Melanocytic naevi and Melanoma Flashcards Preview

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Flashcards in Melanocytic naevi and Melanoma Deck (229)
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1

T/F
Freckling inherited as autosomal dominant trait

T
onset age 5 ish
MC1R gene mutation may lead to freckling

2

T/F
freckles, CALMs and vulval/penile/oral melanosis all have increased melanin production but no increase in number or distribution of melanocytes

T
In vulval melanosis may be slight increase in number of melanocytes esp in larger, darker lesions.

3

T/F
Lentigines have increased melanin production but no increase in number or distribution of melanocytes

F
In lentigines the number of melanocytes is often increased
melanocytes remain limited to basal layer
Solar lentigo may or may not have increased melanocyte numbers
Melnaocytes are usually normal in appearance but PUVA lentigines have large melanocytes with mild cytological atypia

4

T/F
Freckles are independent risk factor form melanoma

T
people with many freckles are more than twice as likely to get a melanoma

5

T/F
freckles and lentigines fade with time out fo the sun

F
freckles do lentigines may fade a little but tend to persist
CALMs do not change

6

T/F
Freckled people have more naevi

T

7

What are Rx for freckles?

Sun protect
IPL first line about 3 treatments
QS 532nm (freq doubled Nd:YAG) laser - end point is even frosting
Can use ablative or fractionated laser – fractionated probably better esp erbium
35% TCA peel
2-4% hydroquinone in morning and retinoic acid in evening and high SPF (UVA blocking) sunscreen
Gentle cryotherapy

8

What syndromes are associated with freckles?

XP
NF (trunk, axilla, groin - Crowe's sign)
Progeria
LEOPARD
Moynihan’s syndrome (HOCM + LEOPARD)

9

T/F
Regarding CALMs
10-20% of normal population have one
1% of normal population have up to 3

T
Rare to have more than 3 unless part of a syndrome

10

T/F
CALMs are rare in afro-caribbeans

F
more common

11

T/F
In CALM there are usually fewer melanocytes than in surrounding normal skin

T
but increased melanin production

12

What syndromes are assoc w/ CALMs?

Cheer leader with CALMs spins the BATANS
Bloom's syndrome
Albright (McCune-Albright) syndrome (coast of Maine)
Tuberous sclerosis
Ataxia telangiectasia
NF1
Silver-Russell (Russell-Silver) syndrome

Also;
Idiopathic
NF1-like syndrome (Legius syndrome)
NF2
Watson syndrome (Allelic to NF1)
Noonans syndrome
LEOPARD syndrome (cafe noir), Moynihan's
Carney complex (cafe noir)
Fanconis anaemia
Gorlin’s
Cowdens (sometimes)
MEN1 (sometimes)
Mafuccis
Gaucher
Chediak-Higashi
Hunter syndrome
Multiple mucosal neuroma syndrome

13

What syndromes are assoc w/ Cafe noir macules?

LEOPARD syndrome
Carney complex

14

T/F
NF1 typically has several CALMs >15cm diameter

T
but only size >15mm in adult required for diagnostic criteria

15

T/F
topical skin lighteners help CALMs

F
no effect
generally Rx resistant
Can try pulsed dye, QS Ruby or freq doubled Nd:YAG lasers
ablative erbium laser has also been used
variable response, high risk of recurrence

16

What is lentiginosis?

Lentiginosis means either many lentigines or lentigines in a specific distribution in keeping with a clinical syndrome
NB lentiginosis syndromes often also have ephelides and/or CALMs

17

What are the types of lentigo?

Simple lentigo (lentigo simplex)
Solar lentigo (=senile lentigo) + variants;
- Ink spot lentigo
- PUVA lentigo
Scar lentigo

18

T/F
Solar lentigo can evolve into lichenoid keratosis or reticulated seb K

T

19

T/F
Xeroderma pigmentosum is associated with many CALMs

F
Many ephelides and solar lentigines

20

What are treatments for solar lentigo?

simialr to freckles but topical whiteners rarely effective
Sun protect
QS 532nm (freq doubled Nd:YAG) laser - end point is even frosting - 1st line treatment
IPL – may need up to 5 Rx at monthly intervals
35% TCA peel
Gentle cryotherapy - C tip spray; 3-5secs from 2cm
Can use ablative or fractionated laser – fractionated probably better esp Erbium

21

PUVA lentigo occurs in 90% of pts treated with PUVA

False
50%
More develop if – receive more treatments, older age, male sex
Fewer develop in darker skin phototypes

22

T/F
PUVA lentigines can occur on any skin exposed to PUVA regardless if normally sun exposed or not

T

23

T/F
PUVA lentigines occcur early during PUVA Rx

F
usually after 5-7 yrs of Rx
Persist for years after PUVA stopped

24

T/F
PUVA lentigines are a marker for increased risk for PUVA-related malignancy

T

25

T/F
PUVA lentigines are darker and more stellate appearance than solar lentigines

T
look more like simple lentigo than solar lentigo

26

T/F
lentifo simplex is more common in darker skin types

T
M=F
simple lentigo may be present at birth or appear shortly after birth

27

T/F
simple lentigo of the nail matrix are a common cause of longitudinal melanonychia

T

28

T/F
simple lentigo is a brown-black homogenous pigmented macule. usually

T

29

T/F
Acral pigmented lesions are most often lentigo simplex histologically

T

30

What is Generalized lentiginosis (syndrome)?

Multiple lentigines appearing singularly in small crops from infancy onwards
No known cause or association