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Pigmented lesions Flashcards

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1
Q

elderly mixed black and white man pt [morgan freeman]

multiple

tan/brown macules [gradully enlarges and elevated]

less than 2 cm in size

In the sun a lot [but not sure] and possible mutation of FGFR3

seen on: skin of face, trunk, and extremites

A

seborrhic keratosis

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2
Q

morgan freeman is black happens 30% of the time so aka

________

clinically descibe the lesion

A

sharply demarcated:

  • fissured
  • pitted
  • verrucous

but may be smooth

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3
Q

seborrheic keratosis is

ACQUIRED ______ proliferation

basal epidermal cells

A

benign

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4
Q

3 histofeatures of seborrheic keratosis

A

1) Hyperkeratosis
2) acanthosis
3) **numerous pseudocytes **

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5
Q

what are pseudocytes

A

keratin filled invaginations

-surrounding the pseudocytes are basaloid in appearance

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6
Q

tx for seborrheic keratosis

A

no tx, usually esthetic purposes

lq nitrogen and curettage [just like actinic keratosis]

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7
Q

seborrheic keratosis is not malignant in potential exception for

_____ _____ sign

A

leser trelat sign

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8
Q

waht is leser trelat sign

A

sudden apperance numerous seborrheic keratosis and pruritus [pus] associated with

internal malignancy

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9
Q

hyperpigmented **MACULE of the skin **

A

ephelis [freckles]

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10
Q

1st decade of life

round oval

sharply demarcated

light brown lesion [intensifies with sun]

A

ephelis

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11
Q

region of increased melanin production

strong genetic predilection

blonde hair blue eyed

red hair green eyed

less than 3 mm in size

A

ephelis

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12
Q

ephelis NOT like lentigo simplex for 2 reasons

A

1) not as dark
2) no elongation of rete ridges

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13
Q

ephelis is not like MELANOCYTIC nevus

A

not elevated

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14
Q

histofeatures of ephelis

A

1) stratisfied sq epithelium

with abundant melanin

deposition in the basal cell layer

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15
Q

true or false

ephelis is not an increase in melanocyte and in fact can be reduced

2) no tx

A

true

true, use sunblock

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16
Q

what 2 diseases can be PREVENTED with sunscreen

A

ephelis

actinic lentigo

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17
Q

olderly white with lesion on skin, dorsum of hand, arm

5 mm - 1 cm

BBM [benign brown macule] from chronic UV light

A

actinic lentigo = senile lentigo = age spot = liver spot

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18
Q

clinical features:

Well demarcateed

uniformly brown and tan macules

irregular borders

A

actinic lentigo

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19
Q

actinic lentigo NO CHANGE IN COLOR with intensity of UV light just **unlike which pigmented lesion **

A

ephelis

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20
Q

waht is the tx for actinic lentigo

A

no tx unless esthetics:

cyrotherapy

laser

pulsed light therapy

topical

sunblock for prevention

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21
Q

how often does actinic lentigo reoccur

A

rare

BUT NEW LESIONS CAN ARISE FROM ADJ SKIN ANYTIME

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22
Q

what is actinic lentigo

A

BBM

benign brown macule

with chronic UV light damage to skin

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23
Q

people with freckles are more likely to develop actinic lentigo

A

true

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24
Q

what is Addison’s Disease

A

adrenal cortical insuffeciency

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25
addisons disease diffuse _____ leads to geranized brown pigmentation sun exposed skin
hypermelanosis
26
B Blk M
multiple circumscribed dark brown/ black macule covered with intact **mucosa**
27
true or false oral mucosal lesion typically 1st sign of addisons disease
true
28
what is the treatment of ORAL lesions from addisons disease
no tx
29
diagnosis of addisions disease: 1) 2)
hx elevated plasma levels of ACTH
30
tx of regular addisons disease
corticosteriod replacement thearpy
31
what 2 diseases does NOT change with **color intensity in sun exposure** which dsiease does change color intensity with sun exposure
does not change color: 1) actinic lentigo 2) lentigo simplex does change: ephelis
32
what is lentigo simplex
BCMH benign cutanenous melanocytic hyperplasia usually affects children unknown cause and not on sun exposed skin
33
TF darker than ephelis
true
34
lentigo simplex is associated with _____ \_\_\_\_\_syndrome
Peutz Jeghers syndrome
35
4 histofeatures of lentigo simplex
1) increased # of benign melanocytes in the **basal cell epidermis ** 2) encrustations of rete ridges 3) lots of melanin: - melanocytes - basal keratinocytes 4) melanin incontinence
36
melanin incontinence
melanophages in papilary dermis
37
waht is the tx for lentigo simplex and is it malignant
no tx not malignant
38
what is Peutz Jeghers syndrome
Autosomal disease freckle like lesions that affect: - hands - perioral skin - oral mucosa Jejunum and ileum affected with intestinal polyps [intestinal **polyposis]** predespostion for **GI adenocarcinoma**
39
clinically features of Peutz Jeghers syndrome
1) muliple circumscribed tan/brown macules covered by intact mucosa 2) affects: labial and buccal mucosa, tongue, and palate
40
1 histofeature of Peutz Jeghers syndrome
benign overgrowth intestinal glandular epithelium supported by **core smooth muscle **
41
TF epithelial **atypia **is NOT a prominent feature of Peutz Jeghers syndrome
true unlike the polyps of Gardner Syndrome
42
tx of Peutz Jeghers syndrome
MONITOR in tuss us ceptions or tumor formation [genetic counseling]
43
TF melasma more commonly affect people with darker complexion
true
44
what is the treatment of melasma
sunblock with zinc oxide and titanium dioxide
45
waht 2 pigmented lesions is not due to sun exposure
1. lentigo simplex 2. oral melanotic macule
46
who is mostly affected in oral melanoma acanthoma
african american women smooth, darkly pigmented MACULE in the **buccal mucosa**
47
is oral melanoacanthoma common how do you make sure its not maligantn
rare incisonal biopsy
48
cafe au lait spot is similar to waht disease
albright syndrome
49
youll see ___ \_\_\_ macules in cafe au lait spot
flat brown **macules** ## Footnote **1.5cm OR GREATER diameter**
50
6 or more flat brown macules [cafe au lait spot] can be given this diagnosis
neurofibromatosis
51
cafe au lait spot is ___ % in indiv
10%
52
how fast does oral melanoacanthoma gro
enlarges within **months very alarming **GROWTH RATE
53
whih pigmented lesions have to be biopsied to rule out early melanom
1. oral melanotic macule 2. oral melanoacanthoma 3. acquired melanocytic neuvs
54
TF lesions of acquired melanocytic nevus can arise at birth and throughout life 2. will regress by mid life
true true
55
what % of newborns have congenital melanocytic nevus
1%
56
can acquired melanocytic nevus be distinguished from congential melanocytic nevus micoscopically 2. waht are the differnces
1. no cant be distinguished 2. congential melanocytic nevus is LARGER in DIAMETER
57
what pigmented lesion up until this point has 3 - 15% **undergoing malignant transformation to melanom**
congential melanocytic nevus
58
large congenital nevi 2 things
1. has 3 - 15% malignant transformation to melanoma 2. called bathing trunk and garment nevus
59
what pigmented lesions has BR/ BLK **plaques with rough surfaces **
congential melanocytic nevus
60
waht is Blue melanocytic nevus melanin producing lesion
blue nevus
61
melanin are ____ to the surface blue color of this melanin producing lesion is explained by _______ \_\_\_\_\_
deep Tyndall effect
62
waht is the tyndall effect
interaction of light with particles in **colloidal suspension**
63
well circumscribed deep blue macule of the palatal mucosa
blue nevus
64
histofeature of blue nevus
1. melanin seen in **spindle shaped melanocytes ** 2. deep in LAMINA PROPRIA and PARALLEL to surface epi
65
heavily pigmented spindle shaped cells
blue nevus
66
tx for blue nevus
biopsy make sure its not early melanoma
67
waht is melanoma
MN MO malignant neoplasm of melanocytic orgin from 1) benign melanocytic lesion 2) de novo melanocytes
68
waht is the major caustive factor of melanoma
damage from UV radiation
69
TF **acute **sun damage is GREATER CAUSTIVE importance than **chronic **sun damage
true
70
what are the 5 risk factors of melanoma
1. light hair and skin 2. indoor job 3. burns easily 4. hx with painful and blistering sunburn in childhood 5. hx with DCN = dysplastic congential nevus
71
TF 3rd most common skin cancer is melanoma most deaths caused by skin cancer is melanoma
true true
72
melanoma has a high mutation in \_\_\_\_\_
BRAF gene [ras - raf - erk] signaling pathway
73
waht are the ABCDE of melanoma
A - assymetry B - border irregularity C - color variation D - diameter is greater than 6mm E -evolving
74
Lentigo Maligna melanoma
1) precursors: lentigo maligna and **hitchinson's freckle ** 2) mid face of old white people 3) exclusively to sun exposed skin 4) melanoma in situ 5) purely radial growth phase
75
radial growth phase
superficial spreading of melanoma most common
76
Histofeatures of lentigo maligna melanoma superifical spreading
1) radial growth phase 2) atypical melanocytes **ALONG THE BORDER ** of basilar portion of **epidermis** 3) indi melanocytes invading higher levels of epithelium
77
acral lentiginous melanoma
1) most common among Af Amer 2) most common oral melanoma
78
histofeatures of acral lentiginous melanoma
aytpical melanocytes **WITHIN basilar **portion of epidermis invasion **into SUPERFICIAL LAMINA PROPRIA**
79
\_\_\_\_\_ of \_\_\_\_\_ important for histopathological evaluation of cutaneous melanoma
depth of invasion histopathologic evaluation
80
why is the depth of invasion important for histopatholgical evaluation
correlation with prognosis
81
true or false prognosis for oral melanoma is extremely poor
true extremely poor
82
\_\_\_\_ system of measurement \_\_\_\_\_ classification which one is more accurate
clark system of measurement breslow classification [more accurate]
83
clark system of measurement
assigns a level to the lesion 2) depends on the **deepest anatomic cutaneous region** invaded by the tumor
84
breslow classifcaiton
more accurate measures the distance: TOP of granular cell layer to DEEPEST
85
WORST PROGNOSIS: Bans
BACK POSTERIOR ARM LATERAL NECK SCALP
86
5 background info of vitiligo
1. **de pigmentation **of broad areas of the skin 2. 1% incidence 3. family tendency 4. onset any age, esp 10 -30 yo 5. maybe autoimmune
87
3 clinical features of vitiligo
1. stress 2. injury sun exposure
88
TF thyoid disease is common among vitiligo pt 2. except for thyroid carcinoma
true true
89
\_\_\_ ___ slight increase with vitiligo pt
DM Addisons diease
90
histofeature of vitiligo
NO MELANOCYTES present in the skin
91
Pityriasis [tinea] versicolor is caused by
fungus [malassezia furfur] found on **normal skin**
92
4 reasons conversion of saprophyic -\> morphologic form
1) genetic predilection warm, humid evn immunosuppressed malnutrition cushing's disease
93
clinically waht does pityriasis versicolor look like
scaly skin macules [obvious with pt tan in the summer]
94
scaly skin macules that can be HYPOpigmented HYPERpigmented
HYPOpigmented scaly skin macules: 1. tyrosinase 2. inhibition of enzyme in melanin synthesis pathway HYPERpigmented scaly skin macules: fungus induces MELANOSOME ENLARGEMENT
95
2 histofeatures of tinea versicolor
1. short cigar butt hyphae 2. KOH spores with short mycelium = sphagetti and meatball
96
diagnosis of tinea versicolor is
confirming KOH examination
97
tx of pityriasis [tinea] versicolor
oral treatments: 1) itraconazole 2) fluconazole
98
TF itraconazole and fluconazole DOES NOT PREVENT high rate of reoccurance
true
99

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