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RB Y2 Dermatology > Pigmented Skin Lesions > Flashcards

Pigmented Skin Lesions Flashcards

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Dermatology Board Prep flashcards
1
Q

describe what melanocytes do during embryogenesis

A

derived from the neural crest, early in embryogenesis melanoblasts migrate to skin, uveal tract and leptominges - when they settle in the skin they form melanocytes. basally situated

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2
Q

does the melanocyte to keratinocyte ratio change depending on race

A

no

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3
Q

melanocytes

A

pigment producing dendritic cells

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4
Q

melanocyte role with UV radiation

A

protect DNA from UV radiation - convert tyrosine to melanin which absorbs light and form a protective cap over nucleus

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5
Q

what does non cancerous growth of melanocytes result in

A

moles and freckles

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6
Q

what gene determines the balance of pigment in skin and hair

A

MC1R

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7
Q

eumelanin causes what hair colour

A

everything but red

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8
Q

phaeomelanin causes what hair colour

A

ed

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9
Q

MC1R role

A

convert phaeomelanin to eumelanin

determines the balance of pigment in skin and hair

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10
Q

one defective copy of MC1R

A

freckles

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11
Q

two defective copies of MC1R

A

red hair

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12
Q

another name for freckles

A

ephilides

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13
Q

what is a freckle

A

a patchy inc in melanin pigment that occurs after UV exposure

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14
Q

actinic/solar lentigines

A

also known as liver/age spots found on face, forearms and dorsal aspects of the hands

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15
Q

actinic/solar lentigines histological features

A

epidermis elongated rete ridges and increase in melanin and basal melanocytes

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16
Q

another name for mole

A
  • melanocytic naevi
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17
Q

size of small mole

A

<2cm diameter

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18
Q

size of medium mole

A

>2 and <20 cm

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19
Q

what risk do large moles have

A

risk of melanoma - surgical excision

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20
Q

usual type acquired naevi

A

A melanocyte proliferation (breakdown of the melanocytes:keratinocytes ratio) which arises in the epidermis and then spreads to the dermis.

Within time the epidermal component, and subsequently the entire naevus disappears.

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21
Q

histological features of usual type acquired naevi

A

epidermis shows lengthening of rete ridges and slight hyperkeratosis

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22
Q

3 phases of naevi

A

junctional compound intradermal

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23
Q

junctional phase

A

naevi arise from epidermal melanocytes, situated at DEJ, these proliferate and form cell nests

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24
Q

compound phase

A

naevus extend into superficial dermus (clinically innocent phenomenon) involve both junction and dermis proper

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25
Q

intradermal phase

A

junctional component disappears in adulthood so all naevus cells are now intradermal

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26
Q

dysplastic naevi size

A

generally >6mm diameter

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27
Q

dysplastic naevi

A

varied pigment and border asymmetry - some hallmarks of melanoma but not enough to be classified as malignant

host reaction fibrosis and inflammation occurs

28
Q

how do dysplastic naevi occur

A

sporadically or familial

29
Q

what is the risk of melanoma with familial dysplastic naevi

A

lifetime risk up to 100% high penetrance (CDKN2A)

30
Q

halo naevi

A

peripheral halo of depigmentation due to loss of melanocytes from lymphocyte action

31
Q

blue naevi - dermal/epidermal involvement

A

entirely dermal

32
Q

blue naevi

A

uniform and structureless

consist of pigment rich dendritic spindle cells

33
Q

spitz naevus presentation

A

symmetrical reddish or skin coloured nodule

34
Q

spitz naevus

A

nest of spindle shaped melanocytes most are entirely benign but there is a malignant variant

35
Q

why are spitz naevus pink

A

due to prominent vasculature

36
Q

what cells do melanomas arise from

A

melanocytes which are found along the basal layer of the epidermis

37
Q

what is the 5 year survival rate for melanoma if confined to epidermis

A

95-100% (<1mm) cannot reach blood supply

38
Q

what is the 5 year survival rate for melanoma if entered the dermis

A

50%

39
Q

what is the 5 year survival rate for melanoma if it has metastasised

A

5%

40
Q

ABCDE rule

A

asymmetry, border, colour, diameter and evolution

41
Q

what is the ugly duckling sign

A

way to identify if any mole stands out from the rest

42
Q

where can superficial spreading melanomas occur

A

anywhere

43
Q

superficial spreading melanoma features

A

most common type, irregular shape, flat periphery and slow growing

grow laterally before vertical invasion

44
Q

where can nodular melanomas be found

A

anywhere

45
Q

nodular melanoma

A

Most aggressive type, grows rapidly from the start.

Presents as rapidly growing pigmented nodule which bleeds or ulcerates.

46
Q

where can Acral/Mucosal Lentiginous Melanoma be found

A

on the nails, soles of feet or palms of hands

may not be related to sun exposure

47
Q

who is Acral/Mucosal Lentiginous Melanoma most common in

A

coloured races

48
Q

where does lentigo maligna melanoma occur

A

sun damaged face/neck/scalp in old people

49
Q

what is the precursor lesion for lentigo maligna melanoma

A

lentigo maligna (Hutchinson’s freckle) - a slow growing macular area of pigmentation seen in elderly people, commonly on the face.

confined to epidermis (in situ)

diagnosed as lentigo maligna melanoma when the malignant melanoma has invaded the dermis

50
Q

what is the prognosis of melanoma related to

A

Breslow depth and ulceration

51
Q

what is breslow depth

A

deepest tumour measured from the granular layer down in mm

52
Q

what does the suffix B when describing tumour staging refer to

A

ulceration - worse prognosis

53
Q

what stain is used to determine lymph node involvement

A

S100

54
Q

what can acral melanomas with c-kit mutation be treated with

A

imatinib

55
Q

what mutation may melanomas on intermittently sun exposed skin have

A

BRAF mutation

56
Q

what is the role of BRAF

A

proto-oncogene that stimulates the MAPKK pathway stimulating cell division. The mutated form becomes a potent oncogene that drives cell division

57
Q

what drugs interfere with the BRAF MAPKK pathway

A

eg dabrafenib and vemurafenib

58
Q
A

spitz naevus

59
Q
A

superficial spreading melanoma

60
Q
A

lentigo maligna melanoma

61
Q
A

halo naevi

62
Q
A

dysplastic naevi

63
Q
A

dysplastic naevi

64
Q
A

melanoma arising in a dysplastic naevi

65
Q

what is this naevi

A

junctional

66
Q

what is this naevi

A

intradermal

67
Q

what is this naevi

A

compound

RB Y2 Dermatology (22 decks)

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