Pigmented lesions and melanoma Flashcards
3 questions for evaluating pigmented lesions
same for last year?
symmetric w/ distinct border and one color?
similar to other moles?
yes to all 3 likely benign
melanoma risk w/ small and medium congenital nevi
less than 1%
risk of melanoma w/ large or giant nevi
5-10%
when to consider biopsy for acquired nevi
new lesions after 50, usually in sun exposed areas
normal changes for nevi
progress to skin colored or pink
symmetry and diameter stay constant
melanoma compared to other nevi
nevi have signature form on a pt, the ugly duckling more likely melanoma
ABCDE of melanoma
Asymmetry Border -irregularity Color- irregular, multi Diameter- greater than 6mm Evolving
describe atypical nevi
variegated color
can have fried egg appearance w/ peripheral macular and central papular
sites for melanoma to develop
atypical nevi and normal skin, more common on latter
atypical mole syndrome
over 50 nevi, usually appears near puberty
increased risk for melanoma
removal of all nevi not recommended
how to biopsy pigmented lesion
take photo first
biopsy entire lesion, need full thickness to see breslow depth (important for px)
genes seen in melanoma
CDKN2A and CDK4 over half
p53 and BRCA2 also seen
subtypes of melanoma 5
superficial spreading- most common, mainly horizontal growth
nodular-rapid vertical growth and increase breslow depth (from granular layer to deepest part of tumor)
lentigo maligna-slow, on sun damaged skin, horizontal
acral lentiginous- more common in dark skin, delayed dx
amelanotic- variable appearanc, confused w/ psoriasis etc
management of melanoma
excision if more than .8mm breslow
excision and node biopsy when greater than .8mm
vitiligo like hypopigmentation w/ immunotherapy for mets melanoma
good sign, positive response
