Melanocytic Lesions - part 2

Question 1

what percent of melanoma lesions are cutaneous?

Answer 1

91%

Question 2

what are the high risk sites of melanoma?

Answer 2

BANS: back, arms, neck and scalp

Question 3

what percent of high risk sites affected by melanoma is head and neck?

Answer 3

25%

Question 4

other than cutaneous, what other sites can melanoma affect?

Answer 4

muscosa, ocular and other

Question 5

how do you describe a melanocytic lesion?

Answer 5

ABCDE's:
Asymmetry
Border irregularity
Color variegation
Diameter >6 mm (size of pencil eraser)
Evolving - enlarging or changing color

Question 6

what are the growth phases of melanoma?

Answer 6

1. radical

2. vertical

Question 7

radial growth phase

Answer 7

spreads laterally

Question 8

vertical growth phase

Answer 8

extends deeper into the CT

Question 9

what is the precursor for melanoma?

Answer 9

lentigo maligna

Question 10

what are the clinicopathologic types of melanoma?

Answer 10

1. lentigo maligna melanoma
2. superficial spreading melanoma
3. nodular melanoma
4. acral lentiginous melanoma

Question 11

lentigo maligna (Hutchinson’s freckle)

Answer 11

melanoma in-situ

Question 12

melanoma in-situ

Answer 12

melanoma in a purely RADIAL growth phase

Question 13

type of people affected by lentigo maligna

Answer 13

older individuals with fair complexion

Question 14

clinical feature of lentigo maligna

Answer 14

large macular lesion with irregular borders and UNEVEN pigmentation

Question 15

how long does it take before vertical growth phase develops?

Answer 15

~15 years

Question 16

what signals a previously flat lentigo maligna to enter the vertical growth phase and lentigo maligna melanoma?

Answer 16

nodularity in a previously flat lentigo maligna

Question 17

histopathologic of lentigo maligna melanoma

Answer 17

nests of malignant melanocytes in epithelium and superficial CT

Question 18

what is the most common type of melanoma?

Answer 18

superficial spreading melanoma

Question 19

what does superficial spreading melanoma begin as?

Answer 19

a macule or plaque

Question 20

clinical features of superficial spreading melanoma

Answer 20

starts off as a macule or plaque and exhibits classic clinical features (A, B, C, D’s and E)

Question 21

superficial spreading melanoma sites

Answer 21

1. interscapular area of men

2. back of legs on women

Question 22

histopathologic of superficial spreading melanoma

Answer 22

1. clusters of atypical melanocytes along basal layer and dropping into CT
2. melanocytes invading epidermis producing pigment

Question 23

T/F: nodular melanoma is a rapidly growing nodule

Answer 23

true, almost immediate vertical phase and little if any radial growth

Question 24

clinical features of nodular melanoma

Answer 24

1. usually deeply pigmented

2. amelanotic

Question 25

amelanotic

Answer 25

melanocytes so poorly differentiated they can no longer produce melanin

Question 26

what is the most common form of oral melanoma?

Answer 26

acral lentiginous melanoma

Question 27

what is the most common form of melanoma in persons of color?

Answer 27

acral lentiginous melanoma

Question 28

what type of melanoma is more aggressive than the cutaneous form?

Answer 28

acral lentiginous melanoma

Question 29

what are the sites for acral lentiginous melanoma?

Answer 29

1. palm of hands 2. soles of feet 3. subungual (under nails) 4. mucous membranes

Question 30

clinical features of CUTANEOUS acral lentiginous melanoma

Answer 30

1. dark, may see color variegation 2. irregular margin 3. macule which develops into nodule

Question 31

clinical features of ORAL acral lentiginous melanoma

Answer 31

1. dark, may see color variegation 2. can be amelanotic 3. irregular margin 4. macule which develops into nodule 5. ± ulceration 6. ± pain, usually if ulcerated 7. soft to palpation 8. cervical lymph node metastasis

Question 32

T/F: there is a female predilection for ORAL acral lentiginous melanoma

Answer 32

false, male predilection

Question 33

what age groups are primarily affected with ORAL acral lentiginous melanoma?

Answer 33

5th-7th decade

Question 34

which site is commonly affected by ORAL acral lentiginous melanoma?

Answer 34

hard palate/maxillary alveolar mucosa

Question 35

how does ORAL acral lentiginous melanoma appear on radiographs?

Answer 35

appears as irregular radiolucency or mixed lesion

Question 36

treatment for melanoma

Answer 36

1. surgical excision 1-2 cm margin for cutaneous lesions (lymph node dissection if needed) 2. genotype-directed immunotherapy 3. chemotheraphy, radiation have little impact but may be used 4. close clinical follow-up 5. SPF products

Question 37

what is the prognosis of a ≤ 0.75 mm invasion?

Answer 37

96% 10 year survival

Question 38

what is the prognosis of a > 3.6 mm invasion?

Answer 38

26% 10 year survival

Question 39

who has a better prognosis for melanoma?

Answer 39

1. younger than 50 | 2. female

Question 40

which cutaneous site has a worse prognosis for melanoma?

Answer 40

trunk, head and neck (esp. scalp and neck)

Question 41

T/F: melanoma has worse prognosis if the lesion was cutaneous rather than mucosal

Answer 41

false, worse for mucosal than cutaneous

Question 42

why is the prognosis for oral melanoma poor?

Answer 42

because of difficulty achieving wide surgical margins and early metastasis

Question 43

routes of metastasis for melanoma

Answer 43

1. lymphatics | 2. blood via brain, liver, bone