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Oral Pathology > Class: Exam 2 Pigmented Lesions > Flashcards

Class: Exam 2 Pigmented Lesions Flashcards

1
Q

Describe Nevi

A

Nevus cells migrate from neural crest to skin and occasionally mucous membranes

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2
Q

Are Nevi acquired or found at birth?

A

Both
Congenital –> Present at birth, about 1% of newborns, larger (“garmet nevus”)

Acquired –> genetic influence and the average person has about 15

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3
Q

name the 4 different acquired Nevi

A
  1. Junctional nevus
  2. Intradermal nevus
  3. Compound nevus
  4. Blue nevus
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4
Q

Describe junctional nevus

A

flat macule

nevus cell in basal epithelium at “junction” of epithelium and connective tissue

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5
Q

Describe intradermal nevus

A

(intramucosal nevus)
nodule +- hair
Nevus cells in dermis or lamina propria

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6
Q

Describe compound nevus

A

nodule

combination of junctional and intradermal

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7
Q

Describe blue nevus

A

dendritic nevus cells deep within connective tissue

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8
Q

Define Melanocanthoma

A

Reactive proliferation of intraepithelial dendritic melanocytes
Reactive! Not neoplastic

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9
Q

Where and within what population is Melanocanthoma most likely?

A

Blacks

Cheek

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10
Q

Treatment of Melanoacanthoma

A

resolves when irritant is removed

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11
Q

Define Ephelis

A

Freckle
Localized overproduction of melanin
**Not an increase in number of cells

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12
Q

Where is Ephelis most common?

A

H&N skin

Is very common

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13
Q

Describe clinical features of Ephelis

A 
Very common
Flat
Tan macules
Multiple
Sun activated
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14
Q

Define Actinic or senile lentigo

A

“age spots”
“Liver spots”
From chronic UV damage - Not seen intraorally

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15
Q

Where and within what population is Actinic or senile lentigo most common?

A

after 40 yrs
90% of elderly
Increasinly found in face, hands and arms

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16
Q

Clinical features of Actinic or senile lentigo

A

flat evenly discolored macules

Multiple

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17
Q

Define or describe Melanotic macule

A

tan to brown flat macule
Like a big freckle but NOT SUN RELATED

15% multiple
Average size 6.8 mm

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18
Q

Where and within what population is Melanotic macule most commonly found?

A

Female 2:1
Average age 43 (1-80)
Lower lip (33%)
Palate and Gingiva

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19
Q

What is the 3rd most common skin cancer?

A

Malignant melanoma (» basal cell carcinoma, > squamous cell carcinoma)

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20
Q

Define Malignant melanoma

A

Malignancy of melanin-producing cells

21
Q

What is the likelihood of a caucasian today developing melanoma during their lifetime?

A

less than 1 in 100

22
Q

Sites where malignant melanoma is found?

A

25% H&N

40% extremities

23
Q

What are the 5 etiological factors of malignant melanoma

A
  1. Risk factors = UV radiation damage from sun
  2. Acute sun damage (burns, blistering) probably more important than chronic exposure
  3. Fair complexion, blond hair, blue eyes
  4. Multiple moles, freckling, dysplastic nevi
  5. Family history
24
Q

Clinical features of malignant melanoma

A

The ABCD

  1. Asymmetry - lesion asymmetric as well as surface with elevated, nodular areas
  2. Borders - irregular and often notched
  3. Color - > variation, red, tan, brown, black
  4. Diameter - history of growth or change or >6 mm
25
Q

Biologic growth phases (the two directional patterns of growth displayed by melanomas)

A

Radial

Vertical

26
Q

Explain the radial growth phase

A

Malignant cells spread laterally through the epithelium, lesion remains flat but size increase

  • can remain for years
  • 75-85% of malnomas have radial growth phase
27
Q

Explain the vertical growth phase

A

Malignant cell grow down and invade producing a mass or tumor

28
Q

List the 5 distinct clinicopathologic types of melanomas

A
  1. Superficial spreading melanoma
  2. Nodular melanoma
  3. Lentigo maligna melanoma
  4. Acral lentiginous melanoma
  5. Oral
29
Q

What is the most common form of melanoma

A

Superficial spreading melanoma

70% of cutaneous melanomas

30
Q

Where are superficial spreading melanomas commonly found and what growth phase do they exhibit

A

Increased in trunk, 28% H&N

- Short radial growth phase, develop nodule/vertical growth

31
Q

What percentage of cutaneous melanomas do nodular melanomas make up

A

about 15%

32
Q

Where are nodular melanomas found commonly?

A

30% in H&N

33
Q

Clinical features of nodular melanomas

A

Produce exophytic, pigmented nodules but rarely no pigment (amelanotic)
- Very short or non-existent radial growth

34
Q

What percentage of cutaneous melanomas do lentigo maligna melanomas make up?

A

5-10%

35
Q

Where and within what population are Lentigo maligna melanomas commonly found?

A

Increase in age

Sun exposed areas of face

36
Q

Clinical features and growth phase of Lentigo maligna melanomas

A

Extremely long radial growth phase which may last 15-20 years
(lentigo maligna/hutchinson’s freckle)
- Ultimately develops nodules/vertical growth

37
Q

Describe acral lentiginous melanoma

A

small subset affecting palms, soles, subungual and mucous membranes

38
Q

Oral melanomas have what growth phase?

A

Most have radial growth (>50%) and many similar to acral lentiginous melanoma

39
Q

where are oral melanomas found commonly?

A

Palate

Maxillary gingiva

40
Q

Treatment of Melanomas

A

Excision (resection) with minimum of 1cm margin
+- lymph node dissection
+- adjunctive chemotherapy, radiation and immunotherapy

41
Q

Prognosis of Melanomas

A
  • Depth of invasion is probably most important factor influencing survival
  • Metastasis decreases survival, many patients have a sentinel lymph node biopsied as a staging procedure
  • Prognosis also affected by site affected and type of melanoma
42
Q

What is the overall survival for melanoma

A

79% for 10 years

43
Q

What is the survival percentage for oral melanomas

A

Much worse…

44
Q

Multifocal pigmentation

A
  1. Physiologic
  2. Drugs
  3. Addison’s Disease
  4. Peutz-Jeghers Syndrome
    Any condition characterized by cafe au lait spots
  5. Smoker’s melanosis
  6. Melanoma
  7. Kaposi’s sarcoma
  8. Petechiae, ecchymosis, purpura
45
Q

What drugs are involved in multifocal pigmentation

A

Antimalarials
antiarrythmics (quinidine)
tranquilizers (thorazine)
cis-platinum

46
Q

Describe Addison’s disease and it’s relation to Multifocal pigmentation

A

Adrenocortical insufficiency triggers hypothalamus to stimulate anterior pituitary to produce ACTH (and MSH- melanin stimulating hormone)

47
Q

Describe Peutz-Jeghers Syndrome

A

Autosomal dominant

  • Skin and mucosal freckles, intestinal polyps (small bowel)(very low rate of malignant degeneration but will produce symptoms of obstruction)
  • oral and perioral freckles, > lips and cheeks
48
Q

What conditions are characterized by cafe au lait spots

A

Neurofibromatosis

McCune Albright Syndrome (polyostotic fibrous dysplasia)

49
Q

Where is Smoker’s melanosis found commonly

A

Palate, gingiva

Oral Pathology (4 decks)

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