Norton Part 1

Question 1

what causes vitiligo

Answer 1

autoimmune disorder
chronic depigmenting condition from complete loss of epidermal melanocytes
may find autoantibody against melanin-concentrating hormone receptor 1 in serum

Question 2

vitiligo peaks when and is more common in what people

Answer 2

2nd and 3rd decades

higher incidence in african americans

Question 3

where is vitiligo mainly found

Answer 3

acral areas (fingers, limbs, ears) and orificies (mouth, eyes, nose, anus)

Question 4

what does vitiligo present as

Answer 4

asymptomatic white macules with sharp borders that gradually enlarge
hair will also loose pigment

Question 5

what can one use to see vitiligo lesions better

Answer 5

Wood’s lamp

Question 6

what is another name for a freckle

Answer 6

ephelis

Question 7

what is an ephelis (freckle)

Answer 7

hyper pigmentation of the basal layer from increased melanosomes

Question 8

freckles appear when

Answer 8

after sun exposure in lightly pigmented kids

darken with sun exposure

Question 9

what does lentigo present as

Answer 9

small (less than 1 cm) circumscribed brown macular lesions

Question 10

lentigo is what?

Answer 10

hyper pigmentation of cells just above the basement membrane

Question 11

what happens to lentigo with sun exposure

Answer 11

they do not darken

Question 12

what histological features are seen in lentigo

Answer 12

rete ridges are elongated and appear club shaped or tortuous
melanocytes are increased in basal layer
malanophages appear in upper dermis

Question 13

what is the main difference between freckle and lentigo

Answer 13

lentigo has increased melanocytes

freckle has increased melanosomes but not melanocytes and gets darker w/ sun exposure

Question 14

what are the gross features of a melanocytic nevi

Answer 14

tan to brown
uniformly pigmented
small (usually less than 6mm)

Question 15

what are the histological features of a melanocytic nevi

Answer 15

sharply defined
well nested at the dermal-epidermal junction
melanocytes mature as they descend in dermis
no deep mitoses
no deep pigment in the melanocytic nest

Question 16

what is a junctional nevi

Answer 16

melanocytic nests at the dermal-epidermal junction which are restricted to the tips and sides of the rete

Question 17

what happens to the cells of a compound nevi and what does it appear as

Answer 17

they invade the dermis and mature and become smaller

more raised and dome shaped than junctional nevus

Question 18

what is seen histologically on an intradermal nevi

Answer 18

melanocytic nests are lost completely

Question 19

what is a spitz nevus composed of

Answer 19

spindle and/or epithelioid cells

Question 20

what is a Kamino body and where is it found

Answer 20

eosinophilic bodies of dyskeratotic melanocytes along dermal-epidermal junction
spitz nevi

Question 21

spitz nevi are common in whom and what do they look like

Answer 21

children

deep red color

Question 22

what are the histological features of a compound nevi

Answer 22

similar to junctional nevus but also has nests and cords of nevus cells in underlying dermis

Question 23

what are the histological feature of a spitz nevus

Answer 23

sharply defined laterally
line symmetry from left to right
nests of melanocytes in epidermis
clefts separating nests from keratinocytes

Question 24

what does a dysplastic (atypical) melanocytic nevus commonly look like

Answer 24

large, oval, and multiple (dysplastic nevus syndrome, AD)

irregular pigment is common

Question 25

a fading border or fried-egg appearance (central papule, surrounding macule) is commonly associated with what?

Answer 25

dysplastic (atypical) melanocytic nevus

Question 26

dysplastic (atypical) melanocytic nevus may be precursor of what

Answer 26

melanoma

Question 27

what is a malignancy of pigment-producing cells

Answer 27

melanoma

Question 28

melanocytes are derived from where?

Answer 28

neural crest

Question 29

what is the number one cause of skin cancer deaths worldwide

Answer 29

melanoma

Question 30

where is melanoma normally found

Answer 30

skin, eyes, GI tract, leptomeninges, oral and genital mucosa

Question 31

the incidence of what neoplasm is increasing the most

Answer 31

melanoma

Question 32

what is the most frequent cancer in white/caucasian/apigmentd women aged 25-29

Answer 32

melanoma

Question 33

what are the subtypes of melanoma?

Answer 33

``` superficial spreading lentigo maligna nodular acral amelanotic ```

Question 34

what are the growth phases of melanoma

Answer 34

vertical and radial

Question 35

what does the vertical growth phase of melanoma determine

Answer 35

tumor stage

Question 36

what stage of melanoma can lead to metastasis

Answer 36

vertical growth phase

Question 37

where does melanoma normally metastasis to?

Answer 37

lymph nodes, brain, GI tract, bone, liver and lungs

Question 38

what is the third most common metastatic tumor to the brain after lung and breast cancer

Answer 38

melanoma

Question 39

what is the number one risk factor for melanoma

Answer 39

a changing mole

Question 40

what are some common risk factors for melanoma

Answer 40

atypical/dysplastic nevi numerous common nevi large (giant) congenital nevi (>20cm diameter) previous melanoma or prior skin cancer (non melanoma) fair skin and history of blistering in sun xeroderma pigmentosa

Question 41

what is the ABCDE rule of skin lesions

Answer 41

``` Asymmetry Border irregularity Color variation Diameter > 6mm Evolving ```

Question 42

how does one manage melanoma

Answer 42

ABCDE rule of skin lesions avoid superficial skin biopsy by shaving, scissors excision, or curettage full-thickness skin extending to the subcutaneous fat with 2mm lateral margins excision, punch, or incisional if lesion is large

Question 43

what margins does one need when biopying melanoma

Answer 43

2mm lateral margins

Question 44

what growth phase of melanoma do the tumor cells lack the ability to metastasize

Answer 44

radial growth phase

Question 45

during the radial growth phase where does the melanoma spread

Answer 45

horizontal spread within the epidermis and superficial dermis

Question 46

in the vertical growth phase where does the melanoma spread

Answer 46

downward into deeper dermal layers as a mass

Question 47

in the vertical growth phase of melanoma what happens to the cells

Answer 47

they have metastatic potential | the invading cells do not mature like in a melanocytic nevi

Question 48

when does a grossly visible nodule appear in melanoma

Answer 48

vertical growth phase