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RB Y2 Dermatology > Pigmented Skin Lesions > Flashcards

Pigmented Skin Lesions Flashcards

(67 cards)

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1
Q

describe what melanocytes do during embryogenesis

A

derived from the neural crest, early in embryogenesis melanoblasts migrate to skin, uveal tract and leptominges - when they settle in the skin they form melanocytes. basally situated

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2
Q

does the melanocyte to keratinocyte ratio change depending on race

A

no

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3
Q

melanocytes

A

pigment producing dendritic cells

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4
Q

melanocyte role with UV radiation

A

protect DNA from UV radiation - convert tyrosine to melanin which absorbs light and form a protective cap over nucleus

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5
Q

what does non cancerous growth of melanocytes result in

A

moles and freckles

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6
Q

what gene determines the balance of pigment in skin and hair

A

MC1R

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7
Q

eumelanin causes what hair colour

A

everything but red

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8
Q

phaeomelanin causes what hair colour

A

ed

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9
Q

MC1R role

A

convert phaeomelanin to eumelanin

determines the balance of pigment in skin and hair

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10
Q

one defective copy of MC1R

A

freckles

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11
Q

two defective copies of MC1R

A

red hair

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12
Q

another name for freckles

A

ephilides

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13
Q

what is a freckle

A

a patchy inc in melanin pigment that occurs after UV exposure

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14
Q

actinic/solar lentigines

A

also known as liver/age spots found on face, forearms and dorsal aspects of the hands

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15
Q

actinic/solar lentigines histological features

A

epidermis elongated rete ridges and increase in melanin and basal melanocytes

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16
Q

another name for mole

A
  • melanocytic naevi
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17
Q

size of small mole

A

<2cm diameter

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18
Q

size of medium mole

A

>2 and <20 cm

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19
Q

what risk do large moles have

A

risk of melanoma - surgical excision

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20
Q

usual type acquired naevi

A

A melanocyte proliferation (breakdown of the melanocytes:keratinocytes ratio) which arises in the epidermis and then spreads to the dermis.

Within time the epidermal component, and subsequently the entire naevus disappears.

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21
Q

histological features of usual type acquired naevi

A

epidermis shows lengthening of rete ridges and slight hyperkeratosis

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22
Q

3 phases of naevi

A

junctional compound intradermal

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23
Q

junctional phase

A

naevi arise from epidermal melanocytes, situated at DEJ, these proliferate and form cell nests

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24
Q

compound phase

A

naevus extend into superficial dermus (clinically innocent phenomenon) involve both junction and dermis proper

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25
intradermal phase
junctional component disappears in adulthood so all naevus cells are now intradermal
26
dysplastic naevi size
generally \>6mm diameter
27
dysplastic naevi
varied pigment and border asymmetry - some hallmarks of melanoma but not enough to be classified as malignant host reaction fibrosis and inflammation occurs
28
how do dysplastic naevi occur
sporadically or familial
29
what is the risk of melanoma with familial dysplastic naevi
lifetime risk up to 100% high penetrance (CDKN2A)
30
halo naevi
peripheral halo of depigmentation due to loss of melanocytes from lymphocyte action
31
blue naevi - dermal/epidermal involvement
entirely dermal
32
blue naevi
uniform and structureless consist of pigment rich dendritic spindle cells
33
spitz naevus presentation
symmetrical reddish or skin coloured nodule
34
spitz naevus
nest of spindle shaped melanocytes most are entirely benign but there is a malignant variant
35
why are spitz naevus pink
due to prominent vasculature
36
what cells do melanomas arise from
melanocytes which are found along the basal layer of the epidermis
37
what is the 5 year survival rate for melanoma if confined to epidermis
95-100% (\<1mm) cannot reach blood supply
38
what is the 5 year survival rate for melanoma if entered the dermis
50%
39
what is the 5 year survival rate for melanoma if it has metastasised
5%
40
ABCDE rule
asymmetry, border, colour, diameter and evolution
41
what is the ugly duckling sign
way to identify if any mole stands out from the rest
42
where can superficial spreading melanomas occur
anywhere
43
superficial spreading melanoma features
most common type, irregular shape, flat periphery and slow growing grow laterally before vertical invasion
44
where can nodular melanomas be found
anywhere
45
nodular melanoma
Most aggressive type, grows rapidly from the start. Presents as rapidly growing pigmented nodule which bleeds or ulcerates.
46
where can Acral/Mucosal Lentiginous Melanoma be found
on the nails, soles of feet or palms of hands may not be related to sun exposure
47
who is Acral/Mucosal Lentiginous Melanoma most common in
coloured races
48
where does lentigo maligna melanoma occur
sun damaged face/neck/scalp in old people
49
what is the precursor lesion for lentigo maligna melanoma
lentigo maligna (**Hutchinson's** **freckle**) - a slow growing macular area of pigmentation seen in elderly people, commonly on the face. confined to epidermis (in situ) diagnosed as lentigo maligna melanoma when the malignant melanoma has invaded the dermis
50
what is the prognosis of melanoma related to
Breslow depth and ulceration
51
what is breslow depth
deepest tumour measured from the granular layer down in mm
52
what does the suffix B when describing tumour staging refer to
ulceration - worse prognosis
53
what stain is used to determine lymph node involvement
S100
54
what can acral melanomas with c-kit mutation be treated with
imatinib
55
what mutation may melanomas on intermittently sun exposed skin have
BRAF mutation
56
what is the role of BRAF
proto-oncogene that stimulates the MAPKK pathway stimulating cell division. The mutated form becomes a potent oncogene that drives cell division
57
what drugs interfere with the BRAF MAPKK pathway
eg dabrafenib and vemurafenib
58
spitz naevus
59
superficial spreading melanoma
60
lentigo maligna melanoma
61
halo naevi
62
dysplastic naevi
63
dysplastic naevi
64
melanoma arising in a dysplastic naevi
65
what is this naevi
junctional
66
what is this naevi
intradermal
67
what is this naevi
compound

RB Y2 Dermatology (22 decks)

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