Pigmented Lesions Flashcards
What gives lesions color
Blood
Melanin
Forein Material
Pigmentation due to blood
Intravascular
- Blanches
- Hemangioma
- Varix
- Kaposis sarcoma
Pigmentation caused by blood
Extravascular
- Does not blanch
- Petechiae
- Ecchymosis
- Hematoma
Hemangioma
Gen
Age
Treat
- 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
Venus Malformation
General
Treat
- 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
Sturge-Weber Angiomatosis
Genetic
Cause
Apperance
Distribution
Associated problems
- 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
Varix
Cause
Apperance
Tx
- 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
Kaposis Sarcoma
Gen
Cause
Assoc
Apperance
Distribution
Tx
- 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
Submucosal Hemorrhage
Def
Leads to
3 diff forms
- 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
Initial evaluation of Pigmented lesions 6
- 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
Localized Melanocytic Lesions of Oral Mucosa 4
- Ephelis
- Oral melanotic macule
- Nevus
- Melanoma
Oral Melanocytic Macule
Cause
Assoc
Apperance
Distribution
- 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
Oral Melanocytic Macule Management
- 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
Acquired Melanocytic Nevus
Cause
Onset
Management
Concerns
- 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
Blue Nevus
Cause
Location
Population target
- Proliferation of melanocytes deep in CT
- Second most common nevus in mouth
- Seen almost always on palate
- Children young adults F>M
Superficial Spreading Melanoma
Occurence
Assoc with
Age
Growth
Apperance
Location for genders
- 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
Lentigo Maligna Melanoma
Assoc
Common location and age
Apperance
Growth
- 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
Acral Lentiginous Melanoma
Location
Population
- Melanomas of oral mucosa, palms, soles, nail beds
- Most common in african americans
Oral Melanoma
Commonly seen in which gender
Location
Begins as
Becomes
- 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
Physiologic Pigmentation
Cause
App/dist
Age
- 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
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
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
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
