Pigmented Lesions

Question 1

what are dome-shaped papules on the face that are generally smaller than 4 mm with sharp borders. can be mammillated (with small protuberances) and have hypertrichosis

Answer 1

• congenital nevi

Question 2

what is hypertrichosis

Answer 2

• growth of hairs out of the mole

Question 3

for small and medium-sized congenital nevi, what is the risk of developing melanoma

Answer 3

< 1%

Question 4

what size are large or giant nevi

Answer 4

> 20 cm

Question 5

for large/giant nevi, the risk of developing melanoma is

Answer 5

5-10%

Question 6

treatment fo small/medium-sized congenital nevi

Answer 6

• shave removal or excision if bothersome

Question 7

when do common acquired nevi occur

Answer 7

• 1st or 2nd decade

Question 8

consider _____(technique) for new lesions after age 50

Answer 8

• biopsy

Question 9

common acquired nevi are more common where

Answer 9

• sun-exposed areas - increased sun exposure

Question 10

changes of nevi over time

Answer 10

• brown macules and papules in youth - progress to skin-colored or pink papules

Question 11

nevi in an individual tend to share a similar pattern, called a ___________

Answer 11

• signature nevus

Question 12

ABCDEs of melanoma

Answer 12

• asymmetry - border - color - diameter - evolving

Question 13

what makes a nevus atypical

Answer 13

• variegated color - fried egg appearance

Question 14

fried egg appearance of a nevi has a peripheral _____ component

Answer 14

• macular

Question 15

fried egg appearance of a nevi has a central _____ component

Answer 15

• papular

Question 16

patients with how many atypical nevi are at an increased risk for developing melanoma over their lifetime

Answer 16

> 5

Question 17

are atypical nevi precancerious

Answer 17

• no

Question 18

what is the syndrome where a patient may have > 50 nevi and may exceed 100

Answer 18

• atypical mole syndrome

Question 19

atypical mole syndrome usually appears near what age

Answer 19

• puberty

Question 20

when you biopsy a lesion, how do you biopsy it

Answer 20

• biopsy the ENTIRE LESION

Question 21

what is Breslow depth

Answer 21

• full thickness of the lesion

Question 22

what is a dark blue to black plaque demonstrating asymmetry, irregularly notched borders, and a pink erythematous rim

Answer 22

• melanoma

Question 23

genes identified in melanomas

Answer 23

• CDKN2A - CDK4 - p53 - BRCA2

Question 24

cell of origin for melanoma

Answer 24

• melanocyte

Question 25

etiology of melanoma

Answer 25

• prolonged UVB/UVA exposure

Question 26

what is the single most important prognostic factor for survival and clinical management

Answer 26

• Breslow depth

Question 27

what subtype of melanoma is the most common type where the growth of the tumor is primarily horizontal rather than down into the dermis

Answer 27

• superficial spreading type

Question 28

superficial spreading type involves ____ in men and ____ in women

Answer 28

• back in men - legs in women

Question 29

what subtype of melanoma has rapid growth that is vertical and gives the tumor an increased breslow’s depth

Answer 29

• nodular type

Question 30

what subtype of melanoma occurs on chronically sun-damaged skin with slow progression

Answer 30

• lentigo maligna

Question 31

what subtype of melanoma is more common in people with darker skin color and diagnosis if often delayed so the lesions tend to be many centimeters in diameter

Answer 31

• aural lentiginous

Question 32

what subtype of melanoma has a variable appears and can be confused with psoriasis, dermatitis, BCC, SCC, and is difficult to diagnose

Answer 32

• amelanotic type

Question 33

< 0.8 mm Breslow depth requires what for treatment

Answer 33

• surgical excision

Question 34

> 0.8 mm Breslow depth requires what for treatment

Answer 34

• local excision - sentinel node biopsy

Question 35

treatment for metastatic melanoma

Answer 35

• BRAF inhibitor and MEK inhibitor - (fenib) and trametinib