pigmented lesions

Question 1

15% of skin melanomas

Usually very pigmented, exophytic

Answer 1

Nodular melanoma

Question 2

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

Answer 2

Melanoma

or

Malignant melanoma

Question 3

T/F

Smoker’s melanosis is premalignant.

Answer 3

FALSE

Smoker’s melanosis itself is not premalignant.

Question 4

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

Answer 4

amalgam tattoo

Question 5

6-7th decades
ususally male
usually dark, lobulated, exophytic mass
usually not ulcerated
>20% have no pigment

Answer 5

Acral lentiginous (palms, soles)

Question 6

Unknown etiology; Due to focal increase in melanin

Oral (intraoral) or labial (vermillion)

Answer 6

Melanotic macule

Or

Focal melanosis

Question 7

how is Lead Line/ Burton Line treated?

Answer 7

The condition is reversible if exposure to lead is eliminated

Question 8

usually solitary, well-demarcated, asymptomatic
Lip vermillion, buccal mucosa, gingival, palate
Female predilection
Tan to dark brown, rarely blue or black

Answer 8

Melanotic macule

Or

Focal melanosis

Question 9

Histologic appearance: granules of amalgam in CT

Answer 9

amalgam tattoo

Question 10

Most common peripheral nerve neoplasm
Young adults; usually asymptomatic
Skin > oral cavity (tongue, buccal mucosa)
Interlacing bundles of spindle-shaped cells w/ wavy nuclei

Answer 10

Neurofibroma

Question 11

congenital or developmental malformation
cutaneous lesions present before 35 years
high number in women
HN is common location

Answer 11

Acquired melanocytic nevus

Or

Pigmented nevus

Or

Mole

Question 12

“café-au-lait” spots in 90% of cases
Crowe’s sign: axillary freckling
Lisch nodules: speckles in iris
Rarely, undergo malignant transformation.

Answer 12

neurofibromatosis type 1

Question 13

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

Answer 13

Lentigo Maligna melanoma

Question 14

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

Answer 14

neurofibromatosis type 1

Question 15

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

Answer 15

Peutz-Jeghers syndrome

Question 16

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?

Answer 16

smoker’s melanosis/

tobacco associated pigmentation

Question 17

how to rule out melanocytic neoplasia vs amalgam tattoo

Answer 17

biopsy

Question 18

Pigmented
Non-raised lesion
Remains same size
Darkens in sunlight
Increase in melanin without an increased in melanocytes

Answer 18

Ephelis

Freckle

Question 19

Spotty gray macules on the buccal mucosa, a coated tongue, neurologic deficits (tremor of the extended tongue), and hypersalivation.

Answer 19

lead line (Burton Line)

Question 20

Very uncommon

Gray- black lead line that occurs from the deposition of lead sulfide in the marginal gingiva.

Answer 20

lead line aka Burton line

Question 21

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.

Answer 21

Neurofibroma

Question 22

Attached gingiva in patients with darker complexion

Even distribution

Answer 22

racial pigmentation

Question 23

True or false: All oral pigmented macule should be biopsied.

Answer 23

TRUTH

Question 24

Condition is not a normal physiologic process but instead results primarily from the deposition of melanin in the basal cell layer of the mucosa.

Answer 24

smoker’s melanosis/

tobacco associated pigmentation

Question 25

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

Answer 25

Peutz-Jeghers syndrome

Question 26

Most common type
70% of skin melanomas
Usually <3m
May be slightly raised

Answer 26

Superficial spreading melanoma