Pigmented lesions condensed

Question 1

these are entirely dermal and consist of pigment rich dendritic spindle cells. The cellular variant may have mitoses and mimic melanoma

Answer 1

Blue naevi

Question 2

Dendritic spindle cells in which type of naevi?

Answer 2

Blue naevi!

Question 3

Halo naevi are overun by which type of cell?

Answer 3

lymphoctyes

Question 4

have a peripheral halo of depigmentation. They show inflammatory regression and are overrun by lymphocytes

Answer 4

Halo naevi

Question 5

Dendritic spindle cells?

Answer 5

Blue naevi!!

Question 6

Consist of large spindle and/or epithelioid cells

Answer 6

Spitz naevi

Question 7

Problems with spitz naevi?

Answer 7

May closely mimic melanoma
Most are entirely benign
Difficult area as there is a malignant variant!

Question 8

Colour of spitz naevus?

Answer 8

Pink/red due to prominent vascularisation

Question 9

Commonest site for superficial spreading melanoma?

Answer 9

Trunk and limbs

Question 10

Commonest site for nodular melanoma?

Answer 10

Varied sites but often trunk

Question 11

Commonest site for acral/mucosal melanom?

Answer 11

Acral and mucosal duh

Question 12

Commonest site for lentigo maligna?

Answer 12

Sun damaged face/scalp

Question 13

How to recognise superficial spreading melanoma?

Answer 13

Looks like a well dodgy flat brown patchy patch with different colours
AREAS of REGRESSION!! i.e. may also have paler splotches within it!

Question 14

Why is nodular melanoma different?

Answer 14

No radial growth phase!! (RGP)

Only VGP

Question 15

Breslow thickness

Answer 15

Deepest tumour from granular layer mm

Question 16

Strong adverse indicator for melanoma prognosis?

Answer 16

Ulceration

High mitotic rate, lymphovascular invasion, satellites, sentinel lymph node involvement

Question 17

Suffix b indicates what

Answer 17

Ulceration

Question 18

Satellite

Answer 18

Satellite lesions are small nodules of tumour/melanoma located more than 0.05mm from the primary lesion, but less than 2cm

Question 19

Hoe does malignant melanoma spread?

Answer 19

1) Satellite deposits of MM
2) Regional lymph node metastases
3) Blood spread (skin/soft tissue, heart, lungs, GI tract, Liver, Brain)

Question 20

Treatment for melanoma?

Answer 20

Primary excision to give clear margins
Some also receive a sentinel node biopsy
If SN positive - regional lymphadenectomy

Treatment of advanced disease difficult
Chemo, immunotherapy, genetic therapies

Question 21

If in situ-clear by

Answer 21

5mm

Question 22

If invasive but less than 1mm thick, clear by

Answer 22

1cm

Question 23

If invasive and more than 1mm thick, clear by

Answer 23

2cm

Question 24

When would you do SNB?

Answer 24

If >1mm thick or thinner with mitoses

SNB = sentinel node biopsy

Question 25

Imatinib

Answer 25

Acral melanomas (c-kit mutation)

Question 26

Dabrafenib and vemurafenib interfere with which pathway?

Answer 26

MEK/ERK pathway (BRAF) -some melanomas on intermittendly sun-exposed skin may have a BRAF mutation

Question 27

Difference between ephilides and lentigines?

Answer 27

Lentigines do not darken following sun exposure

Question 28

Increased basal melanocytes (nests) with downgrowths at dermo-epidermal junction

Answer 28

Navei

Question 29

Acquired melanocytic naevi?

Answer 29

Junctional Compound Intradermal

Question 30

How do congenital melanocytic naevi differ from acquired naevi?

Answer 30

Larger, slightly raised Become more rugose and elevated as child grows older Increased risk of melanoma in large naevi

Question 31

In atypical naevus syndrome, how does your risk of melanoma increase?

Answer 31

Increases by 2 if you have 2 | Increases by 6 if you have 6

Question 32

Dermoscopy of melanoma

Answer 32

atypical pigment network, black dots, irregular streaks, | focally a blue-whitish veil and a white regression zone with hairpin vessels

Question 33

Most common subtype of melanoma?

Answer 33

Superficial spreading

Question 34

Increased melanoma in asian and african people?

Answer 34

Acral lentiginous melanoma

Question 35

Hutchinson sign

Answer 35

Pigmented excision into the nail fold | ACRAL MELANOMA

Question 36

Stuck on appearance

Answer 36

Seborrhoeic keratoses

Question 37

very common older Caucasians brown / black greasy lesions often on trunk usually multiple “stuck-on” appearance often “warty” but may be flat regular border may detach spontaneously or in part

Answer 37

Seborrhoeic keratoses

Question 38

Talon noir

Answer 38

Black heel due to haematoma | -caused by trauma