Melanocyte Eyelid Lesions

Question 1

What is the difference between an ephilis and a lentigo senilis?

Answer 1

Ephilis - Increased production of melanin. Increased pigment with UV exposure.
Lentigo - Increased number of melanocytes. No increase in pigment with UV exposure.

Question 2

What is the difference between a junctional v compound v intradermal nevus?

Answer 2

Junctional - Nevocytes clustering together only in the epidermis. Flat.
Compound - Nevocytes in epidermis and dermis. Slighty elevated.
Intradermal - Nevocytes fully migrated into the dermis. Clinically elevated.

Question 3

What can make a nevus darken and enlarge?

Answer 3

Puberty
Pregnancy
Steroids

Question 4

As a nevus progresses from junctional to compound to intradermal, the skin above this area becomes more ______ and less ______

Answer 4

More elevated and less pigmented

Question 5

A congenital nevus is usually what type of nevus?

Answer 5

Compound

Question 6

What is spitz - juvenile melanoma?

Answer 6

BENIGN congenital melanocytic nevus that appears fleshy with variable pigmentation and vascular ectasia.

Question 7

What is a Halo nevus?

Answer 7

(Macrophages?) are eating away at the melanocytes leaving a depigmented ring around the lesion. Good prognostic indicator

Question 8

What lesion appears as black paint scattered on a brown background? What is indicated for this lesion?

Answer 8

Lentigo maligna - “Hutchison’s freckle”

Punch biopsy indicated

Question 9

Actinic Keratosis is to Squamous Cell Carcinoma as ________ is to Lentigo Malignant Melanoma

Answer 9

Lentigo Maligna (so easy!)

Question 10

Lentigo maligna first slowly grows along the _______. If it breaches the _______ then it is officially Lentigo Malignant Melanoma

Answer 10

Lentigo Maligna slowsly grows along the epidermal-dermal junction. Once it breaches the basement membrane it is Lentigo Malignant Melanoma

Question 11

True / False. Lentigo maligna shows full thickness dysplasia and loss of polarity

Answer 11

TRUE

Question 12

What are the 3 type of malignant melanoma? Which is the most common?

Answer 12

1. Lentigo Malignant Melanoma
2. Superficial Spreading Melanoma - most common
3. Nodular Melanoma

Question 13

Where is Superficial Spreading Melanoma typically found?

Answer 13

Upper back

Question 14

What predisposes a patient to Nodular Malignant Melanoma?

Answer 14

Lentigo Malignant Melanoma

Superficial Malignant Melanoma

Question 15

What are the ABCDE’s of LMM and SMM?

Answer 15

Asymmetry
Border Irregularity
Color Variegation
Diameter / Depth
Evolving characteristics

Question 16

What is the difference between Stage 0, Stage I, Stage II, Stage III, and Stage IV melanoma?

Answer 16

Stage 0: “Carcinoma in situ” - abnormal area with no penetration into the dermis
Stage IA: Tumor is 1mm with no ulceration
Stage IB: Tumor is 1 mm with ulceration OR Tumor is 2mm with no ulceration
Stage IIA, IIB, IIC: Tumor is growing in size with or with no ulceration
Stage III: Tumor has infiltrated local lymph node
Stage IV: Tumor has infiltrated a different organ (i.e. lungs)

Question 17

What is Lymphoscintigraphy?

Answer 17

A method used to determine if cancer has spread to the sentinal lymph node by following the movement of radioactive dye from the tumor. The lymph node is removed and checked for disease.

Question 18

What are the possible causes of a Superficial Malignant Melanoma?

Answer 18

1. De novo
2. UV light
3. Genetics
4. Nevus

Question 19

What type of lesion presents like a “broken blueberry”

Answer 19

Nodular Melanoma

Question 20

What is the most common cause of Nodular Melanoma?

Answer 20

De novo

Question 21

How is malignant melanoma treated? How do the medicines work?

Answer 21

Excision
Interferon Alpha 2 - Increase MHC-II expression in normal and cancer cells. Inhibits angiogenesis.
Zelboraf - Stops oncogenic BRAF cell signaling
Yervoy - Monoclonal antibody that blocks the activity CTLA-4 (immune off switch) which keeps the immune system active against the tumor

Question 22

Cafe au lait spots are indicative of what underlying condition?

Answer 22

Neurofibromatosis

Question 23

What is the difference between a Kissing Nevus, Spitz Nevus, Halo Nevus, Blue Nevus, Nevus of Ota, & Dysplastic Nevus?

Answer 23

1. Kissing Nevus - Migration of melanocytes occurs before the eyelids separate. After separation, melanocytes are on upper and lower lids just opposite each other.
2. Spitz Nevus - (juvenile melanoma) is a BENIGN nevi with varying degrees of vascular ectasia. Look suspicious but are NOT malignant.
3. Halo Nevus - Depigmented zone surrounding a melanocytic nevus. Local immune response
4. Blue Nevus - Melanocytes that were trapped in the dermis during development and never migrated up. Associated with primary orbital melanoma.
5. Nevus of Ota - (congenital oculodermal melanocytosis). Follows distribution of trigeminal nerve. Common and usually benign in pigmented races.
6. Dysplastic Nevus - Broad macular lesions with variegated pigmentation. Found in northern European races. Often mistake for Lentigo Maligna. Multiple dysplastic nevus is known as AMS (atypical mole syndrome)

Question 24

What type of lesion is associated with melanoma that has metastasized from a remote source?

Answer 24

Amelanotic Melanoma. Typically do NOT produce pigment.