Pigment Disorders Flashcards
1
Q
What are the SALT cells in the skin?
A
Langerhans cells–APCs of the immune system
2
Q
What is a major issue with tanning in terms of cellular damage (which cells in particular)?
A
Langerhans cells are damaged
3
Q
What is skin type I of the Fitzpatrick skin types?
A
White people who can’t tan
4
Q
What is skin type II of the Fitzpatrick skin types?
A
Fair skin (burns easily, but can tan a little bit) (you)
5
Q
What is skin type III of the Fitzpatrick skin types?
A
Darker, white skin
tans after initial burn
6
Q
What is skin type IV of the Fitzpatrick skin types?
A
Light brown skin
7
Q
What is skin type V of the Fitzpatrick skin types?
A
Brown skin
8
Q
What is skin type VI of the Fitzpatrick skin types?
A
Dark brown or black skin
9
Q
Are nevi macules or papules?
A
Either
10
Q
What happens to nevi with age, generally?
A
Regress/ go deeper
11
Q
True or false: dark skinned people do not develop nevi
A
false
12
Q
What are the ABCDEs of melanoma changes?
A
Asymmetry Border Color Diameter Evolving
13
Q
What are the two major ways to classify type of nevi?
A
By onset
By depth
14
Q
At what age do nevi begin to form? When does it peak?
A
Age 10 ish
Peaks around age 50
15
Q
It is unusual to develop nevi after what age?
A
50
16
Q
What usually causes nevi? What is the genetic predisposition to them?
A
- Sunlight
- Mutation in the BRAF gene
17
Q
What are the two major shapes of junction nevi?
A
Flat or slightly elevated
18
Q
What are the two major shapes of compound nevi?
A
Slightly elevated
Dome
19
Q
What are the four major shapes of dermal nevi?
A
Dome
Warty
Polypoid
Pedunculated
20
Q
What are junction nevi?
A
Nevus whose cells are at the dermoid-epidermal junction
21
Q
What are compound nevi?
A
Nevus whose cells are at the derm-epidermal junction and upper dermis
22
Q
What are dermal nevi?
A
Neves whose cells are in the dermis, sometime along with fat cells
23
Q
What are the color of the following:
- Junction nevi
- Compound nevi
- Dermal nevi
A
- Junction nevi = uniform tan
- Compound nevi = flesh color
- Dermal nevi = flesh to pink
24
Q
True or false: junction nevi are sharply demarcated
A
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
