Melanoma features based on anatomical site

Question 1

What is the single most important dermoscopic feature for early lentigo maligna detection?

Answer 1

Asymmetric pigmentation of follicular openings

Question 2

According to Tschandl et al., what dermoscopic pattern indicates malignancy in lesions?

Answer 2

Circle-within-circle (isobar sign)

Question 3

What are the additional criteria described by Pralong et al. for lentigo maligna diagnosis?

Answer 3

1. ‘Target-like pattern’, 2. ‘Darkening at dermoscopic examination’, 3. ‘Red rhomboidal structures’, 4. ‘Increased density of the vascular network’

Question 4

Which dermoscopic criteria are most useful for rare, amelanotic (non-pigmented) lentigo maligna variants?

Answer 4

‘Red rhomboidal structures’ and ‘Increased density of the vascular network’

Question 5

What type of facial lesions may display ‘regression structures’ like peppering and ‘white scar-like depigmentation’?

Answer 5

Lentigo maligna

Question 6

What approach has been proposed for diagnosing lentigo maligna by recognizing seven benign features?

Answer 6

Inverse approach

Question 7

What features are commonly observed in thick scalp melanomas on dermoscopy?

Answer 7

Blue-white veil, irregular pigmented blotches, unspecific pattern

Question 8

In thick scalp melanomas, which pattern is frequently demonstrated in nodular melanomas?

Answer 8

Unspecific pattern

Question 9

What dermoscopic features are associated with scalp melanoma disease progression?

Answer 9

Atypical network, regression in thin melanomas; blue-white veil, irregular pigmented blotches in thick lesions

Question 10

What is the ‘BB’ rule aimed at increasing the dermoscopic diagnostic accuracy of pigmented nodular melanoma?

Answer 10

The combination of blue and/or black pigmented areas

Question 11

Why is dermoscopy considered essential for accurate melanoma diagnosis?

Answer 11

Dermoscopy is essential for accurate and early melanoma diagnosis, as per international guidelines.

Question 12

What are the key points about lentigo maligna melanoma on the facial skin?

Answer 12

Lentigo maligna melanoma is common on facial skin with distinct dermoscopic criteria around hair follicles.

Question 13

What are the unique dermoscopic characteristics of lentigo maligna on facial skin?

Answer 13

Dermoscopic features include perifollicular grey dots, rhomboidal structures, and pigmented blotches.

Question 14

How do lentigo maligna and lentigo maligna melanoma lesions typically appear on the face?

Answer 14

They present as irregularly pigmented macules or patches on facial skin.

Question 15

What makes diagnosing facial melanoma challenging with the ‘ABCDE rule’?

Answer 15

The ‘ABCDE rule’ is not applicable for facial melanomas like lentigo maligna.

Question 16

Where are lentigo maligna/lentigo maligna melanoma lesions most commonly found on the head and neck for men and women?

Answer 16

They are commonly found on the cheek and central face area in women and on the scalp, ear, and neck in men.

Question 17

What are the key points regarding mucosal melanoma?

Answer 17

Mucosal melanoma is rare, diagnosed late, and can develop in various mucosal areas.

Question 18

How is mucosal melanoma clinically visualized?

Answer 18

Initially as a brown to black macule that progresses to a nodule or plaque.

Question 19

What dermoscopic features characterize mucosal melanoma?

Answer 19

Multicomponent, structureless patterns with blue, grey, or white colors.

Question 20

What increases the difficulty in diagnosing mucosal melanoma?

Answer 20

Around 1/5 are amelanotic, complicating correct diagnoses.

Question 21

What are the limitations in dermoscopy of mucosal melanoma?

Answer 21

Limited data due to rarity, difficulties in examination, and probe limitations.

Question 22

What is the significance of multiple colors in mucosal melanoma?

Answer 22

Associated with melanoma diagnosis, especially with structureless distribution.

Question 23

How can mucosal melanoma be differentiated from benign lesions?

Answer 23

Presence of blue, grey, or white colors with a structureless pattern.

Question 24

What pattern is common in mucous membrane melanoma?

Answer 24

Multicomponent or polymorphous pattern with multiple structures.

Question 25

What are some dermoscopic features common to mucosal and cutaneous melanomas?

Answer 25

Asymmetry of structures, multiple colors, irregular vessels, and milky-red areas.

Question 26

What are some dermoscopic features of melanoma on the lower limbs?

Answer 26

Prominent or delicate network, hypo-pigmentation with dotted vessels, diffuse light pigmentation.

Question 27

Where are most melanomas located in women?

Answer 27

Lower limbs.

Question 28

What is the most common site of melanoma in women?

Answer 28

Lower limbs.

Question 29

What are the additional associated features of melanoma on the lower limbs?

Answer 29

Polygons/angulated lines, regression, dermoscopic islands.

Question 30

What is the Hutchinson's sign in nail melanoma?

Answer 30

Periungual spread of pigmentation, visible in adults, suggestive of malignancy.

Question 31

What is the most common clinical presentation of nail melanoma?

Answer 31

Longitudinal band of melanonychia.

Question 32

Where do nail melanomas generally occur?

Answer 32

Fifth to seventh decades of life, both in fingernails and toenails.

Question 33

What is the Hutchinson's sign associated with in adults?

Answer 33

Nail melanoma.

Question 34

What is the significance of Hutchinson's sign in adults?

Answer 34

Suggests a suspicious clinical diagnosis of nail melanoma.

Question 35

What dermoscopic features are associated with a melanoma diagnosis if the total score is ≥4?

Answer 35

Presence of multicomponent or polycircular pattern, irregular globules, blue-whitish or white veil, ≥3 colours, irregular vessels, and palpable, unilateral or unifocal lesion.

Question 36

Describe the dermoscopy features of thin or in situ vulvar melanomas.

Answer 36

Structureless areas, grey areas, irregular black-brown dots, and blue-white structures.

Question 37

What dermoscopic characteristics are commonly observed in conjunctival melanoma?

Answer 37

Dark brown, black, and grey color, dots in a structureless pattern, prominent feeder linear vessels, multiple patterns and colors, asymmetry, irregular dots and globules, regression structures, and blue-white veil.

Question 38

How is acral melanoma defined anatomically?

Answer 38

Melanoma located on glabrous (hairless) skin of the extremities.

Question 39

What is the typical dermoscopic feature of acral melanoma?

Answer 39

The parallel ridge pattern (PRP), characterized by a band-like pigmentation along the rete ridges.

Question 40

In which populations is acral melanoma most common?

Answer 40

Dark-skinned people (Asian, African, and Hispanic populations).

Question 41

What are specific dermoscopic features for melanoma on the trunk?

Answer 41

Regression structures and shiny white lines for the upper back, negative pigment network for the abdomen.

Question 42

Describe the dermoscopic features of superficial spreading melanoma of the trunk.

Answer 42

Asymmetric with regression, irregular globules, pigment blotches, blue-white veil.

Question 43

What is the dermoscopic appearance of nevus-associated melanoma?

Answer 43

Inverse network and regression, dermoscopic island possible.

Question 44

How do melanoma and nevus remnants appear when coexisting?

Answer 44

Reported at histopathological examination, melanoma usually SSM subtype, thicker in congenital NAMs.

Question 45

What are some dermoscopic criteria associated with nevus-associated melanoma?

Answer 45

Negative pigment network, globules, streaks, sometimes blue-white veil.

Question 46

Where can nodular melanomas (NMs) be found on the body?

Answer 46

Any part, including the trunk.

Question 47

What are traditional dermoscopic features of pigmented NMs?

Answer 47

Blue-black color, irregular dots and globules, crystalline structures, vessels.

Question 48

How are amelanotic NMs characterized?

Answer 48

Diagnostic dilemma, lack typical pigmentation.

Question 49

What vascular patterns are seen in pink melanomas?

Answer 49

Predominant central vessels, hairpin vessels, milky red-pink areas, polymorphic vessels.

Question 50

What did a recent study highlight about tumour thickness and vascular patterns?

Answer 50

Tumour thickness strongly influences the vascular pattern on dermoscopy.

Question 51

What is the BB rule used for?

Answer 51

To differentiate thick lesions like BCC, SCC, angiomas, blue nevi, and seborrheic keratoses.

Question 52

Describe the dermoscopic features of amelanotic nodular melanomas.

Answer 52

Milky-red background, irregular vessels, suggestive of malignancy.

Question 53

What are the key dermoscopic characteristics to differentiate BCCs and SCCs from pigmented nodular melanomas?

Answer 53

Presence or absence of vascular patterns, streaks, brown globules, and structureless brown areas.

Question 54

How are nevus-associated melanomas typified dermoscopically?

Answer 54

By dermoscopic island, negative pigment network, globules, and streaks.

Question 55

What are the main dermoscopic clues for pigmented nodular melanomas?

Answer 55

Blue and black color under the BB rule.

Question 56

Describe the dermoscopic features of superficial spreading melanoma (SSM) on the trunk.

Answer 56

Irregular hyperpigmented areas, prominent skin markings in thin lesions, multicomponent pattern, asymmetry, blue-grey veil.

Question 57

What is the most common histologic subtype of melanoma on the trunk?

Answer 57

Superficial spreading melanoma (SSM).

Question 58

What is the BRAFV600E mutation associated with in melanomas of the trunk?

Answer 58

Almost half of the confirmed SSM cases.

Question 59

When does the vertical growth phase typically begin in melanomas?

Answer 59

After the slow and progressive horizontal growth phase.

Question 60

What dermoscopic findings are common in thin trunk melanomas?

Answer 60

Multicomponent pattern, asymmetry, blue-grey coloration.

Question 61

What are typical dermoscopic features associated with invasive acral melanoma?

Answer 61

They include parallel ridge pattern (PRP), irregular diffuse pigmentation, and irregular brown to black dots/clods.

Question 62

What is the clinical three-step algorithm for surgical excision of acquired acral melanocytic lesions?

Answer 62

The algorithm recommends excision for lesions with non-typical dermoscopic pattern, diameter ≥7 mm, and patient age >50 years.

Question 63

How does the BRAAFF dermoscopic scoring system improve acral melanoma diagnostic accuracy?

Answer 63

It includes positive patterns like PRP and irregular blotches, with negative predictors such as parallel furrow and fibrillar pattern.

Question 64

What does the presence of an irregular fibrillar pattern in acral melanoma indicate?

Answer 64

It indicates an asymmetric and irregular arrangement of fibrillar pigmentation with varying size and color of fibrils.

Question 65

What dermoscopic features characterize amelanotic acral melanoma?

Answer 65

Microscopic remnants of pigmentation and a polymorphous vascular pattern including milky-red areas, irregular vessels, and hairpin vessels.

Question 66

Why may the overall sensitivity of the clinical three-step algorithm for acral melanoma be low?

Answer 66

It may be low due to misclassification of fibrillar pattern as high-risk and the frequency of small multicomponent diagnoses.

Question 67

What is the color range of the background band in nail melanoma?

Answer 67

Grey to brown to black.

Question 68

Describe the characteristics of irregular lines in nail melanoma.

Answer 68

Variable colors, thickness, interrupted, and cross into each other.

Question 69

What features are significantly associated with nail melanoma observed with onychoscopy?

Answer 69

Brown colored background and irregular longitudinal lines.

Question 70

What is the 'Micro-Hutchinson's sign' visible by dermoscopy?

Answer 70

Parallel ridge pattern and irregular diffuse pigmentation.

Question 71

What are the indicative features of nail melanoma according to onychoscopy?

Answer 71

Presence of dots/globules of brown-black color, width of the band >2/3 of the nail plate, and nail plate dystrophy.

Question 72

What is the significance of nail plate dystrophy in onychoscopy?

Answer 72

It is an indicator of invasive melanoma.