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Δερματοσκόπηση > Step 2: Methods to DD btw melanoma & benign melanocytic nevi > Flashcards

Step 2: Methods to DD btw melanoma & benign melanocytic nevi Flashcards

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1
Q

Colors in benign lesions vs melanoma

A

1-2

vs

+3

5-6 colors => 95% specificity for melanoma

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2
Q

What colors have the greatest impact on melanoma dx?

A
  • Red
  • White
  • Blue/gray

Much more suspicious than brown

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3
Q

Red color

vs

Black

vs

White

vs

Gray

A

Hb in the skin

vs

melanin in stratum corneum or epidermis

vs

fibrosis or hyperkeratosis

vs

melanin in papillary dermis

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4
Q

Comma vessels are ass/w?

A

Benign (intradermal) nevi

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5
Q

Dermoscopic equivalent of ^blood volume within a lesion

A

Milky red areas

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6
Q

Gray colored granularity in benign vs malignant lesions

A

< 10% of lesion surface area(LSA)

vs

> 50%

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7
Q

Melanin located in stratum corneum vs below stratum corneum

A

Can be tape stripped off

vs

cannot

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8
Q

Tape stripping method

A
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9
Q

Blotches

vs

irregular black dots

in melanoma correspond to?

A

melanin in all layers of the epidermis and dermis

vs

pagetoid spread

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10
Q

What does pagetoid spread mean?

A

“upward spreading” of abnormal cells in the epidermis

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11
Q

Characteristic color of benign melanocytic lesions

A

Light brown

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12
Q

Light brown color

+

atypical vessels

should raise suspicion for?

A

Hypomelanotic melanoma

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13
Q

MC dermoscopic manifestation of melanoma in fair-skinned individuals

A
  • Few colors & structures
  • Light brown color
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14
Q

Name the dermoscopic melanoma-specific structures

A
  • Atypical pigment network
  • Negative network
  • Irregular streaks (radial streaming, pseudopods)
  • Atypical dots & globules
  • Blue white veil (BWV)
  • Chrysalis-like structures
  • Regression structures
  • Atypical vessels
  • Atypical blotch
  • Peripheral brown structureless areas
  • 5-6 colors
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15
Q

Which of the melanoma specific structures has the highest OR?

A

Peripheral brown structureless areas

28 (!!)

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16
Q

Pigment network in

benign nevi

vs

melanoma

A
  • Relatively uniform in thickness, color
  • Thinning at the periphery

vs

  • heterogeneous
  • color variegation
  • abrupt cutoff at periphery
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17
Q

Define negative network

A

serpiginous interconnecting hypopigmented lines that surround irregularly shaped pigmented structures

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18
Q

Negative network DDx

A
  • Congenital nevi
  • Acquired nevi (eg, Spitz)
  • Melanoma
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19
Q

Negative network

benign lesions

vs

melanoma

A
  • symmetrically distributed
  • involves ENTIRE lesion

vs

  • asymmetrically distributed
  • focally within the lesion
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20
Q

Lesion with regular streaks in an adult. Management?

A

Excisional biopsy

bcz some melanomas present with relatively regular streaks

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21
Q

MC types of melanoma in childhood(rare) ?

A

Nodular +/- amelanotic

( thus they do not display any streaks)

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22
Q

Lesions with streaks in childhood, management?

A

Closely monitored or excised

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23
Q

Blue white veil over a flat or raised part of the lesion, corresponds with regression?

A

Flat

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24
Q

Regression structures include?

A
  • Blue-white veil over flat part of lesion
  • Peppering/granularity
  • Scar-like depigmentation
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25
Regression structures seen in benign lesions vs melanoma
\< 10% of LSA vs \> 50%
26
Homogeneous blue-white veil in entire lesion vs homogeneous BWV in central part vs Irregular BWV in melanocytic lesion
Blue nevus vs combined nevi, Spitz vs melanoma
27
Chrysalis-like structures DDx
* Melanoma * Spitz nevi * BCC * Dermatofibroma * LPLK
28
Regular vs irregular blotches
* Symmetrically in the center * can be stripped off * black uniform color, "lamella" vs * located off center * cannot be stripped off * multiple shades of color
29
Peripheral brown structureless areas correlate with?
* Flattening of DEJ * Presence of pagetoid cells
30
Describe the major dermoscopic findings in this lesion Dx?
* Multiple colors ( "chaos") * atypical pigment network * Irregular dots & globules * irregular blotch * regression structures * atypical vessels * milky red areas **Melanoma**
31
Describe the major dermoscopic findings in this lesion Dx?
* One color ( light brown) * Typical pn * Few typical globules Benign nevus
32
Describe the major dermoscopic findings in this lesion Dx?
* Comma shaped vessels Benign intradermal nevus
33
Describe the major dermoscopic finding in this lesion Dx?
* Polymorphous vessels * Milky red areas Hypomelanotic melanoma
34
Describe the major dermoscopic findings in this lesion Dx?
Extensive regression with: 1. granularity/peppering 2. scar-like depigmentation
35
How to differentiate BWV from chrysalis-like structures
BWV much more evident in NPD vs Chrysalis in PD
36
Describe the major dermoscopic findings in this lesion Dx?
* Multiple colors * Atypical pn ( thick lines, small, holes, abrupt cutoff periphery) * Irregularly distributed streaks & globules * Regression structures * Chrysalis Melanoma
37
Describe the major dermoscopic findings in this lesion Dx?
* **Atypical dots & globules** * **Atypical blotches** * multiple colors Melanoma arrow corresponds to pagetoid cells & nests in epidermis
38
Describe the major dermoscopic finding in this lesion Dx?
* Typical pn * One color, (light brown) Benign nevus
39
Describe the major dermoscopic findings in this lesion Dx?
* Atypical pn * Peripheral brown structureless area Melanoma
40
Describe the major dermoscopic finding in this lesion Dx?
Negative network centrally Benign nevus
41
Describe the major dermoscopic finding in this lesion Dx?
Focal negative network (lower part) Melanoma
42
Highly suggestive of Spitz/Reed nevus?
Streaks around the entire perimeter
43
Describe the major dermoscopic findings in this lesion Dx?
* 2 colors, black/brown * Central blotch * Regular peripheral streaks & globules Spitz/Reed nevus
44
Describe the major dermoscopic finding in this lesion Dx?
Focally distributed streaks Microinvasive melanoma
45
Describe the major dermoscopic finding in this lesion Dx?
* Typical pn * Black dots regularly distributed Benign nevus
46
Describe the major dermoscopic finding in this lesion Dx?
Typical globular pattern throughout the lesion Benign nevus
47
Describe the major dermoscopic findings in this lesion Dx?
* Peripheral pn * Central globules Benign nevus
48
Describe the major dermoscopic finding in this lesion Dx?
Peripheral rim of globules Benign nevus
49
Identify the most prominent dermoscopic finding in image A vs B Dx? (Same lesion)
A) NPD: Blue-white veil vs B) PD: Chrysalis-like structures Melanoma
50
Describe the major dermoscopic finding in this lesion Dx?
* Central black blotch, "lamella" * Typical pn Benign nevus
51
Describe the major dermoscopic findings in this lesion Dx?
* Central structureless area * Peripheral pn Benign nevus
52
Describe the major dermoscopic finding in this lesion Dx?
Peripheral brown structureless area Melanoma
53
Which one has better diagnostic accuracy: analysis-based algorithms vs pattern analysis
Pattern analysis (slightly better) Usage of both methods optimizes diagnostic outcome
54
Asymmetry is a prerequisite for melanoma dx T/F ?
False Some melanomas may manifest dermoscopic symmetry
55
Dermoscopic "definition" of melanoma
* Lesions that deviate from benign nevus patterns * Manifest at least 1 out of 10 melanoma-specific structures Melanoma until proven otherwise
56
Schematic drawings of the 10 benign nevus patterns
57
Features of diffuse reticular pattern
* Diffuse homogenous network * uniform thickness, color of network lines * Network fading at periphery
58
Diffuse reticular pattern is MC seen in..?
* Acquired nevi, individuals with darker phenotype * Congenital nevi, \> lower extremity
59
Features of patchy reticular pattern
* Focal patches of homogeneous network * surrounded by homogeneous structureless areas
60
Patchy reticular pattern is MC seen in...?
* Acquired nevi, torso * Superficial congenital nevi, lower extremity
61
Features of peripheral reticular with central hypopigmentation
* uniform network at the periphery * central homogenous, hypopigmented, structureless area
62
Features of peripheral reticular pattern with central hyperpigmentation
* uniform network at the periphery * central homogenous, hyperpigmented structureless area or blotch
63
Peripheral reticular pattern with central hyperpigmentation vs hypopigmentation is MC seen in?
Acquired nevi in: dark skin phenotype vs fair skin
64
Features of homogeneous pattern
* diffuse homogenous structureless pattern * +/- few globules * +/- small network fragments * N.B: amelanotic & hypomelanotic melanomas can manifest in a similar manner; however, most melanomas will also reveal atypical blood vessels +/- crystalline structures
65
# Define this pattern MC seen in..?
Peripheral reticular with central globules Congenital nevi
66
Typical pattern of Spitz nevi
Starburst pattern with streaks
67
Features of peripheral globular pattern with central network
* central component: reticular or homogeneous * When 1 row of uniform globules around the entire perimeter =\> **actively growing nevus** ( not yet undergone senescence) * When \> 2 rows =\> **Starbust pattern**
68
# Define this pattern MC seen in...?
Globular Congenital nevi
69
Define the 2-component pattern, give examples
* Half of lesion manifests one pattern, * the other half a different one * Examples: 1. reticular-globular 2. reticular-homogenous 3. globular-homogenous
70
Define multicomponent pattern
Two definitions (only the 1st applies for benign nevi) 1. Organized +/- symmetrically distributed typical dots/globules, typical network, homogenous areas. **One axis of symmetry** 2. Symmetrically distributed globules, network, blotches, dots, veil, regression structures, +/- structureless areas​. **\>3 structures are required to classify the lesion as multicomponent**
71
Schematic drawings of a few malignant patterns
72
Atypical pn histologically correlates with...?
Atypical lentiginous or nested melanocytic proliferation along the DEJ
73
Streaks (radial streaming, pseudopods) histologically correlate with...?
Confluent junctional nests of melanocytes at the periphery. This corresponds to the radial growth phase of the melanoma
74
Negative network histologically correlates with...?
1. Thin elongated rete ridges together with large tubular melanocytic nests within a widened papillary dermis 2. Bridging of adjacent rete ridges 3. Nests surrounded by a fibrotic stroma
75
Chrysalis/crystalline histologically correlates with...?
remodeled or new dermal collagen
76
Atypical dots & globules histologically correlates with...?
Junctional or dermal nests of melanocytes dots can also represent **pagetoid nests**
77
Irregular blotches histologically correlates with...?
Melanin pigmentation throughout the epidermis or dermis or both
78
Blue-white structures over raised areas histologically correlate with...?
Compact **orthokeratosis** overlying melanophages, melanocytes, or free melanin in the dermis
79
Blue-white structures over flat areas histologically correlate with...?
**Fibrosis** within the papillary dermis and melanosis
80
Atypical vascular structures histologically correlate with...?
Tumor-induced neoangiogenesis
81
Peripheral brown structureless areas histologically correlate with...?
Flattening of the rete ridges with pagetoid spread of melanocytes
82
Describe the pattern of this lesion Dx?
Diffuse reticular Compound dysplastic nevus
83
Describe the pattern of this lesion Dx?
peripheral reticular network with central hyperpigmentation Benign nevus
84
Describe the pattern of this lesion
Peripheral reticular with central hypopigmentation Benign nevus
85
Describe the pattern of this lesion Dx?
Patchy reticular pattern Dysplastic nevus
86
Describe the pattern of this lesion Dx?
Diffuse reticular pattern (asymmetric silhouette) Junctional dysplastic nevus
87
Describe the pattern of this lesion Dx?
Homogeneous pattern few globules Congenital nevus
88
Describe the pattern of this lesion Dx?
Homogeneous blue pattern Blue nevus
89
Describe the pattern of this lesion Dx?
Homogeneous pattern (tan to pink color) Dysplastic nevus
90
Describe the pattern of this lesion Dx?
Homogeneous pattern Congenital nevus
91
Describe the pattern of this lesion Dx?
Peripheral reticular network with central globules Congenital nevus
92
Describe the pattern of this lesion Dx?
Peripheral globules (growing nevus) Benign nevus
93
Describe the pattern of this lesion Dx?
Strarbust pattern with radial streaks Spitz nevus
94
Describe the pattern of this lesion Dx?
Starbust pattern Spitz nevus
95
Describe the pattern of this lesion Dx?
Globular pattern Benign nevus
96
Describe the pattern of this lesion Dx?
Globular (cobblestone) pattern Congenital nevus
97
Describe the pattern of this lesion Dx?
Two component pattern reticular - globular Benign nevus
98
Describe the pattern of this lesion Dx?
Organized multicomponent pattern with dots/globules, network, and homogenous areas Benign nevus
99
Describe the pattern of this lesion Dx?
Organized multicomponent pattern with dots/globules, network, and homogenous areas Benign nevus
100
Describe the major dermoscopic finding in this lesion Dx?
Atypical pigment network Melanoma in situ
101
Describe the major dermoscopic findings in this lesion Dx?
* atypical network * scar-like depigmentation * peripheral brown structureless areas Melanoma
102
Describe the major dermoscopic finding in this lesion Dx?
Atypical patchy network pattern Melanoma in situ
103
Describe the major dermoscopic findings in this lesion Dx?
Atypical pigment network Blue white veil Dysplastic nevus **Case highlighting the limitations of dermoscopy**
104
Describe the major dermoscopic findings in the upper & lower image Dx? (same lesion)
* Upper: NPD 1. peripheral patchy network 2. asymmetric homogenous area * Lower: PD 1. Chrysaline structures **Microinvasive melanoma**
105
Describe the major dermoscopic finding in this lesion Dx?
Presence of negative network Melanoma
106
Describe the major dermoscopic findings in this lesion Dx?
* focal network * peripheral tan structureless areas * numerous irregular linear and serpentine blood vessels (polymorphic) Melanoma
107
Describe the major dermoscopic findings in this lesion Dx?
* focal streaks * peripheral tan structureless areas Melanoma
108
Describe the major dermoscopic findings in this lesion Dx?
* Diffuse reticular network * Bluish globules focale distributed * Atypical pigment network (upper-right part) Melanoma (bluish globules) arising within a dysplastic nevus
109
Describe the major dermoscopic finding in this lesion Dx?
Disorganized homogeneous pattern Nodular melanoma
110
Describe the major dermoscopic findings in images A vs B, Dx? (Same lesion)
* A) NPD: 1. regression structures 2. blue-white veil 3. irregular globules 4. peripheral tan structureless areas * B) PD: chrysalis structures **Melanoma**
111
Describe the major dermoscopic finding in this lesion Dx?
* Relatively structureless pink pattern * Presence of dotted vessels **Melanoma**
112
Describe the major dermoscopic findings in this lesion Dx? (photos: follow-up over 4mo )
Homogeneous structureless lesion Melanoma
113
Describe the major dermoscopic finding in this lesion Dx?
Atypical globular pattern Melanoma
114
Describe the major dermoscopic findings in images A vs B, Dx? (Same lesion)
* A) NPD: 1. negative network 2. peripheral tan structureless areas * B) PD: 1. crystalline structures **Melanoma**
115
Describe the major dermoscopic findings in this lesion Dx?
* asymmetric multicomponent pattern * irregular globules * peripheral structureless areas * atypical network * peripheral blotch * blue-white veil **Melanoma**
116
Describe the major dermoscopic findings in this lesion Dx?
* asymmetric multicomponent pattern * focal streaks, globules, * dotted vessels * structureless areas **Melanoma**
117
Describe the major dermoscopic findings in this lesion Dx?
* atypical network * focal streaks * blue-white veil Melanoma
118
Describe the major dermoscopic findings in this lesion Dx?
* disorganized homogenous pattern * peripheral blotch * focal regression structures Melanoma
119
Describe the major dermoscopic findings in this lesion Dx?
* atypical network * peripheral blotch * irregular globules Melanoma
120
Describe the major dermoscopic findings in this lesion Dx?
* Symmetric lesion * blue-white veil over raised area Melanoma
121
Describe the major dermoscopic findings in this lesion Dx?
* Symmetric lesion * peripheral atypical network * central negative network Melanoma
122
Name the ABCD rule
Assymetry Border sharpness Colors Dermoscopic structures Evolution (revised ABCD rule)
123
How is assymetry according to ABCD rule defined?
* The lesion is bisected by two lines that are placed 90° to each other * The first line attempts to bisect the lesion at the division of “most symmetry” and the other line is then placed 90° to it * Symmetry takes into account the contour, colors & structures within a lesion
124
Scoring of assymetry in ABCD rule
* If lesion symmetric in both axes = 0 * If one axis symmetry = 1 * If biaxial assymetry = 2 Scoring range: 0-2
125
How is border sharpness defined in ABCD rule?
* the lesion is divided into 8 equal pie-shaped pieces * Next, count the number of segments that have an abrupt perimeter cutoff Scoring range: 0-8
126
What colors are evaluated in ABCD rule?
* Number of following colors present: 1. light brown 2. dark brown 3. black 4. red 5. white​ 6. blue-gray Scoring range: 0-6
127
What dermoscopic structures are evaluated in ABCD rule?
* dots * globules * structureless (homogeneous) areas * network * branched streaks Scoring range: 0-5
128
After you have evaluate a lesion according to ABCD rule, BNS?
Calculate Total Dermoscopy Score(TDS) Linear equation TDS range: 1.0-8.9
129
Formula & coefficients utilized in multivariate analysis for determination of TDS
130
TDS score for melanocytic neoplasms
131
Cutoff values in ABCD rule Benign vs Suspicious vs Malignant
Benign \< 4,75 4,75 \< Suspicuous \< 5,45 Malignant \> 5,45
132
Exceptions to ABCD rule
133
Schematic summary of ABCD rule
134
Grade the assymetry according to ABCD rule in the following lesions (A,B,C) Dx?
* A) **0** , compound nevus * B) **1** , SSM * C) **2** , SSM
135
Grade border sharpness according to ABCD rule in the following lesions (A,B,C) Dx?
* A) **0** , compound nevus * B) **4** (segments 3-6) , melanoma in situ * C) **8** , dysplastic nevus
136
Grade color variegation according to ABCD rule in the following lesions (A,B,C) Dx?
* A) **2** ( light & dark brown) , junctional nevus * B) **4** ( light & dark brown,blue-gray, black) , melanoma in situ * C) **6** , SSM
137
Grade dermoscopic structures according to ABCD rule in the following lesions (A,B,C) Dx?
* A) **1** (one structureless area) , **compound nevus** * B) **​3** [structureless areas (\*), areas with network (=\>), and branched streaks (→)] , **SSM** * C) **5** [structureless areas, network (=\>), branched streaks (\>), dots ( ), and pigmented globules (→)], **SSM**
138
Menzies method features
* based on 11 features ( 2 negative , 9 positive for melanoma) * scored as present or absent * reduces the intra- & interobserver errors * sensitivity of 92% & specificity of 71% for invasive melanoma
139
Melanoma dx based on Menzies method requires...?
* Absence of two negative features * At least 1 out of 9 positive features
140
Name the 2 negative features of Menzies method
* Symmetry of pigmentation pattern: 1. symmetry of all pattern structures, including color along any axis through the center (of gravity) of a lesion 2. **does not require symmetry of shape** * Single color: 1. **White is not scored** 2. single color excludes the diagnosis of melanoma
141
Name the 9 positive features of Menzies method
* blue-white veil * multiple brown dots * focal pseudopods * focal radial streaming * scar-like depigmentation * peripheral black dots/globules * 5-6 colors, * multiple blue-gray dots/peppering * focally broadened network
142
Menzies method (table)
143
Positive features of Menzies method
144
Evaluate symmetry in the following patterns according to Menzies method
* A) **Symmetrical pigmentation pattern** (symmetry of pattern/texture over all axes through the center of gravity. It **does not require symmetry of shape**) * B) **Symmetrical pigmentation pattern** (despite asymmetry of shape) * C) **Asymmetric pigmentation pattern** ( lacks symmetry over short axis)
145
Evaluate this lesion according to Menzies method Dx?
Symmetrical pigmentation pattern (hence not malignant) Junctional acral nevus
146
Evaluate this lesion according to Menzies method Dx?
Symmetrical pigmentation pattern (asymmetry of shape doesn't matter) Dysplastic nevus
147
Evaluate this lesion according to Menzies method Dx?
* Not symmetrical pigmentation pattern * Not single color ( \> 4 ) * Peripheral globules * Broadened network Melanoma
148
Evaluate this lesion according to Menzies method Dx?
* Not symmetrical pigmentation pattern * Not single color ( \> 4 ) * Blue-white veil Melanoma
149
How to differentiate pseudopods vs globules?
* Pseudopods need to: 1. directly connected to the tumor 2. have a maximum diameter larger than the atypical network from which it originates
150
In the following drawing which knobs can be characterized as pseudopods?
3,4 1 - lacks connection to the tumor body 2 - has smaller diameter from the network from which it originates
151
Evaluate this lesion according to Menzies method Dx?
* Asymmetrical pigmentation pattern * Multiple colors * Scar-like depigmentation Melanoma
152
Evaluate this lesion according to Menzies method Dx?
* Asymmetrical pigmentation pattern * Multiple colors \> 5 * Blue-white veil * Scar-like depigmentation * Broadened network Melanoma **presence of ^ vasculature can lead to multiple colors**
153
Evaluate this lesion according to Menzies method Dx?
* Absence of negative features * Multiple blue-gray dots ( black arrows) * Blue-white veil (red arrow) Melanoma
154
Evaluate this lesion according to Menzies method Dx?
* Absence of negative features * BWV ( black arrow) * Focal broadened network (red arrow) Melanoma
155
Evaluate this lesion according to Menzies method Dx?
* Symmetrical pigmentation pattern ( over the center of gravity) * 2 colors * Peripheral globules Compound nevus
156
Evaluate this lesion according to Menzies method Dx?
* Absence of negative features * Absence of positive features Dysplastic nevus
157
Evaluate this lesion according to Menzies method Dx?
* Absence of negative features * Multiple blue-gray dots (arrows) Lentigo melanoma
158

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