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Flashcards in Pigment Disorders Deck (116):
1

What are the SALT cells in the skin?

Langerhans cells--APCs of the immune system

2

What is a major issue with tanning in terms of cellular damage (which cells in particular)?

Langerhans cells are damaged

3

What is skin type I of the Fitzpatrick skin types?

White people who can't tan

4

What is skin type II of the Fitzpatrick skin types?

Fair skin (burns easily, but can tan a little bit) (you)

5

What is skin type III of the Fitzpatrick skin types?

Darker, white skin
tans after initial burn

6

What is skin type IV of the Fitzpatrick skin types?

Light brown skin

7

What is skin type V of the Fitzpatrick skin types?

Brown skin

8

What is skin type VI of the Fitzpatrick skin types?

Dark brown or black skin

9

Are nevi macules or papules?

Either

10

What happens to nevi with age, generally?

Regress/ go deeper

11

True or false: dark skinned people do not develop nevi

false

12

What are the ABCDEs of melanoma changes?

Asymmetry
Border
Color
Diameter
Evolving

13

What are the two major ways to classify type of nevi?

By onset
By depth

14

At what age do nevi begin to form? When does it peak?

Age 10 ish

Peaks around age 50

15

It is unusual to develop nevi after what age?

50

16

What usually causes nevi? What is the genetic predisposition to them?

-Sunlight
-Mutation in the BRAF gene

17

What are the two major shapes of junction nevi?

Flat or slightly elevated

18

What are the two major shapes of compound nevi?

Slightly elevated
Dome

19

What are the four major shapes of dermal nevi?

Dome
Warty
Polypoid
Pedunculated

20

What are junction nevi?

Nevus whose cells are at the dermoid-epidermal junction

21

What are compound nevi?

Nevus whose cells are at the derm-epidermal junction and upper dermis

22

What are dermal nevi?

Neves whose cells are in the dermis, sometime along with fat cells

23

What are the color of the following:
-Junction nevi
-Compound nevi
-Dermal nevi

-Junction nevi = uniform tan
-Compound nevi = flesh color
-Dermal nevi = flesh to pink

24

True or false: junction nevi are sharply demarcated

True

25

What makes a nevi atypical? (4)

-Having flat or raised within the same nevus
-More than 5 mm
-Irregular pigmentation
-Irregular borders

26

When do atypical nevi usually appear in life? How long do they progress for?

near puberty, and continue to develop past the fourth decade

27

True or false: atypical nevi are not a marker for a person at risk for melanoma

False--they are, and may even be a precursor to it

28

What is atypical mole syndrome (dysplastic nevus syndrome)?

a cutaneous condition described in certain families, and characterized by unusual nevi and multiple inherited melanomas

29

What is the gene that predisposes people to melanoma?

BRAF kinase

30

What is the prophylactic treatment for patient with the BRAF V600E gene? MOA?

Vemurafenib--B-Raf enzyme inhibitor

31

What is the tumor marker that is positive in melanoma?

S100

32

Are cafe au lait spots congenital nevi?

Nah dawg

33

True or false: large congenital nevi may undergo a malignant transformation

True

34

True or false: congenital nevi tend to be raised at birth

false--usually flat, but can later become raised

35

Do junctional nevi tend to be with hair or without?

without

36

What are the cells that give rise to junctional nevi, and where are they found?

Melanocytes, above the BM

37

When do junctional nevi tend to develop?

After 2 years

38

Junctional nevi on palms, soles, conjunctiva, or nail beds are most common in which ethnicities?

African or asian

39

Are junctional nevi generally symmetric or asymmetric? Regular or irregular?

Symmetric and regular

40

Do compound nevi tend to be with hair or without?

May have associated hair

41

Are compound nevi generally symmetric or asymmetric? Regular or irregular?

May be irregular or warty appearing surface

42

Where on the body can compound nevi occur?

Anywhere

43

How big, generally, are intradermal nevi?

Less than 1 cm

44

Where do intradermal lesions tend to become pedunculated?

Trunk or flexures

45

What are halo nevi?

Compound or dermal nevus that forms a white border

46

What causes halo nevi?

The formation of a halo surrounding a nevi is believed to occur when certain white blood cells called CD8+ T lymphocytes destroy the pigment-producing cells of the skin (melanocytes). The cause for the attack is unknown.

47

What are the characteristics of the border of halo nevi?

Round, sharply demarcated

48

Where on the body do halo nevi usually occur?

Trunk, never on hands/feet

49

What is the natural h/o halo nevi?

Repigmentation may occur, or entire lesion may disappear

50

What is the average age of onset for halo nevi?

15 years

51

What are speckled lentiginous nevi?

Hairless, oval or irregularly shaped brown lesion that is dotted with darker spots

52

When do speckled lentiginous nevi occur?

At any age, but tend to look like cafe au lait spots at birth

53

What are the size ranges for lentiginous nevi?

1-20 cm

54

Are lentiginous nevi related to sun exposure?

Nah

55

What are Becker's nevi?

not a nevocelluar nevus

56

In whom do Becker's nevi occur?

Adolescent men

57

Where on the body do Becker's nevi generally occur?

Shoulder
Submammary area
Upper/lower back

58

What are the characteristics of the borders of Becker's nevi?

Irregular, but sharply demarcated

59

What are the characteristics of the syndrome that may occur with Becker's nevi?

Ipsilateral hypoplasia of breast and skeletal abnormalities

60

True or false: Becker's nevi tend to be hairy

True

61

What is benign juvenile melanoma (spitz nevus)?

a benign melanocytic nevus, a type of skin lesion, affecting the epidermis and dermis

62

In whom do spitz nevi tend to occur in?

Children

63

Why are spitz nevi also called benign juvenile melanomas?

Look like melanoma, but are benign

64

What are the characteristics of Spitz nevi?

Hairless, dome shaped papule around 1 cm in size that is highly vascular

65

What is the classic presentation of a Spitz nevi?

Nevi that occurred suddenly (within a week)

66

What are the borders like with Spitz nevi?

Sharply demarcated

67

What are blue nevi?

a type of melanocytic nevus. The blue colour is caused by the pigment being deeper in the skin than in ordinary nevi. In principle they are harmless

68

Blue nevi are usually less than what size?

0.5 cm

69

When do blue nevi generally occur? Where on the body?

-Childhood
-Extremities and dorsum of the hand

70

True or false: melanomas can arise from blue nevi

True

71

What are labial melanotic macules?

Benign brown macules on the lower lip (usually). Appear like a freckle, but do not darken with sun exposure

72

In whom do labial melanotic macules occur?

Young women

73

What is pityriasis alba? Who does it usually occur in, and what is the prognosis?

A common skin condition mostly occurring in children with atopic disease, and usually seen as dry, fine-scaled, pale patches on the face.

It is self-limiting (usually resolving after puberty) and only requires use of moisturizer creams

74

What is koebner's phenomenon?

also called the isomorphic response, refers to the appearance of lesions along a site of injury. This phenomenon is seen in a variety of conditions; for example, lichen planus, warts, molluscum contagiosum, psoriasis, lichen nitidus, and the systemic form of juvenile rheumatoid arthritis

75

What is vitiligo?

*Acquired* loss of pigmentation (absence of melanocytes) d/t autoimmune antibodies

76

Is vitiligo localized or generalized?

Either

77

What are the two autoimmune diseases that are related to vitiligo?

DM I
Autoimmune thyroid disease

78

What is the distribution of type A vitiligo?

Non-dermatomal

79

What is the distribution of type B vitiligo?

Dermatomal

80

What is the difference in age of onset between type A and B vitiligo?

A = any age
B = young

81

What is the difference in progression between types A and B vitiligo?

A = Lifelong
B = rapid spread in 1 year

82

Which has Koebner phenomenon: type A or B vitiligo? Which is associated with immunological diseases

A for both

83

What is idiopathic guttate hypomelanosis? What does it look like? S/sx?

-Acquired white spots on arms and legs, usually 2-5 mm in size.
-Sharply demarcated borders
-Asymptomatic

84

What predisposes patients to developing idiopathic guttate hypomelanosis?

Sun exposure

85

What is nevus anemicus?

A localized and congenital disorder characterized by macules of varying size and shape, that are paler than the surrounding skin and cannot be made red by trauma, cold, or heat. The paler area is due to the blood vessels within the area which are more sensitive to prostaglandins

86

Where on the body is nevus anemicus usually found?

Trunk

87

Are melanocytes and/or melanin present with nevus anemicus?

Yes

88

Are melanocytes and/or melanin present with idiopathic guttate hypomelanosis?

No

89

What is the defect in tuberous sclerosis?

TSC is caused by a mutation of either of two genes, TSC1 and TSC2, which code for the proteins hamartin and tuberin, respectively.

90

What, generally, is tuberous sclerosis?

Diffuse growth of hamartomas throughout the body

91

Where are the ash leaf spots usually found with tuberous sclerosis?

Extremities and trunk

92

What can be used to help located the ash leaf spots of tuberous sclerosis?

Woods lamp

93

What are ephelides?

Freckles

94

What is a lentigo? When do they develop?

(liver spots)--a small pigmented spot on the skin with a clearly defined edge, surrounded by normal-appearing skin. It is a benign hyperplasia of melanocytes which is linear in its spread

-Develop with increasing age

95

What happens to Freckles with age?

Decrease

96

What is the difference in gender between ephelides and lentigo?

Males = lentiges
Females = ephelides

97

Where on the body are lentigo?

Anywhere

98

Are lentigo affected by sunlight?

No

99

What is melasma (chloasma)? What causes it?

Mask of pregnancy
-Acquired hyperpigmentation of the face and neck during prego
-Caused by UV light and estrogen/progesterone levels

100

Is there inflammation associated with melasma?

No

101

True or false: you can cause melasma with oral contraceptives

True

102

What number of cafe au lait spots suggest NF?

6+

103

What is erythema ab igne? Prognosis?

Erythema, hyperpigmentation, telangiectasia, and/or scaling, caused by prolonged exposure to heat

may fade over time or not

104

How does UV light cause skin damage?

ROS

105

Which type of UV light can go through window glass?

UVA

106

What type of UV light causes CT changes and photoaging?

UVA

107

Which type of UV light has the most harmful effects?

UVB

108

What is elastosis?

Coarsening and yellow discoloration of the skin

109

What kind of wrinkles does UV light cause?

Coarse, deep wrinkles

110

what is poikiloderma of civatte?

a common, benign skin condition that mainly affects the skin on the sides of the neck. It mainly affects women. It characteristically spares the shaded area under the chin. The skin in the affected skin is red-brown with prominent hair follicles.

111

What is polymorphous light eruption? Prognosis?

Recurring, light induced pruritic/burning rash, that may be genetic. Chronic sun exposure lessens the likelihood, but

112

Is there scarring with polymorphous light eruption?

No

113

Which gender is usually affected more by polymorphus light eruption?

Females

114

What are the three types of polymorphous light eruption?

-Papular type
-Papulovesicular type
-Plaque type

115

What are the abx that can cause phototoxicity?

Tetracyclines
Fluoroquinolones

116

What diameter is concerning inn terms of the ABCDEs?

More than 6 mm