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59 Cards in this Set
- Front
- Back
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What do we mean by the term 'pigmented lesion' in any clinical setting?
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Any brown lesion
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What does 'pigmented lesion' mean pathologically?
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A lesion of melanocytic origin
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What are 3 lesions of melanocytic origin?
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-Nevi
-Lentigo -Melanoma |
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What is the only way to know if a pigmented lesion is malignant?
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Biopsy
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What are pigmented lesions that are often the legs and due to trauma like shaving?
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Dermatofibromas
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Are dermatofibromas more visual to the eye, or palpable?
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Palpable
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Are dermatofibromas benign or malignant?
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Benign
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What is the cell type origin of Dermatofibromas?
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Fibrohistiocytes
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What are freckles caused by? What are they NOT caused by?
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A reactive increase in melanin PRODUCTION - NOT an increase in cell number
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How are Freckles differentiated from other benign dark lesions?
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They are <2 mm
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What are freckles a reaction TO?
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Sun exposure
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What are pigmented macules between 5mm - 1cm called?
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Lentigo
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How are Lentiginous lesions similar to Freckles?
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Neither are due to increased NUMBER of melanocytes; just more melanin production
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What are tan-brown macules on sun damaged skin that are 1-10 mm called?
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Solar lentigo
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How is solar lentigo differentiated from normal lentigo?
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The dermis shows sun damage and there is a slight increase in melanocytes!
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What is Solar lentigo often called?
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Age spots
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Even though there can be an increase in melanocyte #, is Solar lentigo benign or malignant?
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Benign; just a reactive process to chronic sun exposure.
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What are Melanocytic nevi? When can they develop?
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Lesions composed of nevus cells
Can develop in utero or later at any other age |
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What are Nevus cells?
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Melanocyte variants
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At what age is the peak incidence for ACQUIRED melanocytic nevi?
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Adolescence (teens)
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What is the clinical appearance of melanocytic nevi?
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-Symmetric
-Evenly pigmented |
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How many nevi does the average caucasian have?
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20-100
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What does the # of melanocytic nevi that a person has correspond to?
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Their RR for melanoma
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What are melanocytic nevi caused by?
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Sun exposure
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What are 3 stages through which Nevi progress with aging?
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1. Junctional (DE jnct only)
2. Compound (DE jnct + dermis) 3. Intradermal (dermis only) |
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What happens to the SIZE of nevus cells as they mature with age and go deeper into the dermis?
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They get smaller
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What is a Clark's nevus?
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a DYSPLASTIC nevus
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What is FAMM?
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Familial atypical mole syndrome where 1/more close relatives have a lot of melanocytic nevi and some are dysplastic .
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What do Dysplastic nevi look like clinically? (size, border, color)
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Larger - >6mm
Irregular borders Varigated pigment |
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Why is it important to know about the Familial dysplastic nevus syndrome?
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Patients with it are at high risk of developing melanoma!
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How do you differentiate someone with just a lot of melanocytic nevi, from someone with the familial syndrome?
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FAMM shows a higher number of DYSPLASTIC clark's nevi.
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What is the lifetime risk of melanoma in people with sporadic clark's nevi? In people with familial dysplastic nevus syndrome?
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Sporadic - 10%
Familial - 100% |
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What should you do if you identify what looks like a Clark's nevus?
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-Alert the clinician of the possibility for acq or familial
-Follow up exams |
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What is an ACQUIRED nevus often in childhood and young adults?
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Spitz nevus
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What color is a spitz nevus typically? Border?
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Red
Symmetric border |
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What is the hallmark feature of Spitz nevi?
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Their cytologic atypia!!
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What is the importance of knowing about Spitz nevi?
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Not overcalling them melanoma
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What % of all skin cancers ARE melanoma?
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Only 3%!
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Why is it so important to be able to identify melanomas then?
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They account for >60% of all deaths due to skin cancer
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Why do melanomas cause so much death?
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Because their incidence is one of the fastest growing cancers today
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What is the m/f ratio of melanoma?
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Equal
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Where do men vs women most commonly get melanomas?
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Men - back
Women - legs |
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Where in the skin do melanomas begin and how do they spread?
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Begin: dermal-epidermal junction
Spread: laterally and then down into the dermis |
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What are 3 risk factors for melanoma?
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-Sun BURNS
-Fair skin -Family history |
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What are the 2 most important prognostic factors for melanoma?
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-Depth of invasion
-Ulceration |
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What is the best way to evaluate melanoma?
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-Excision biopsy
-Deep shave biopsy |
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What is NOT the way to evaluate for melanoma?
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With a punch biopsy!
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Why is a punch biopsy NOT the way to evaluate melanoma?
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Melanomas can regress deep into the dermis; if the punch doesn't get that deep you'll miss the diagnosis altogether.
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What are 2 measurements of melanoma?
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-Breslow depth
-Clark's level |
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Which measurement is an actual measurement? of what?
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Breslow - the deepest point of penetration
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What is Clark's level?
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At which level of the epidermis or dermis the deepest point of the cancer's penetration is.
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How do Breslow's depth and Clark's level compare?
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They correlate very well
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What is Clark's level 1? 5?
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1 - intraepidermal
5 - penetrates the fat below the dermis |
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What is the 5yr vs 10yr survival of melanoma if there is lymph node metastasis? What stage is this?
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Stage II
5yr = only 30% 10yr = 0-3%!! |
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What is the survival of melanoma if there is distant metastasis?
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0!!!
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How common is childhood melanoma, and if it occurs what kind is it usally?
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Very rare; Spitzoid if it occurs
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What is the highest age group in which spitzoid melanomas may occur?
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12-15
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What are 2 ways that childhood melanoma can occur in younger children?
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-From a giant congenital nevus
-From transplacental spread from mother in utero |
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What are the 3 most important things to note about a melanoma in general?
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-Breslows depth
-Ulceration -Presence of metastasis |
