Pigmented Lesions Flashcards
1
Q
What gives lesions color
A
Blood
Melanin
Forein Material
2
Q
Pigmentation due to blood
Intravascular
A
- Blanches
- Hemangioma
- Varix
- Kaposis sarcoma
3
Q
Pigmentation caused by blood
Extravascular
A
- Does not blanch
- Petechiae
- Ecchymosis
- Hematoma
4
Q
Hemangioma
Gen
Age
Treat
A
- Not present at birth
- tumor of infancy that has rapid growth and endothelial cell proliferation
- Gradual involution
- Found in 5-10% 1 yo, more common in Females
- Will regress
- Systemic corticosteroids may help reduce size
5
Q
Venus Malformation
General
Treat
A
- Present at birth and persists through life
- Anomalies of blood vessels
- No endothelial proliferation
- Treat
- small-no treatment
- Large-sclerosing agent and later resection
- Biopsy is contraindicated
6
Q
Sturge-Weber Angiomatosis
Genetic
Cause
Apperance
Distribution
Associated problems
A
- Non-hereditary developmental condition
- Vascular proliferation involving tissues of brain and face
- Born with vascular malformation- Port Wine Stain
- Unilateral along 1 or more segments of trigeminal nerve
- Leptomeningeal angiomas on ipsilateral cerebral cortex may cause mental retardation or convulsive disorder
7
Q
Varix
Cause
Apperance
Tx
A
- Abnormally dilated and tortous veins
- Common in elderly
- Loss of CT tone supporting vessels
- Usually blanches, unless thrombosis
- Commonly sublingual
- Firm, non-tender, blue-purple
- No tx needed
8
Q
Kaposis Sarcoma
Gen
Cause
Assoc
Apperance
Distribution
Tx
A
- Vascular neoplasm
- Caused by Human Herpesvirus 8 (HHV8)
- Seen in association with HIV
- Painless blue-purple macules/plaque on surface of skin
- Orally- usually on palate
- Tx- chemo or radiation
9
Q
Submucosal Hemorrhage
Def
Leads to
3 diff forms
A
- Bruise from minor trauma
- Leads to extravasated erythrocytes
-
Petechiae
- very small hemorrhages into skin, mucosa, serosa
-
Ecchymosis
- blood accumulation greater than 2 cm
-
Hematoma
- accumulation produces mass
- Non-blanching
10
Q
Initial evaluation of Pigmented lesions 6
A
- Localized vs diffuse
- Flat (macule) vs raised (plaque)
- Blanching vs non- blanching
- Duration if known
- Has lesion changed in shape
- Has lesion increased in size
11
Q
Localized Melanocytic Lesions of Oral Mucosa 4
A
- Ephelis
- Oral melanotic macule
- Nevus
- Melanoma
12
Q
Oral Melanocytic Macule
Cause
Assoc
Apperance
Distribution
A
- Increased melanin production- hyperactivity of melanocytes
- Not sun related
- Apperance
- Brown discoloration, uniform in color
- Flat- not thickened or raised
- Typically solitary
- well defined, reg borders
- Round oval
- Vermillion border of lower lip, gingiva, buccal mucosa, palate
- No premalignant potential
13
Q
Oral Melanocytic Macule Management
A
- Small unchanging non thickened lesions uniform in color and with regular borders can be followed
- Indications to biopsy
- Recent onset, enlargement, unknown duration
- Raised
- Large
- Irregular pigmentation
14
Q
Acquired Melanocytic Nevus
Cause
Onset
Management
Concerns
A
- Malformation of skin and mucosa
- Proliferative melanocytes, neveus cells
- Develop during childhood
- Management
- May be flat early on but raies and thickens
- Premalignant and complete excision recommended
- Cant distinguish btw Melanoma
15
Q
Blue Nevus
Cause
Location
Population target
A
- Proliferation of melanocytes deep in CT
- Second most common nevus in mouth
- Seen almost always on palate
- Children young adults F>M
16
Q
Melanoma of the skin
Type of
Significant factors
A
- Malignant neoplasm of melanocytic origin
- Damage from UV major factor
- Acute sun exposure more significant than chronic
- Most cases in white adults
17
Q
Superficial Spreading Melanoma
Occurence
Assoc with
Age
Growth
Apperance
Location for genders
A
- Most common, accounts for most
- Assoc with acute and chronic sun
- Can occure in young adults
- Can remain in radial growth for years
- 70% of cutaneous lesions
- Macule with variety of colors, may be slightly elevated
- Interscapular M
- Legs of women
18
Q
Nodular Melanoma
Apperance
Growth
Location
A
- Domed darkly pigmented nodule
- Grows rapidly
- Starts in vertical growth and thus tends to be deeply invasive
- Mainly head and neck
19
Q
Lentigo Maligna Melanoma
Assoc
Common location and age
Apperance
Growth
A
- Associated with chronic sun
-
Most commonly on face of elderly
- cheeks hands
- Appears as 1 or more arising in a solar lentigo
- Most slowly growing melanoma
- Remains in Radial growth for years
- Brown nonthickened macule larger than freckle
20
Q
Acral Lentiginous Melanoma
Location
Population
A
- Melanomas of oral mucosa, palms, soles, nail beds
- Most common in african americans
21
Q
Melanoma Areas of Bad prognosis
BANS
A
- Interscapular area of Back
- Posterior upper Arm
- Posterior and lateral Neck
- Scalp
22
Q
Oral Melanoma
Commonly seen in which gender
Location
Begins as
Becomes
A
- 66% men
- 80% palate or maxillary alveolus
- Begins as brown or black macule
- Become exophytic mass
- Usually thickened or raised, but may be flat
- Lesion is usually advanced at initial presentation, poor prognosis
23
Q
ABCDE of Melanoma
A
- Asymmetry
- Border irregularity
- Color variation
- Diameter greater than 6mm
- Evolving
24
Q
Physiologic Pigmentation
Cause
App/dist
Age
A
- Increased Melanin production
- Oral pigmentation is similar to skin color
- Symmetric and persistent
- Gingiva most common
- Does not alter normal structure
- All ages and genders
25
Peutz-Jeghers Syndrome
Cause
Apperance/location
Features
Oral apperance and location
* Genetic mutation
* Frekle like (doesnt wax and wane with sun) lesions of the hands, perioral skin and oral mucosa
* GI features
* Oral lesions
* Vermillion zone labial buccal mucosa tongue
* 1-4mm blue-gray macules
26
Addisons Disease
Cause
Symptoms
Apperance and cause of
Tx
* Insufficient production of adrenal corticosteroid hormones
* **Mineralcorticoid, cortisol**
* Destruction of **adrenal cortex or pituitary dysfunction**
* Fatigue depression irratibility hypotension
* Bronzing- hyperpigmentation
* ACTH stimulates melanocytes
* Diffuse brown macular pigmentation of oral mucosa
* Tx test serum cortisol, replacement therapy
27
Soking Associated Melanosis
Location
Cause
Tx
* Most common in anterior gingiva
* Palate and buccal mucosa
* Tobacco stimulates melanocytes
* Pigmentation resolves after quitting
28
Melasma
Apperance
Cause
Assoc
* AKA mask of pregnancy
* Hypermelanosis
* Irregular, symmetric, brown macules on **sun exposed face and lips**
* Cause unknown but assoc with pregnancy
* Also use of oral contraceptives
* Perhaps link with estrogen receptors
29
Drug-induced Pigmentation
Cause
* Several meds cause discoloration
* Stimulation of melanocytes of deposition of drug metabolites
* Most produce diffuse melanosis
* Tx not needed
* Discontinue meds
30
Drugs that cause drug-induced pigmentation 8
* Estrogen
* **Anti-malarial drugs**
* **Anti-psychotic**
* Chemotherapeutic drugs
* Laxatives
* Meds for AIDS **AZT**
* **Tetracycline- assoc with hairy tongue**
* **Minocycline**
31
Neurofibromatosis
Cause
Apperance
Inc risk of
Tx
* Gene mutation
* App
* Multiple cafe au lait freckles, 6 freckles at least for diagnosis
* Axillary freckling
* Multiple neurofibromas
* Lisch nodules- eyes
* Other CNS lesions
* Increased incidence of neurogenic sarcoma
* No tx
32
Heavy Metal Pigmentation
* Arsenic, bismuth, platinum, lead, silver, mercury
* Occupational exposure to vapors
* Deposited in skin and oral mucosa
* Gray to black color
* Burtons line (lead)- blue gray line along gingival margin
* Arhyria (silver)- blue man
33
Melanoacanthoma
Pop
Location
App
Growth tx
* Appears to be a reactive process
* Almost always in **AA**
* Buccal mucosa most common
* Usually solitary, can be bilateral or multifocal
* Typically smooth, flat, dark brown-black asymptomatic
* **Often rapid growth**
* **Biopsy to rule out melanoma**
34
Melonama
Growth phases
* Radial growth
* Melanoma cells along the epidermal-dermal junction and grow laterally
* May remain for yrs
* Does not metastasize during this time
* Vertical growth phase
* Melanoma cells grow down
* Metastasis occurs
35
Melanoma tx and prognosis factor
* Surgical excision
* Depth of invasion most imp prognostic factor
36
Amalgam Tattoo
* Soft tissue implantation of amalgam particles
* Most common pidmentation of oral mucosa
* Typically macular and gray
* May be detected by radiographs
