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FITZPATRICK'S DERMATOLOGY 9TH EDITION (SHAMMY) > 20 - 115: MELANOCYTIC NEVI > Flashcards

20 - 115: MELANOCYTIC NEVI Flashcards

1
Q

Pigmented lesions attaining a diameter of ____ cm or more are likely to be CMN, dysplastic nevi, or melanoma

A

1.5

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2
Q

Which of the following statements is INCORRECT?

a. The risk of melanoma appears to be proportionate to the number of melanocytes that comprise the nevus.
b. The most important complication of congenital nevi is that they can give rise to melanoma.
c. Symptomatic NCM presents with failure to thrive in the first few years of life
d. Most CMNs present as flat brown patches or plaques with smooth or slightly uneven borders

A

c. Symptomatic NCM presents with failure to thrive in the first few years of life

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3
Q

Which of the following statements is INCORRECT?

a. CMNs generally expand in direct proportion to growth of a given anatomic region
b. CMNs may also develop a halo of depigmentation, potentially heralding spontaneous regression
c. Asians are more predisposed to melanoma developing from CMN in contrast to Caucasians.
d. Symptomatic NCM carries a poor prognosis, even in the absence of malignant degeneration

A

c. Asians are more predisposed to melanoma developing from

CMN in contrast to Caucasians.

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4
Q

Lesion presents with two components: a light brown patch (café-au-lait) containing speckled dark macules or papules.

A

nevus spilus

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5
Q

Dermoscopy reveals dark speckled foci with a reticuloglobular pattern in a background light brown and reticular pattern.

A

nevus spilus

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6
Q

Related lesions include nevus of Ota/Ito, Mongolian spot, dermal dendritic hamartoma. Initiating mutations in GNAQ or GNA11 are present in most cases

A

blue nevus

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7
Q

Flat or raised with smooth or “pebbly” surface, irregular shape, indistinct borders, variable pigmentation, and measure at least 5 mm in diameter.

A

dysplastic melanocytic nevus

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8
Q

Clinically, lesions are hyperpigmented macules, occurring alone, in focal clusters, or have a generalized distribution. They occur on the skin, conjunctivae and mucous membranes.

A

lentigo simplex

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9
Q

Children with xeroderma pigmentosum develop _______ during the first year of life.

A

solar lentigo

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10
Q

Acquired, benign melanocytic tumor composed of heavily pigmented characteristically-shaped melanocytes in nests confined primarily to the epidermis. Lesions are jet black often with “starburst” appearance on dermoscopy.

A

reed nevus

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11
Q
A
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12
Q

Melanocytic nest is defined as having at least how many melanocytes?

A

3 or more melanocytes in direct dontact

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13
Q

melanocytic cells forming nevi are referred to as

A

Nevomelanocytes

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14
Q

descriptive term used to indicate increased melanocytes confined to the basal layer of the epidermis in the absence of nest formation

A

melanocytic hyperplasia

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15
Q

Cranial or midline congenital melanocytic nevi and those with satellite lesions have an increased risk of?

A

leptomeningeal involvement

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16
Q

Most common location of congenital melanocytic nevus

A

Trunk and extremities

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17
Q

What is the size of small congenital melanocytic nevus

A

Less than 1.5 cm

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18
Q

Size of M1 CMN

A

1.5 to 10 cm

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19
Q

Size of M2 CMN

A

More than 10 to 20 cm

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20
Q

Size of L1 CMN

A

More than 20 to 30 cm

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21
Q

Size of L2 CMN

A

More than 30 to 40 cm

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22
Q

Size of G1 CMN

A

More than 40 to 60 cm

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23
Q

Size of G2 CMN

A

More than 60 cm

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24
Q

How many satellite nevi are present in S1?

A

Less than 20

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25
Q

How many satellite Nevi are present in S2

A

More than 20 to 50

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26
Q

How many satellite are present in S3?

A

More than 50

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27
Q

These mutations are most prevalent in large- and giant-sized congenital melanocytic nevus

A

NRAS

28
Q

One of the most important related physical conditions in patients with CMNs on the head neck or posterior midline

A

Neurocutaneous melanosis

In this condition, the cells of the congenital nevus involve the meninges or even the parenchymal cells of the brain.

Most patients with NCM have many cutaneous congenital nevi, either in the form of a giant nevus with many satellites or in the form of many medium-sized lesions.

29
Q

The most important complication of congenital nevi is that they can give rise to what malignacy?

A

melanoma

30
Q

In CMNs, it is probably prudent to delay treatment until after the first ___ months of life to reduce surgical and anesthetic risks.

A

6 months

31
Q

Histology shows localized collections of nevus elements forming in the background of mild melanocytic hyperplasia

A

NEVUS SPILUS

32
Q

Lesion presents with two components, a light brown patch (café-au-lait) containing speckled dark macules or papules.

A

NEVUS SPILUS

33
Q

Macular variety of nevus spilus is associate with what disease?

A

phakomatosis spilorosea

constitutes presentation of both nevus flammeus and nevus spilus with or without nevus anemicus.

34
Q

Papular variant of nevus spilus is typically seen in what condition

A

phakomatosis pigmentokeratotica

includes nevus spilus plus organoid nevus with or without systemic symptoms, which include neurologic deficits and skeletal abnormalities.

35
Q

Phakomatosis spilorosea constitutes presentation of what type of nevus

A

both nevus flammeus and nevus spilus with or without nevus anemicus

36
Q

It is likely the risk of melanoma increases to some degree with the size of the nevus spilus, particularly with larger segmental lesions greater than

A

40 cm

37
Q

Differentiate intradermal and junctional nevus based on size and color

A

Intradermal
- papillomatous/dome-shaped
- lighter in color

Junctional
- flatter
- more pigmentation

Lesions that are papillomatous or dome shaped tend to be lighter in color and display a more dominant intradermal component, but flat lesions tend to show more pigmentation and a more robust junctional component.

38
Q

presents as an asymptomatic or slightly pruritic, red, and slightly scaly eczematous halo around a central nevus.

A

Meyerson’s nevus

Lesions occur most often on the trunk and proximal extremities and may be multiple. Unlike halo nevi, the skin does not depigment, and regression of the nevus does not occur. Eczematous changes often self-resolve over the course of months.

39
Q

spontaneous and concurrent development of multiple nevi, often similar in appearance

A

eruptive nevi

This phenomenon has been described in the context of blistering diseases of the skin (immunobullous as well as erythema multiforme–Stevens-Johnson syndrome–toxic epidermal necrolysis spectrum), immunosuppression, neoplasia, and drugs (particularly chemotherapeutic and immune-modulating agents). Eruptive nevi may be of the common acquired type, Spitz, or blue nevus varieties.

40
Q

Halo nevus may be associated with what conditions?

A

Vitiligo
Turner syndrome

Halo nevi, particularly when multiple, may be associated with concurrent or subsequent development of vitiligo or other autoimmune disease. 37 Halo nevi are also more frequent in patients with Turner syndrome.

41
Q

In one study of melanomas, the presence of this history predicted the greatest risk for nevus-associated melanoma.

A

history of frequent sunburns

42
Q

the most critical risk factor for the development of acquired nevi

A

Environmental exposure to UV radiation

Intermittent intense sun exposure appears to impose greatest risk for nevus development

43
Q

In patients with Turner syndrome, there was a significantly higher association of ________in those who developed halo nevi, suggesting a genetic predisposition.

A

HLA-CW6

44
Q

refers to the intermingling of two different nevus types in one lesion

A

combined nevus

Most such lesions are composed of either an acquired or congenital nevus and blue nevus.

45
Q

Worrisome features for possible melanoma on hostopath

A
  • pagetoid upward migration of cells in the epidermis,
  • cytologic atypia of melanocytes (including irregularity of size and shape of cells and nuclear hyperchromasia),
  • failure of the cells to “mature” in the deeper dermis,
  • persistence of pigment production in the deep dermis,
  • lack of symmetry,
  • increased or deep dermal mitotic figures,
  • focal areas of necrosis, and
  • desmoplasia or fibroplasia.
46
Q

What type of blue nevi may have an elevated risk for development of melanoma?

A

Cellular blue nevi

47
Q

What mutations are present in most blue nevi?

A

GNAQ or GNA11

48
Q

most frequent sites for blue nevi

A

dorsal hands and feet, scalp, and buttocks or sacral skin

49
Q

The blue hue seen in many blue nevi comes from the _______, the result of the refraction of light reflected from the nevus by the overlying dermis.

A

Tyndall effect

50
Q

Histopath findings of blue nevus

A

All types of blue nevus have components that include some of the following:

  • deeply pigmented dendritic melanocytes,
  • spindled and less pigmented melanocytes,
  • oval melanocytes,
  • melanophages, and
  • fibrotic stroma

Almost all blue nevi lack a junctional component.

The stereotypic common blue nevus is an inverted dermal wedge-shaped mass in which pigmented dendritic melanocytes are admixed with melanophages within a fibrotic stroma.

51
Q

Syndromes or diseases associated with blue nevus

A

Carney complex/LAMB syndrome and phakomatosis pigmentovascularis

52
Q

Acquired, benign melanocytic tumor composed of heavily pigmented spindle-shaped melanocytes in nests confined primarily to the epidermis

A

pigmented spindle cell nevus (PSCN)/ reed nevus

53
Q

Lesions are jet black often with “starburst” appearance on dermoscopy.

A

pigmented spindle cell nevus (PSCN)/ reed nevus

54
Q

Histopathologic features of pigmented spindle cell nevus

A

The PSCN is a sharply circumscribed lesion composed of fascicles of uniform pigment-synthesizing melanocytes with spindled appearance along the junction and to a lesser extent the superficial dermis (Fig. 115-13). Melanocytes have uniform nuclei and small nucleoli. Occasionally, there is an admixture of epithelioid appearing cells. Pagetoid cells may be seen but are usually limited to the central portion of the nevus. Extension of the spindle cells along skin adnexal structures is relatively common. There are invariably pigment-laden macrophages in the papillary dermis with a mild perivascular infiltrate of lymphocytes.

55
Q

Spitz nevus often harbor what mutations?

A

HRAS mutations

Spitz tumors often either harbor HRAS mutations or demonstrate genomic rearrangements involving kinase genes (ALK, ROS1, NTRK1, BRAF, RET, MET).

56
Q

Histopathologic features of Spitz tumor

A

Spitz nevi are characterized by melanocytic cells with large epithelioid nuclei, often with prominent nucleoli and surrounded by a rim of eosinophilic cytoplasm with “ground-glass” appearance

These lesions are well-circumscribed and symmetric from side to side and from top to bottom. In contrast to melanoma, the melanocytic cells in Spitz nevi show progressive maturation with increasing depth, becoming smaller with the overall distribution of cells in the dermis being wedge shaped, with narrowing of the wedge toward the subcutaneous fat.

57
Q

In spitz nevus, Small intraepidermal eosinophilic globules, which are positive for periodic acid–Schiff and diastase resistant (resembling colloid bodies), may be seen. What do you call these globules?

A

Kamino bodies

58
Q

Lentigo simplex may be associated with what disorders?

A
  • LEOPARD (lentigines, electrocardiographic conduction abnormalities, ocular hypertelorism, pulmonary valve stenosis, abnormalities of genitalia, growth retardation, and sensorineural deafness) syndrome,
  • Carney syndrome,
  • Peutz-Jeghers syndrome,
  • LaugierHunziker syndrome (idiopathic lenticular mucocutaneous pigmentation), and
  • centrofacial lentiginosis.
59
Q

True or false. Avoidance of sun exposure and UVR does not reduce the risk of development of lentigo simplex.

A

True

Avoidance of UVR exposure may decrease the risk of developing additional solar lentigines.

60
Q

Clinically, dysplastic nevi often measure at least how many millimeters in diameter

A

5 mm

61
Q

dysplastic nevi frequently have a flat macular component, which corresponds to what finding histopathologically?

A

‘shoulder’ or junctional component of a compound lesion

62
Q

most significant clinical features that had the highest correlation to histologically proven dysplastic nevi

A

nevus size and irregular borders

63
Q

Criteria for atypical nevi

A

Atypical nevi typically have a diameter (diameter in one dimension at least 5 mm and a prominent flat component) and two of three other features (irregular asymmetric outline, indistinct borders, and variable pigmentation).

64
Q

most common site of malignant transformation in dysplastic nevus syndrome

A

Trunk

65
Q

most clinically concerning complication, associated with dysplastic nevi.

A

Melanoma

FITZPATRICK'S DERMATOLOGY 9TH EDITION (SHAMMY) (122 decks)

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