pigmented lesions Flashcards
15% of skin melanomas
Usually very pigmented, exophytic
Nodular melanoma
A malignant tumor that begins in melanocytes
3rd most common skin cancer; cause majority of skin cancer deaths; UV damage or genetic predisposition
Radial growth phase í horizontal spread
Vertical growth phase í invasion in CT
Asymmetric, irregular border, varying color
Diameter >6mm
Melanoma
or
Malignant melanoma
T/F
Smoker’s melanosis is premalignant.
FALSE
Smoker’s melanosis itself is not premalignant.
Incorporation of amalgam into the oral mucosa
Via mucosal abrasion, extraction sockets
macules or slightly raised
Blue, black, or grey
Well-defined or irregular or diffuse borders
Gingiva, alveolar mucosa, buccal mucosa
amalgam tattoo
6-7th decades ususally male usually dark, lobulated, exophytic mass usually not ulcerated >20% have no pigment
Acral lentiginous (palms, soles)
Unknown etiology; Due to focal increase in melanin
Oral (intraoral) or labial (vermillion)
Melanotic macule
Or
Focal melanosis
how is Lead Line/ Burton Line treated?
The condition is reversible if exposure to lead is eliminated
usually solitary, well-demarcated, asymptomatic
Lip vermillion, buccal mucosa, gingival, palate
Female predilection
Tan to dark brown, rarely blue or black
Melanotic macule
Or
Focal melanosis
Histologic appearance: granules of amalgam in CT
amalgam tattoo
Most common peripheral nerve neoplasm
Young adults; usually asymptomatic
Skin > oral cavity (tongue, buccal mucosa)
Interlacing bundles of spindle-shaped cells w/ wavy nuclei
Neurofibroma
congenital or developmental malformation
cutaneous lesions present before 35 years
high number in women
HN is common location
Acquired melanocytic nevus
Or
Pigmented nevus
Or
Mole
“café-au-lait” spots in 90% of cases
Crowe’s sign: axillary freckling
Lisch nodules: speckles in iris
Rarely, undergo malignant transformation.
neurofibromatosis type 1
5-10% of skin melanomas
Precursor lesion is lentigo malingna or Hutchinson’s freckle
Sun exposed to skin, often in mid-face region
Slowly expanding macule - 15 years
Nodularity (vertical growth) = sign of transformation to melanoma
Lentigo Maligna melanoma
Inherited, autosomal dominant
Type I Von Recklinghausen’s is most common
Increase in the size of fungiform papillae
Multiple neural tumors, especially neurofibromas
Papules, nodules, pendulous masses
Tumors develop at puberty, continue to adulthood
Few to 100’s of neurofibromas
Mostly mild disease
neurofibromatosis type 1
Autosomal dominant; rare
Asymptomatic
Freckles on hands, perioral skin, oral mucosa
Skin freckles occur in about half of patients
Do not increase or decrease with sun exposure í not true freckles
Peutz-Jeghers syndrome
anterior facial gingiva
Extent correlated with cigarettes/day,
Histopathology similar to melanotic macule
Gradually disappears with smoking cessation >3 years
22% of tobacco smokers have melanin (vs. 3% in non smokers) - Protective effect?
smoker’s melanosis/
tobacco associated pigmentation
how to rule out melanocytic neoplasia vs amalgam tattoo
biopsy
Pigmented Non-raised lesion Remains same size Darkens in sunlight Increase in melanin without an increased in melanocytes
Ephelis
Freckle
Spotty gray macules on the buccal mucosa, a coated tongue, neurologic deficits (tremor of the extended tongue), and hypersalivation.
lead line (Burton Line)
Very uncommon
Gray- black lead line that occurs from the deposition of lead sulfide in the marginal gingiva.
lead line aka Burton line
Benign tumors resulting from proliferation of peripheral nerve components: the Schwann cells and perineural fibroblasts. They commonly appear as sessile, firm, pink nodules. They may be solitary or multiple. Solitary nodules are rare.
Neurofibroma
Attached gingiva in patients with darker complexion
Even distribution
racial pigmentation
True or false: All oral pigmented macule should be biopsied.
TRUTH
Condition is not a normal physiologic process but instead results primarily from the deposition of melanin in the basal cell layer of the mucosa.
smoker’s melanosis/
tobacco associated pigmentation
Oral lesions - extension of perioral freckling
1-4mm brown to blue-gray macules
vermillion of lip, labial, buccal mucosa, tongue
Treatment: Monitor for intestinal obstruction (Intestinal polyposis which are hamartomas), tumors
Peutz-Jeghers syndrome
Most common type
70% of skin melanomas
Usually <3m
May be slightly raised
Superficial spreading melanoma
