Pink tumours

Question 1

How does tumour volume influence vascular morphology?

Answer 1

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

Question 2

How does melanoma size influence vascular morphology?

Answer 2

< 1 mm : dotted - coiled
< 2 mm : coiled - linear irregular
> 2 mm : linear irregular

Question 3

a polymorphous (crazy) vascular pattern is suggestive of ….

Answer 3

Malignant tumour

Question 4

polymorphous vessel definition

Answer 4

> 1 type vessel arrange in chaotic distribution

Question 5

most common vessel combination in melanoma

Answer 5

dotted + linear vessels

Question 6

Approach to pink tumours : use the …

Answer 6

3 Step Algorithm

Question 7

3 Step algorithm

Answer 7

1st step morphology of vessels - type of vascular pattern
2nd step architectural arrangement of vessels - distribution within lesion
3rd step Dermoscopic clues

Question 8

6 main types of vessels

Answer 8

Comma, curved vessels. May vary in size.
Dotted
Linear irregular
Hairpin
Glomerular - coiled
Arborizing - branched, usually sharp in focus, large stem then finer

Question 9

Hairpin vessel with surrounding white area is clue for …

Answer 9

keratinizing tumours

Question 10

Glomerular vessels usually seen in ..

Answer 10

Bowen’s disease

Question 11

Vascular arrangement - 6 types

Answer 11

Regular
String - like
Clustered
Radial
Branching
Irregular

Question 12

Dotted vessels in regular distribution usually seen in -

Answer 12

melanocytic skin tumours

Question 13

Dotted vessels in string distribution usually seen in -

Answer 13

Clear cell acanthoma

Question 14

Glomerular vessels in Bowen’s disease are usually arrange in ….

Answer 14

Clusters or groups

Question 15

Hairpin vessels arrange in radial distribution associated with keratin found in ..

Answer 15

Squamous cell Ca

Question 16

Red-purple aggregated globules seen in …

Answer 16

Cherry angioma

Question 17

Bright red structureless areas with whitish intersections seen in …

Answer 17

Pyogenic granuloma

Question 18

Milky red globules (strawberry milkshake) + central linear vascular pattern seen in ….

Answer 18

Thick amelanotic nodular melanoma

Question 19

Crown vessels surrounding yellow area seen in …

Answer 19

sebaceous hyperplasia

Question 20

Strawberry pattern - erythematous background intermingled with white to yellow hair follicles seen in …

Answer 20

actinic keratosis on face

Question 21

Structureless pink areas and multiple erosions

Answer 21

Superficial BCC

Question 22

Vascular patterns of melanocytic tumours

Answer 22

1. Comma (curved) - Intradermal nevus
2. Dotted (dots) - Spitzoid neoplasms
3. Linear irregular (lines) - melanoma

Question 23

Intraderal nevus Dermoscopy features

Answer 23

1. Comma vessels
2. Regular (Within papilla)
3. Brown globules, comedo openings, milia

Question 24

Dermoscopic features spitzoid neoplasms incl. Spitz nevus and melanoma in situ

Answer 24

1. Dotted vessels.
2. Regular pattern.
3. Clues: Pink color, white network, residual brown-grey pigment.,

Question 25

Features that favour Spitz nevus as opposed to early melanoma

Answer 25

1. Early age | 2. White network.

Question 26

Features that favour invasive melanoma

Answer 26

1. Lear/ irregular +/- dotted vessels 2. Central 3. Clues: Residual pigment. Pink color. White short stream. (Polarizing specific white lines.)

Question 27

Linear irregular vessels. Distinguishing features from barbarizing vessels in BCC:

Answer 27

1. Thinner 2. Shorter 3. Not as well defined - less sharply in focus.

Question 28

% of true melanotic melanoma

Answer 28

< 2%

Question 29

Amelanotic melanoma important clue

Answer 29

Residual pigment

Question 30

Vascular patterns of non melanocytic tumours n

Answer 30

Hairpin vessels: Seb keratosis, may also be seen in SCC Glomerular : Bowens disease. Arborizing: BCC

Question 31

Derm features seb keratosis

Answer 31

Hairpin vessels - usually at border. In centre mainly curved vessels. Arrangement, regular Clues: White halo around vessels, milia, comedo openings

Question 32

Clear cell acanthoma

Answer 32

Morphology: Dotted. Arrangement: String like Clues: White halos around vessels.

Question 33

Bowen's disease

Answer 33

Morphology: glomerular Arrangement: Clustered Clues: White halo around vessels. yellow white scales.

Question 34

Nodular cystic basal cell Ca

Answer 34

Morphology : arborizing. Arrangement: Focussed. Clues: Blue/grey globules

Question 35

Superficial basal cell Ca

Answer 35

Morphology: Often lack vessels. Mainly seen at periphery as short linear vessels. Clues: Structureless white to red areas Multiple erosions. White short lines (polarizing)

Question 36

Importance of erosions in flat pink lesions

Answer 36

erosions occur late in melanoma and are not seen in flat melanoma. multiple small erosions are important clue to basal cell carcinoma

Question 37

How many grades of actinic keratosis?

Answer 37

3

Question 38

AK, grade 1

Answer 38

Better felt than seen

Question 39

AK, grade 2

Answer 39

Moderately thick. Easily felt and seen. Classic reddish plaques.

Question 40

AK, grade 3.

Answer 40

Very thick. Hyperkeratotic.

Question 41

AK Dermoscopy grade 1

Answer 41

red pseudo-network and fine scales. | lines around follicular openings which are similar in size and very fine

Question 42

AK Dermoscopy grade 2

Answer 42

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"

Question 43

AK Dermoscopy grade 3

Answer 43

Structureless white/yellow keratotic areas. | Keratotic clods within hair follicles

Question 44

Dermoscopy squamous cell carcinoma

Answer 44

Morphology: Hairpin, glomerular Arrangement: Radial Clues, white structureless areas, white circles Central masses of keratin

Question 45

Pinkish colour in suspect benign tumour - management

Answer 45

Biopsy - should not see pinkish colour in benign tumour

Question 46

Suspected pyogenic granuloma - biopsy

Answer 46

May mimic melanoma

Question 47

Benign pink lesions to know

Answer 47

1. Intradermal nevus 2. Seborrheic keratosis including clear cell acanthoma 3. Sebaceous hyperplasia.

Question 48

Any pink lesions that is not clearly identified as benign lesion - management

Answer 48

Biopsy