Pigmented Lesions Flashcards
1
Q
What gives lesions color?
A
- Blood
- Melanin
- Foreign material
2
Q
Hemangioma
A
- Tumor of infancy that has rapid growth and endothelial cell proliferation
- Not present @ birth - first 8 wks of life
- Rapid growth phase followed by gradual involution
- Most common
- 60% in head/neck, more in females
- Tx: N/A, they regress on their own. Systemic corticosteroids may help reduce size
3
Q
Vascular Malformation
A
- Anomalies of BV’s w/o endothelial proliferation
- Present @ birth & persists through life
- Tx:
- Small lesion: N/A
- Large lesion: Sclerosing agent and resection
4
Q
Sturge-Weber Angiomatosis
A
- Vascular proliferation involving tissues of brain and face
- Non-hereditary developmental condition
- Vascular malformation of the face = port wine stain
- Unilateral distribution along one or more segments of trigeminal nerve
- Leptomeningeal angiomas on ipsilateral cerebral cortex may cause convulsive disorder or mental retardation
- Tx:
- Flash lamp pulsed dye laser can improve esthetics
- Mental complications/epilepsy may need neurosurgical tx
5
Q
Varix
A
- Abnormally dilated & tortuous veins
- Common in older adults
- Loss of CT tone supporting vessels
- Usually blanche, but not if thrombus
- Common location: sublingual varix
- Tx: N/A; removed for esthetics
6
Q
Kaposi’s Sarcoma
A
- Vascular neoplasm caused by HHV-8
- Associated w/ HIV
- Painless blue-purple macules/plaques on surface of the skin
- Oral lesions generally occur on the palate
- Tx: Chemo or radiation
7
Q
Sarcoma vs. Carcinoma
A
Sarcoma: Mesenchymal tissue so BVs, nn, salivary glands
Carcinoma: Epithelial derived
8
Q
Petechiae
A
Small hemorrhages into skin, mucosa, serosa
9
Q
Ecchymosis
A
Blood accumulation >2cm
10
Q
Hematoma
A
Accumulation produces a mass
11
Q
Ephelis (Freckle)
A
- Represent region of increased melanin production
- Face, arms, back of fair-skinned, blue-eyed, red or blond hair
- Melanocortin-1-receptor gene (MC1R)
- More pronounced after skin exposure
12
Q
Oral Melanocytic Macule
A
- Brown, mucosal discoloration due to increased melanin production
- Flat
- Not related to sun exposure
- Vermillion border of lower lip (33%), buccal mucosa, gingiva, palate
- Typically solitary (83%), well-defined, round/oval, <7cm
- No premalignant potential
- Management
- Small, unchanging non-thickened lesions uniform in color w/ regular borders can be followed
- Indications to biopsy a suspected melanotic macule
- Recent onset, recent enlargement, or unknown duration
- Raised
- Large size
- Irregular pigmentation
13
Q
Melanoacanthoma
A
- Reactive process
- Almost exclusive to AA, mostly 3rd & 4th degrades
- Buccal mucosa most common
- Usually solitary, but occasionally bilateral or multifocal
- Typically asymptomatic, smooth, flat, dark-brown to black
- Often demonstrate rapid growth, reaching several cm in a few wks
- Management: Biopsy to rule out melanoma
14
Q
Nevus (Acquired Melanotic Nevus)
A
- Malformation of the skin and mucosa
- Proliferation of nevus cells, which are derived from neural crest
- Develop during childhood and more are present before 35yo
- Men and women, more in whites, above the waist
- Management:
- May be flat early in development, but eventually raised/thickened
- Oral nevus is considered premalignant & should be completely excised
- Melanoma cannot always be distinguished from nevus on a clinical basis
15
Q
Blue Nevus
A
- Proliferation of melanocytes deep in CT
- Second most common nevus in the mouth
- Seen almost always in the palate
- Children & young adults, female predilection
18
Q
Superficial spreading melanoma
A
- Most common type of melanoma. Accounts for increased incidence of melanoma
- Associated w/ acute & chronic sun exposure
- Can occur in young adults
- Can remain in radial growth phase for years
- Nicest, spreads along the surface instead of invading
19
Q
Nodular Melanoma
A
- Appears as a dome-shaped, darkly pigmented nodule
- Grows rapidly
- Exists in the vertical growth phase from the beginning, thus tends to be deeply invasive
20
Q
Lentigo Maligna Melanoma
A
- Associated w/ chronic sun exposure
- Occurs most commonly on the face of older adults
- One or more darkly pigmented nodules arising in a solar lentigo
- The most slow growing melanoma - may remain in radial growth phase for years
- Solar lentigo: Brown (non-thickened) macule, larger than a freckle
- Occurs on chronically sun-exposed skin, esp cheeks and dorsal surface of hands
- Constant pigmentation
21
Q
Acral (mucosal) Lentiginous Melanoma
A
- Most common form in the oral cavity
- Melanomas of oral mucosa, palms, soles, nail beds
- Most common in AA
22
Q
Oral Melanoma
A
- Patients 6th-7th decades
- 66% men
- 80% palate or MX alveolus
- Begins as black-brown macule
- Becomes exophytic mass
- Typically thickened & raised but may be flat early in development
- Lesion is usually advanced at initial presentation and has poor px
23
Q
ABCDE - Clinical Features of Melanoma
A
- Asymmetry
- Border irregularity
- Color variation
- Diameter >6mm
- Evolving
28
Q
Generalized Physiologic Melanotic Lesions of Oral Mucosa
A
- Symmetric & persistent
- Does not alter normal architecture
- Seen in all ages and genders
- Found in any location, gingiva is most commonly affected
-
Occurs due to increased production of melanin
- Similar in intensity to skin pigmentation
29
Q
Addison’s Disease
A
- Insufficient production of adrenal corticosteroid hormones (mineralcorticoids, cortisol)
- Destruction of adrenal cortex or pituitary gland dysfcn
- Fatigue, irritability, depression, weakness, hypotension
- Bronzing: Generalized hyperpigmentation of skin
- Caused by increased ACTH stimulating melanocytes (primary)
- Diffuse, brown, macular pigmentation of oral mucosa
- Dx: Lab test
- Cortisol <20ug/dL
- High ACTH: Primary
- Low/normal ACTH: Secondary
- Tx: Replacement tx
30
Q
Peutz-Jeghers Syndrome
A
- Freckle-like lesions of hands, perioral skin & oral mucosa (do not wax/wane w/ sun exposure)
- Genetic mutation
-
Gastro-intestinal features
- Intestinal polyposis (not premalignant)
- Intestinal obstruction due to intussusception
- GI malignancy: 33% by 60yo
-
Oral lesions seen in 90% of pts
- Vermillion zone, labial/buccal mucosa, tongue
- 1-4mm blue-gray macules
- Tx: Monitored for intussusception or tumor formation; genetic counseling
31
Q
Neurofibromatosis
A
- Genetic mutation
- Clinical features
- Café au lait freckles - 6 freckles at least 1.5cm in diameter needed for dx
- Axillary freckling
-
Multiple neurofibromas
- Benign tumor of neural & fibril tissue
- Lisch nodules
- Other CNS lesions
- Increased incidence of neurogenic sarcoma
- Tx: Symptomatic tx
32
Q
Smoker’s Melanosis
A
- Most common in anterior gingiva
- Palate & buccal mucosa from pipe smoking
- Pigmentation often resolves w/in 3yr after smoking cessation
- Tobacco is stimulating melanocyte activity
- Lesion is not premalignant in itself
33
Q
Melasma
A
- Irregular, symmetric, brown macules on sun-exposed face and lips
- AKA mask of pregnancy
- Hypermelanosis
- Unknown cause but associated w/ pregnancy
- May also occur with oral contraceptives
- Estrogen receptor link
34
Q
Medication Induced Pigmentation
A
- Drug metabolites stimulate melanocytes
- Most produce diffuse melanosis
- Estrogen
- Anti-malarials, anti-psychotics, chemotherapeutics, laxatives, AIDS meds, tetracycline, minocyclines
- Tx: N/A; d/c drug
35
Q
Heavy Metal Ingestion
A
- Arsenic, bismuth, platinum, lead, silver, mercury
- Mainly after occupational exposure to vapors
- Can be deposited in skin & oral mucosa
- Gray to black color
36
Q
Amalgam Tattoo
A
- ST implantation of amalgam particles
- Passive transfer by chronic friction of mucosa against amalgam restoration
- Most common pigmentation of oral mucous membranes
- Typically macular & gray
- May be detected in rads
