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OPath > Exam 2- Blue, Brown, Gray, and Black Lesions > Flashcards

Exam 2- Blue, Brown, Gray, and Black Lesions Flashcards

(63 cards)

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1
Q

What is the most common location of physiologic pigmentation?

A

Attached gingiva most common location

Can be seen anywhere (even tips of fungiform papillae on dorsal tongue)

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2
Q

T/F Physiologic pigmentation falls into the developmental category. It is defined by an increase in production of melanin by melanocytes
(Normal Number of Melanocytes).

A

True

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3
Q

How do you diagnose and tx physiologic pigmentation?

A

Established clinically because a biopsy is not conclusive without clinical correlation

No tx

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4
Q

Name the Pathology: Oral and Perioral freckles that first present during childhood and adolescence.

Lips and Cheeks
Skin and mucosal freckles.

Multiple gastrointestinal hamartomatous polyps

A

Peutz-Jeghers Syndrome

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5
Q

What category does Peutz-Jeghers Syndrome fall into?

A

Developmental

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6
Q

T/F Hamartomatous polyps have the same risk of transformation to colorectal cancer as adenomatous polyps.

A

False

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7
Q

Peutz-Jeghers Syndrome increases the risk of malignancies for _______, _________, ________, and _______.

A

GI, Pancreas, Breast, Ovarian

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8
Q

T/F Peutz-Jeghers Syndrome is an autosomal dominant disease.

A

True

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9
Q

How would you diagnose and tx Peutz-Jeghers Syndrome?

A

Family history
Genetic Testing
Oral/perioral biopsy not supportive

Oral and perioral pigmentation persists throughout life and does not require tx.
Lifelong monitor for development of neoplasia.

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10
Q

What category does amalgam tattoo fall under?

A

Injury

Note the differential would be Neoplasm

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11
Q

Describe an amalgam tattoo appearance

A

Black, blue, or gray
Macule
Gingiva, alveolar mucosa, and buccal mucosa most common

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12
Q

How do you diagnose an amalgam tattoo?

A

Radiograph - may appear as a dense radiopacity

Biopsy- it must be distinguished from melanocytic neoplasia
If can’t

Don’t get confused with Intentional Tattoos

No tx necessary

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13
Q

What is the etiology of smokers melanosis?

A

Increase in production of melanin, normal number of melanocytes, protective response against noxious chemical in tobacco smoke

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14
Q

T/F Men are affected with a higher frequency of smoker melanosis.

A

False - females

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15
Q

Give the clinical presentation of smoker melanosis.

A

Anterior facial mandibular gingiva most common
Multiple brown macules

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16
Q

How do you diagnose smokers melanosis?

A

Correlate clinical presentation with smoking history and medical history
Biopsy if any doubt
Biopsy not diagnostic for smokers melanosis, but can rule out neoplasia.

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17
Q

T/F Pigmentation Associated with smoker melanosis can disappear after smoking cessation

A

True

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18
Q

_________ __________ pigmentation is different for different medications. Some chelate with ______ or ________ and deposit in _____ _____. Some stimulate __________ to produce melanin.

A

Drug related pigmentation is different for different medications. Some chelate with iron or melanin and deposit in lamina propria. Some stimulate melanocytes to produce melanin.

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19
Q

What are the medications known to cause drug related pigmentation?

A

(Mighty Ants Try Climbing Every Hill)

Minocycline
Antimalarials (chloroquine, hydroxychloroquine, quinidine, quinacrine)
Tranquilizers (chlorpromazine)
Chemotherapeutic agents (imatinib)
Estrogen
AIDS medications (zidovudine/AZT)

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20
Q

What are the 4 antimalarials?

A

chloroquine, hydroxychloroquine, quinidine, quinacrine

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21
Q

What is the tranquilizer talked about for drug related pgimentation?

A

Chlorpromazine

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22
Q

What is the AIDS medication talked about for drug related pigmentation?

A

zidovudine/AZT

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23
Q

What is the clinical presentation for drug related pigmentation?

A

Diffuse, painless, symmetric, bluish-gray macular pigmentation of the hard palate

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24
Q

T/F You must do a biopsy to rule out neoplasia for drug related pigmentation.

A

False there is no tx

First correlate between initiation of the drug and onset of the pigmentation. Go through medications. Second do a biopsy if there are suggestions of neoplasia.

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25
T/F Drug related pigmentation is an injury.
True
26
Name the lesion: increase in melanin and sometimes the number of melanocytes.
Melanotic macule
27
What are melanotic macule demographics?
2:1 Female predilection Average age of 42 years old
28
What is the clinical presentation of melanotic macule?
Solitary, uniformly tan to dark brown Most common on lower lip
29
How do you diagnose and tx a melanotic macule?
BIOPSY - Especially if recent onset, recent enlargement, large size, irregular pigmentation, and unknown duration - Usually say melanotic macule is less than 6mm if larger DEF biopsy No tx
30
Melanocytic nevus is also called a ______.
mole
31
Name the lesion: Benign localized proliferation of nevus (melanocytic) cells derived from the neural crest.
Melanocytic Nevus (mole)
32
What are melanocytic nevus derived from?
neural crest
33
What's an average amount of melanocytic nevus to have?
10-40 cutaneous per white adult
34
Clinical Presentation of melanocytic nevus.
Uncommon intraorally, more common on skin. If intraoral can happen anywhere in the mouth . Junctional nevus Compound nevus Intradermal/intramucosal nevus
35
Match the correct nevus with the description: 1. Brown/black macule 2. Brown/tan papule 3. Brown/tan papule with papillomatous surface (hair may grow from the center)
1. Junctional nevus 2. Compound nevus 3. Intradermal/intramucosal nevus
36
How to diagnose and tx melanocytic nevus?
If the nevus is > 6mm def biopsy. If cutaneous use clinical judgment. Always biopsy intraoral nevus. Monitor for signs of change.
37
T/F A large percentage of Melanocytic Nevus (“mole”) progress to melanoma.
FALSE only small percentage
38
Name the lesion: Benign proliferation of dendritic melanocytes usually within CT
Blue Nevus
39
What type of cells proliferate for a blue nevus?
Dendritic melanocytes usually within CT
40
What are the demographics of a blue nevus?
Female predilection Usually in children/ young adults
41
Clinical presentation of a blue nevus Macular or dome-shaped, blue or blue-black lesion. Smaller than _____. Any cutaneous or mucosal site. _______ is most common oral location
Macular or dome-shaped, blue or blue-black lesion. Smaller than 1cm Any cutaneous or mucosal site Palate is most common oral location
42
T/F A blue nevus can be at any cutaneous or mucosal site.
True
43
How to diagnose and tx a blue nevus?
Biopsy (definitive) and surgical excsion.
44
T/F There is not tx for a blue nevus.
False- surgical excision a small percentage can progress to melanoma along with melanocytic nevus
45
Name that lesion: Malignancy of melanocytic cells
Melanoma
46
What are the 4 risk factors for melanoma.
1. Acute sun damage 2. Fair complexion (blonde hair, blue eyes) 3. Family history 4. Multiple molar, freckling, dysplastic nevi
47
What are the demographics for melanoma?
5th-7th decade of life Male predilection
48
Melanoma _____% are head and neck _____% are extremities <____% are intraoral
25% head and neck 40% extremities <1% intraoral
49
What are the most common sites of melanoma even though less than 1% occurs intraorally?
Hard palate and gingiva
50
Remember the ABCDEs of melanoma.
Asymmetry Borders irregular Color variegation Diameter - greater than 6mm Evolving
51
How do you tx melanoma?
Wide surgical excision Radiation Immunotherapy Oral mucosal melanoma has worse prognosis than cutaneous melanoma (<20% 5 year survival)
52
What is an important prognostic factor for melanoma?
The depth of the invasion
53
T/F Oral mucosal melanoma has worse prognosis than cutaneous melanoma (<20% 5 year survival).
True
54
What is the 5 year survival rate for oral mucosal melanoma?
<20%
55
What category does addisons disease fall under?
Metabolic
56
Addison disease (adrenal insufficiency) Increased _____ by anterior pituitary but decreased production of ________ and ____________. Problem with the adrenal gland. The byproduct is increased production of ______ but don't know the reason why.
Increased ACTH by anterior pituitary but decreased production of cortisol and mineralocorticoids. Problem with the adrenal gland. The byproduct is increased production of melanin but don't know the reason why.
57
Adrenocortical insufficiency can be secondary to: (5 things)
1. Autoimmune adrenalitis 2. TB 3. Sarcoidosis 4. Adrenal hemorrhage 5. Metastatic cancer
58
Name the pathology: Generalized hyperpigmentation of the skin (bronzing) Diffuse or patchy, brown, macular pigmentations of the oral mucosa Systemic symptoms Weakness, weight loss, irritability, depression, nausea, vomiting, hypotension
Addison Disease (Adrenal Insufficiency)
59
T/F One of Addison Disease (Adrenal Insufficiency) systemic symptoms may be hypertension.
False hypotension Systemic symptoms Weakness, weight loss, irritability, depression, nausea, vomiting, hypotension
60
How do you diagnose Addisons Disease? ____________ (increase/decrease) serum cortisol ____________ (increase/decrease) plasma ACTH levels
Decrease; Increase
61
How do you tx Addison's Disease?
Steroid replacement therapy Tx of underlying tension
62
T/F Drug related pigmentation is painful.
False it’s not painful
63
Where is a melanotic macule most commonly found?
The lower lip

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