Pigmented Lesions

Question 1

Definition: nevus cells migrate from neural crest to skin and occasionally mucous membranes?

Answer 1

nevi (common mole)

Question 2

Present at birth in about 1% of newborns, larger “garment nevus”

Answer 2

congenital nevus

Question 3

Genetic influence and the average person has about 15?

Answer 3

acquired nevus

Question 4

Definition: flat macule, nevus cell in basal epithelium at “junction” of epithelium and connective tissue

Answer 4

junctional nevus

Question 5

Definition: Nodule +/- hair, nevus cells in dermis or lamina propria?

Answer 5

intradermal nevus

Question 6

Definition: Nodule, combination of junctional and intradermal?

Answer 6

compound nevus

Question 7

Definition: dendritic nevus cells deep within connective tissue?

Answer 7

blue nevus

Question 8

Your patient is black with a mole on his cheek that is reactive, but resolves upon irritant removal. It appears as a reactive proliferation of intraepithelial dendritic melanocytes. What is it?

Answer 8

Melanoacanthoma

Question 9

Your patient recently did a lot of activity in the sun and came back to your office with multiple flat, tan macule on head and neck skin. What is it?

Answer 9

Ephelis (freckles)

Question 10

What causes freckles from sun exposure?

Answer 10

localized overproduction of melanin, not an increase in the number of cells

Question 11

Your patient is over 40 and/or elderly and has multiple flat evenly discolored macule from chronic UV damage. What are they?

Answer 11

actinic or senile lentigo AKA age spots or liver spots

Question 12

Your female age 43, has multiple 6.8mm tan to brown flat macule like a big freckle in the lower lip, palate, or gingiva. What are they?

Answer 12

melanotic macule

Question 13

What is the 3rd most common skin cancer?

Answer 13

malignant melanoma

Question 14

How do individuals get melanoma?

Answer 14

Acute sun damage
Fair complexion
multiple moles, freckles
family history

Question 15

What do the clinical features ABCD stand for for melanoma?

Answer 15

Assymetry - elevated surface as well
Borders - irregular
Color - variation
Diameter - growth, change, >6mm

Question 16

Melanoma has 2 growth phases. What are they?

Answer 16

Radial (75-85%)

Vertical (grown down into tumor)

Question 17

Most common clinical melanoma?

Answer 17

superficial (70%) in the trunk

Question 18

Second most common clinical melanoma?

Answer 18

nodular melanoma in Head and Neck

Question 19

Third most common melanoma?

Answer 19

lentigo maligna melanoma (old age) and on face

Question 20

Where does aural lentiginous melanoma grow?

Answer 20

palms, soles, subungual (toenail), mucous membranes

Question 21

Where does oral melanoma occur and how does it grow?

Answer 21

palate
Maxillary gingiva
radial growth

Question 22

Melanoma Tx?

Answer 22

excision with 1mm margin
lymph node dissection
chemo, radiation, immunotherapy

Question 23

Most important factor influencing survival of melanoma?

Answer 23

depth of invation

metastasis decreases survival

Question 24

What type of melanoma has a worse survival prognosis?

Answer 24

oral =

Question 25

What drugs cause multifocal pigmentation?

Answer 25

antimalarials
antiarrythmics (quinidine)
Tranquilizers (thorazine)
cis-platinum

Question 26

Patient walks in with a bronze coloration all over his body. What caused it and how?

Answer 26

adrenocortical insufficiency triggers hypothalamus to stimulate anterior pituitary to produce ACTH and MSH (melanin stimulating hormone)

Question 27

Patient walks in with oral and perioral freckles, especially on the lips and cheek and is complaining of intestinal polyps. What is it?

Answer 27

autosomal dominant

Peutz-Jeghers Syndrome

Question 28

A person walks in with cafe au laits spots. Name the generic condition and the syndrome?

Answer 28

Neurofibromatosis

McCune Albright syndrome

Question 29

A patient walks in with melanin pigmentation on his palate especially and possibly on the gingiva. What caused this?

Answer 29

smoker’s melanosis

Question 30

Name the last 4 multifocal pigmentations not covered

Answer 30

Physiologic
Satellite lesions
Kaposi’s sarcoma
Petechiae, ecchymosis, purpura