Pigmented Lesions Flashcards
(36 cards)
1
Q
What gives lesions color?
A
- Blood
- Melanin
- Foreign material
2
Q
Hemangioma
A
- Tumor of infancy that has rapid growth and endothelial cell proliferation
- Not present @ birth - first 8 wks of life
- Rapid growth phase followed by gradual involution
- Most common
- 60% in head/neck, more in females
- Tx: N/A, they regress on their own. Systemic corticosteroids may help reduce size
3
Q
Vascular Malformation
A
- Anomalies of BV’s w/o endothelial proliferation
- Present @ birth & persists through life
- Tx:
- Small lesion: N/A
- Large lesion: Sclerosing agent and resection
4
Q
Sturge-Weber Angiomatosis
A
- Vascular proliferation involving tissues of brain and face
- Non-hereditary developmental condition
- Vascular malformation of the face = port wine stain
- Unilateral distribution along one or more segments of trigeminal nerve
- Leptomeningeal angiomas on ipsilateral cerebral cortex may cause convulsive disorder or mental retardation
- Tx:
- Flash lamp pulsed dye laser can improve esthetics
- Mental complications/epilepsy may need neurosurgical tx
5
Q
Varix
A
- Abnormally dilated & tortuous veins
- Common in older adults
- Loss of CT tone supporting vessels
- Usually blanche, but not if thrombus
- Common location: sublingual varix
- Tx: N/A; removed for esthetics
6
Q
Kaposi’s Sarcoma
A
- Vascular neoplasm caused by HHV-8
- Associated w/ HIV
- Painless blue-purple macules/plaques on surface of the skin
- Oral lesions generally occur on the palate
- Tx: Chemo or radiation
7
Q
Sarcoma vs. Carcinoma
A
Sarcoma: Mesenchymal tissue so BVs, nn, salivary glands
Carcinoma: Epithelial derived
8
Q
Petechiae
A
Small hemorrhages into skin, mucosa, serosa
9
Q
Ecchymosis
A
Blood accumulation >2cm
10
Q
Hematoma
A
Accumulation produces a mass
11
Q
Ephelis (Freckle)
A
- Represent region of increased melanin production
- Face, arms, back of fair-skinned, blue-eyed, red or blond hair
- Melanocortin-1-receptor gene (MC1R)
- More pronounced after skin exposure
12
Q
Oral Melanocytic Macule
A
- Brown, mucosal discoloration due to increased melanin production
- Flat
- Not related to sun exposure
- Vermillion border of lower lip (33%), buccal mucosa, gingiva, palate
- Typically solitary (83%), well-defined, round/oval, <7cm
- No premalignant potential
- Management
- Small, unchanging non-thickened lesions uniform in color w/ regular borders can be followed
- Indications to biopsy a suspected melanotic macule
- Recent onset, recent enlargement, or unknown duration
- Raised
- Large size
- Irregular pigmentation
13
Q
Melanoacanthoma
A
- Reactive process
- Almost exclusive to AA, mostly 3rd & 4th degrades
- Buccal mucosa most common
- Usually solitary, but occasionally bilateral or multifocal
- Typically asymptomatic, smooth, flat, dark-brown to black
- Often demonstrate rapid growth, reaching several cm in a few wks
- Management: Biopsy to rule out melanoma
14
Q
Nevus (Acquired Melanotic Nevus)
A
- Malformation of the skin and mucosa
- Proliferation of nevus cells, which are derived from neural crest
- Develop during childhood and more are present before 35yo
- Men and women, more in whites, above the waist
- Management:
- May be flat early in development, but eventually raised/thickened
- Oral nevus is considered premalignant & should be completely excised
- Melanoma cannot always be distinguished from nevus on a clinical basis
15
Q
Blue Nevus
A
- Proliferation of melanocytes deep in CT
- Second most common nevus in the mouth
- Seen almost always in the palate
- Children & young adults, female predilection
16
Q
Melanoma
A
- Damage from UV radiation is a major causative factor
- 3rd most common skin cancer
- # 1 - basal cell carcinoma
- # 2 - squamous cell carcinoma
- Most cases seen in white adults (avg age 50-55yr)
- Acute sun exposure (sunburn) may be of greater importance than chronic
- Risk factors
- Fair complexion and light hair
- Burns easily
- Indoor occupation w/ outdoor recreational habits
- Personal/family h/o melanoma
- H/o dysplastic or congenital nevus
17
Q
4 Clinicopathologic Types of Melanoma
A
- Superficial spreading melanoma
- Nodular melanoma
- Lentigo maligna melanoma
- Acral (mucosal) lentiginous melanoma
18
Q
Superficial spreading melanoma
A
- Most common type of melanoma. Accounts for increased incidence of melanoma
- Associated w/ acute & chronic sun exposure
- Can occur in young adults
- Can remain in radial growth phase for years
- Nicest, spreads along the surface instead of invading
19
Q
Nodular Melanoma
A
- Appears as a dome-shaped, darkly pigmented nodule
- Grows rapidly
- Exists in the vertical growth phase from the beginning, thus tends to be deeply invasive
20
Q
Lentigo Maligna Melanoma
A
- Associated w/ chronic sun exposure
- Occurs most commonly on the face of older adults
- One or more darkly pigmented nodules arising in a solar lentigo
- The most slow growing melanoma - may remain in radial growth phase for years
- Solar lentigo: Brown (non-thickened) macule, larger than a freckle
- Occurs on chronically sun-exposed skin, esp cheeks and dorsal surface of hands
- Constant pigmentation
21
Q
Acral (mucosal) Lentiginous Melanoma
A
- Most common form in the oral cavity
- Melanomas of oral mucosa, palms, soles, nail beds
- Most common in AA
22
Q
Oral Melanoma
A
- Patients 6th-7th decades
- 66% men
- 80% palate or MX alveolus
- Begins as black-brown macule
- Becomes exophytic mass
- Typically thickened & raised but may be flat early in development
- Lesion is usually advanced at initial presentation and has poor px
23
Q
ABCDE - Clinical Features of Melanoma
A
- Asymmetry
- Border irregularity
- Color variation
- Diameter >6mm
- Evolving
24
Q
Management of Melanoma
A
- Benign & malignant melanocytic lesions may be clinically indistinguishable in the oral cavity
- Only way to exclude malignant melanoma is excisional biopsy
- W/o early intervention, px right now is almost hopeless
25
Tx of Melanoma
Tx: Surgical excision
* Radiation is of limited value
* Chemo & immunotherapies are evolving
* **Most important px indicator = histologic depth of invasion**
* Melanomas \<0.75mm thick have almost 100% 5yr survival
26
Clark Method of Staging
Melanoma
* Stage 1: Melanoma in situ (no invasion)
* 10yr survival = 96%
* Stage 2: Tumor in papillary dermis
* 10yr survival = 96%
* Stage 3: Tumor to junction papillary and reticular dermis
* 10yr survival = 90%
* Stage 4: Tumor in reticular dermis
* 10yr survival = 67%
* Stage 5: Tumor in subQ tissue
* 10yr survival = 26%
27
Areas of poor px for melanoma
**BANS**
* Interscapular area of the **B**ack
* Posterior upper **A**rm
* Posterior & lateral **N**eck
* **S**calp
28
Generalized Physiologic Melanotic Lesions of Oral Mucosa
* Symmetric & persistent
* Does not alter normal architecture
* Seen in all ages and genders
* Found in any location, gingiva is most commonly affected
* **Occurs due to increased production of melanin**
* **Similar in intensity to skin pigmentation**
29
Addison's Disease
* Insufficient production of adrenal corticosteroid hormones **(mineralcorticoids, cortisol)**
* **Destruction of adrenal cortex or pituitary gland dysfcn**
* Fatigue, irritability, depression, weakness, hypotension
* Bronzing: Generalized hyperpigmentation of skin
* Caused by increased ACTH stimulating melanocytes (primary)
* Diffuse, brown, macular pigmentation of oral mucosa
* Dx: Lab test
* Cortisol \<20ug/dL
* High ACTH: Primary
* Low/normal ACTH: Secondary
* Tx: Replacement tx
30
Peutz-Jeghers Syndrome
* Freckle-like lesions of hands, perioral skin & oral mucosa (do not wax/wane w/ sun exposure)
* Genetic mutation
* **Gastro-intestinal features**
* Intestinal polyposis (not premalignant)
* Intestinal obstruction due to intussusception
* GI malignancy: 33% by 60yo
* **Oral lesions seen in 90% of pts**
* Vermillion zone, labial/buccal mucosa, tongue
* 1-4mm blue-gray macules
* Tx: Monitored for intussusception or tumor formation; genetic counseling
31
Neurofibromatosis
* Genetic mutation
* Clinical features
* **Café au lait freckles - 6 freckles at least 1.5cm in diameter needed for dx**
* **Axillary freckling**
* **Multiple neurofibromas**
* Benign tumor of neural & fibril tissue
* **Lisch nodules**
* Other CNS lesions
* Increased incidence of neurogenic sarcoma
* Tx: Symptomatic tx
32
Smoker's Melanosis
* **Most common in anterior gingiva**
* **Palate & buccal mucosa from pipe smoking**
* Pigmentation often resolves w/in 3yr after smoking cessation
* Tobacco is stimulating melanocyte activity
* Lesion is not premalignant in itself
33
Melasma
* Irregular, symmetric, brown macules on **sun-exposed face and lips**
* AKA mask of pregnancy
* Hypermelanosis
* Unknown cause but associated w/ **pregnancy**
* May also occur with **oral contraceptives**
* Estrogen receptor link
34
Medication Induced Pigmentation
* Drug metabolites stimulate melanocytes
* Most produce diffuse melanosis
* Estrogen
* **Anti-malarials, anti-psychotics, chemotherapeutics, laxatives, AIDS meds, tetracycline, minocyclines**
* Tx: N/A; d/c drug
35
Heavy Metal Ingestion
* **Arsenic, bismuth, platinum, lead, silver, mercury**
* Mainly after occupational exposure to vapors
* Can be deposited in skin & oral mucosa
* Gray to black color
36
Amalgam Tattoo
* ST implantation of amalgam particles
* Passive transfer by chronic friction of mucosa against amalgam restoration
* Most common pigmentation of oral mucous membranes
* Typically macular & gray
* May be detected in rads
