pigmented lesions Flashcards

(37 cards)

1
Q

where are melanocytes derived from?

A

neural crest

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2
Q

where do melanoblasts migrate to early in embryogenesis?

A

skin
uveal tract
leptomeninges

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3
Q

when do melanoblasts form melanocytes?

A

once settled in the skin

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4
Q

what is melanocortin 1 receptor gene?

A

encodes MC1R protein-sits on cell surface
determines balance of pigment in skin and hair

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5
Q

what does eumelanin responsible for?

A

all hair colours except red

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6
Q

what does phaeomelanin cause?

A

red hair

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7
Q

what does MC1R do?

A

turns phaeomelanin into eumelanin

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8
Q

what does 1 defective copy of MC1R cause?

A

frecklesw

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9
Q

what does 2 defective copies of MC1R cause?

A

red hair and freckles

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10
Q

what do freckles (ephilides) reflect?

A

clumpy distribution of melanocytes

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11
Q

what are actinic lentigines related to?

A

UV exposure and increase melanin and basal melanocytes

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12
Q

where are actinic lentigines usually seen?

A

face
forearms
dorsal hands

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13
Q

what allows for the formation of simple naevi?

A

during infancy the melanocytes to keratinocyte ratio breaks down at a number of cutaneous sites

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14
Q

what are the characteristics of dysplastic naevi?

A

> 6mm diameter
variated pigment
border asymmetry

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15
Q

what are the characteristics of sporadic DN?

A

not inherited
one to several atypical naevi
risk of MM raised

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16
Q

what are the characteristics of familial DN?

A

strong FHx of melanoma
autosomal inheritance
high penetrance
many atypical naevi
risk of melanoma hella high

17
Q

which layer of the skin isn’t affected by DN?

18
Q

what are halo-naevi?

A

peripheral halo of depigmentation
show inflammatory regression
overrun by lymphocytes

19
Q

what are blue naevi?

A

entirely dermal
consist of pigment rich dendritic spindle cells
cellular variant may have mitoses and mimic melanoma

20
Q

what are the characteristics of spitz naevi?

A

very rare
<20 y/o
large spindle and/or epithelioid cells
mimic melanoma
most are benign
pink colouration (prominent vasculature)

21
Q

where are melanoma most commonly found?

A

sun exposed areas
scalp, face, neck, arm, trunk, leg

22
Q

what is the main cause of malignant melanoma?

23
Q

what are the features that would make you sus of malignant melanoma?

A

new pigmented lesion develops in adulthood
ulceration
development of satellite nodules
bleeding
irregular pigmentation
change in shape

24
Q

what are the 4 main types of melanoma and where are they commonly found?

A

superficial spreading - trunk and limbs
acral/mucosal lentiginous - acral and mucosal
lentigo maligna - sun damaged face/neck/scalp
nodular - varied, mainly trunk

25
what are the features of SSM, A/MLM and LMM?
grow as macules either entirely in-situ or with dermal microinvasion (RGP) eventually melanoma cells invade the dermis forming an expansile mass with mitosis (VGP)
26
only RGP or VGP can metastasise?
VGP
27
what type of tumour is a nodular melanoma?
simple nodule of VGP tumour
28
what does the prognosis of melanoma relate to?
breslow thickness
29
what are other prognostic indicators?
ulceration suffix b = tumour ulceration high mitotic rate, lymphovascular invasion, satellites, sentinel lymph node involvement
30
how can malignant melanoma spread?
local dermal lymphatics -> satellite deposits of MM regional lymph node metastases - common patterns of disease progression (nodes excised) blood spread - skin/soft tissue, heart, lungs, GI tract, liver, brain
31
how is melanoma treated?
primary excision = to give clear margins some receive sentinel node biopsy SN positive = regional lymphadenectomy
32
what is used to treat advanced disease?
chemo immunotherapy genetic therapies
33
what is the clearance if invasive but <1mm?
1cm clearance
34
what is the clearance if invasive and >1mm?
2cm
35
what is BRAF?
a weak cytosolic proto-oncogene
36
what happens if BRAF is mutated
drives cell proliferation by up-regulating MEK and ERK
37