

blue nevus

66
Q

tx for blue nevus

A

biopsy

make sure its not early melanoma

67
Q

waht is melanoma

A

MN MO

malignant neoplasm of melanocytic orgin

from

1) benign melanocytic lesion
2) de novo melanocytes

68
Q

waht is the major caustive factor of

melanoma

A

damage from UV radiation

69
Q

TF

**acute **sun damage is GREATER CAUSTIVE importance

than

**chronic **sun damage

A

true

70
Q

what are the 5 risk factors of melanoma

A
  1. light hair and skin
  2. indoor job
  3. burns easily
  4. hx with painful and blistering sunburn in childhood
  5. hx with DCN = dysplastic congential nevus
71
Q

TF

3rd most common skin cancer is melanoma

most deaths caused by skin cancer is melanoma

A

true

true

72
Q

melanoma has a high mutation in _____

A

BRAF gene

[ras - raf - erk] signaling pathway

73
Q

waht are the ABCDE of melanoma

A

A - assymetry

B - border irregularity

C - color variation

D - diameter is greater than 6mm

E -evolving

74
Q

Lentigo Maligna melanoma

A

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

75
Q

radial growth phase

A

superficial spreading of melanoma

most common

76
Q

Histofeatures of lentigo maligna melanoma

superifical spreading

A

1) radial growth phase
2) atypical melanocytes **ALONG THE BORDER **

of basilar portion of epidermis

3) indi melanocytes invading higher levels of epithelium

77
Q

acral lentiginous melanoma

A

1) most common among Af Amer
2) most common oral melanoma

78
Q

histofeatures of acral lentiginous melanoma

A

aytpical melanocytes **WITHIN basilar **portion of epidermis

invasion into SUPERFICIAL LAMINA PROPRIA

79
Q

_____ of _____

important for

histopathological evaluation

of cutaneous melanoma

A

depth of invasion

histopathologic evaluation

80
Q

why is the depth of invasion important

for histopatholgical evaluation

A

correlation with prognosis

81
Q

true or false

prognosis for oral melanoma is extremely poor

A

true extremely poor

82
Q

____ system of measurement

_____ classification

which one is more accurate

A

clark system of measurement

breslow classification [more accurate]

83
Q

clark system of measurement

A

assigns a level to the lesion

2) depends on the deepest anatomic cutaneous region

invaded by the tumor

84
Q

breslow classifcaiton

A

more accurate

measures the distance:

TOP of granular cell layer

to DEEPEST

85
Q

WORST PROGNOSIS:

Bans

A

BACK

POSTERIOR ARM

LATERAL NECK

SCALP

86
Q

5 background info of vitiligo

A
  1. **de pigmentation **of broad areas of the skin
  2. 1% incidence
  3. family tendency
  4. onset any age, esp 10 -30 yo
  5. maybe autoimmune
87
Q

3 clinical features of vitiligo

A
  1. stress
  2. injury

sun exposure

88
Q

TF

thyoid disease is common among vitiligo pt

  1. except for thyroid carcinoma
A

true

true

89
Q

___ ___ slight increase with vitiligo pt

A

DM

Addisons diease

90
Q

histofeature of vitiligo

A

NO MELANOCYTES

present in the skin

91
Q

Pityriasis [tinea] versicolor is caused by

A

fungus [malassezia furfur] found on normal skin

92
Q

4 reasons conversion of saprophyic -> morphologic form

A

1) genetic predilection

warm, humid evn

immunosuppressed malnutrition

cushing’s disease

93
Q

clinically waht does pityriasis versicolor look like

A

scaly skin macules

[obvious with pt tan in the summer]

94
Q

scaly skin macules that can be

HYPOpigmented

HYPERpigmented

A

HYPOpigmented scaly skin macules:

  1. tyrosinase
  2. inhibition of enzyme in melanin synthesis pathway

HYPERpigmented scaly skin macules:

fungus induces MELANOSOME ENLARGEMENT

95
Q

2 histofeatures of tinea versicolor

A
  1. short cigar butt hyphae
  2. KOH spores with short mycelium = sphagetti and meatball
96
Q

diagnosis of tinea versicolor is

A

confirming KOH examination

97
Q

tx of pityriasis [tinea] versicolor

A

oral treatments:

1) itraconazole
2) fluconazole

98
Q

TF

itraconazole and fluconazole DOES NOT PREVENT high rate of reoccurance

A

true

99
Q
A

Opath (6 decks)

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