Pink tumours Flashcards
How does tumour volume influence vascular morphology?
Flat tumour - mainly see dotted vessels
Elevated tumour - see curved vessels - parts of loops of vessels
Nodular tumour - see linear vessels - long parts of vessels
How does melanoma size influence vascular morphology?
< 1 mm : dotted - coiled
< 2 mm : coiled - linear irregular
> 2 mm : linear irregular
a polymorphous (crazy) vascular pattern is suggestive of ….
Malignant tumour
polymorphous vessel definition
> 1 type vessel arrange in chaotic distribution
most common vessel combination in melanoma
dotted + linear vessels
Approach to pink tumours : use the …
3 Step Algorithm
3 Step algorithm
1st step morphology of vessels - type of vascular pattern
2nd step architectural arrangement of vessels - distribution within lesion
3rd step Dermoscopic clues
6 main types of vessels
Comma, curved vessels. May vary in size.
Dotted
Linear irregular
Hairpin
Glomerular - coiled
Arborizing - branched, usually sharp in focus, large stem then finer
Hairpin vessel with surrounding white area is clue for …
keratinizing tumours
Glomerular vessels usually seen in ..
Bowen’s disease
Vascular arrangement - 6 types
Regular String - like Clustered Radial Branching Irregular
Dotted vessels in regular distribution usually seen in -
melanocytic skin tumours
Dotted vessels in string distribution usually seen in -
Clear cell acanthoma
Glomerular vessels in Bowen’s disease are usually arrange in ….
Clusters or groups
Hairpin vessels arrange in radial distribution associated with keratin found in ..
Squamous cell Ca
Red-purple aggregated globules seen in …
Cherry angioma
Bright red structureless areas with whitish intersections seen in …
Pyogenic granuloma
Milky red globules (strawberry milkshake) + central linear vascular pattern seen in ….
Thick amelanotic nodular melanoma
Crown vessels surrounding yellow area seen in …
sebaceous hyperplasia
Strawberry pattern - erythematous background intermingled with white to yellow hair follicles seen in …
actinic keratosis on face
Structureless pink areas and multiple erosions
Superficial BCC
Vascular patterns of melanocytic tumours
- Comma (curved) - Intradermal nevus
- Dotted (dots) - Spitzoid neoplasms
- Linear irregular (lines) - melanoma
Intraderal nevus Dermoscopy features
- Comma vessels
- Regular (Within papilla)
- Brown globules, comedo openings, milia
Dermoscopic features spitzoid neoplasms incl. Spitz nevus and melanoma in situ
- Dotted vessels.
- Regular pattern.
- Clues: Pink color, white network, residual brown-grey pigment.,
Features that favour Spitz nevus as opposed to early melanoma
- Early age
2. White network.
Features that favour invasive melanoma
- Lear/ irregular +/- dotted vessels
- Central
- Clues: Residual pigment. Pink color. White short stream. (Polarizing specific white lines.)
Linear irregular vessels. Distinguishing features from barbarizing vessels in BCC:
- Thinner
- Shorter
- Not as well defined - less sharply in focus.
% of true melanotic melanoma
< 2%
Amelanotic melanoma important clue
Residual pigment
Vascular patterns of non melanocytic tumours n
Hairpin vessels: Seb keratosis, may also be seen in SCC
Glomerular : Bowens disease.
Arborizing: BCC
Derm features seb keratosis
Hairpin vessels - usually at border. In centre mainly curved vessels.
Arrangement, regular
Clues: White halo around vessels, milia, comedo openings
Clear cell acanthoma
Morphology: Dotted.
Arrangement: String like
Clues: White halos around vessels.
Bowen’s disease
Morphology: glomerular
Arrangement: Clustered
Clues: White halo around vessels. yellow white scales.
Nodular cystic basal cell Ca
Morphology : arborizing.
Arrangement: Focussed.
Clues: Blue/grey globules
Superficial basal cell Ca
Morphology: Often lack vessels. Mainly seen at periphery as short linear vessels.
Clues: Structureless white to red areas
Multiple erosions.
White short lines (polarizing)
Importance of erosions in flat pink lesions
erosions occur late in melanoma and are not seen in flat melanoma.
multiple small erosions are important clue to basal cell carcinoma
How many grades of actinic keratosis?
3
AK, grade 1
Better felt than seen
AK, grade 2
Moderately thick. Easily felt and seen. Classic reddish plaques.
AK, grade 3.
Very thick. Hyperkeratotic.
AK Dermoscopy grade 1
red pseudo-network and fine scales.
lines around follicular openings which are similar in size and very fine
AK Dermoscopy grade 2
background erythema and white hair follicles (strawberry pattern)
hair follicles are enlarged, consist of central yellowish clod surrounded by white halo
background erythema
“strawberry pattern”
AK Dermoscopy grade 3
Structureless white/yellow keratotic areas.
Keratotic clods within hair follicles
Dermoscopy squamous cell carcinoma
Morphology: Hairpin, glomerular
Arrangement: Radial
Clues, white structureless areas, white circles
Central masses of keratin
Pinkish colour in suspect benign tumour - management
Biopsy - should not see pinkish colour in benign tumour
Suspected pyogenic granuloma - biopsy
May mimic melanoma
Benign pink lesions to know
- Intradermal nevus
- Seborrheic keratosis including clear cell acanthoma
- Sebaceous hyperplasia.
Any pink lesions that is not clearly identified as benign lesion - management
Biopsy
