Cs: Benign Melanocytic Neoplasms

Front 1

Ephelides

Back 1

Signs/Symptoms:
-well-circumscribed pigmented macules
-on sun-exposed areas of fair-skin
-not present at birth
-transport melanosomes from melanocytes to keratinocytes
-Marker of UV damage

Differential Diagnosis
-Simple lentigines
-Solar lentigines
-Cafe-au-lait macules
-Junctional nevi

Treatment:
-Minimize sun exposure
-Sunscreen
-Cryotherapy
-Hydroquinone
-Topical retinoid

Front 2

Cafe-au-lait macules (CALM)

Back 2

Signs/Symptoms:
-Well-circumscribed, macules or patches about 2-5 cm.
-Onset in childhood
-Increased melanin in keratinocytes - not a proliferation of melanocytes
-No tendency toward malignancy; could be sitting on top of a lesion just by chance.
-Multiple cafe-au-lait macules may suggest neurofibromatosis. Feels like a button hole when pushing on a neurofibroma.
Differential Diagnosis:

Treatment:
-NO Topical therapy
-Lasers can be effective

Front 3

Becker's Melanosis

Back 3

Signs/Symptoms:
-Unilateral, hyperpicgmented, hypertrichotic (increased hair)
-More in males
-normally on the chest (shoulders, submammary, back)
-Hammatoma (faulty development of an organ with abnormal mixture of tissues) with epidermal involvement
-Sometimes will have soft tissue and bony abnormalities

Differential Diagnosis:

Treatment:
-Electrolysis
-Waxing
-Camouflage makeup
-Surgical excision/grafting (usually looks worse)
-Laser

-NOT melanocytic lesion - no increase in melanocytes (why there is not incrase potential for malignancy)

Front 4

Solar Lentigines
-lentigo senilis
-liver spot
-old age spot
-senile freckle

Back 4

*Make sure to look closely to make sure there is no other lesions present so that you do not miss any melanomas*
Signs/Symptoms:
-Brown macule due to sun damage
Seen on the hands, face, neck, and legs
-Well-circumscribed round/irregular bordered. Yellow, tan, or brown (color is uniform)

Diagnosis:
Pathogenesis- epidermal hyperplasia with variable proliferation of melanoctyes. Accumulation of melanin in keratinocytes in response to UV.

Treatment:
-Cryotherapy (can cause damage that looks worse)
-Laser (most effective)

Front 5

Congenital Dermal Melanocytosis
-Mongolian Spot

Back 5

Signs/Symptoms:
-Melaocytes that get hung up in migration
-Lumbosacral steel-blue patch at birth or early childhood
-Oval/angulated
-few cm to >20cm
-More common in pigmented races
-NOT PREMALIGNANT
-Blue/black due to location in the dermis

*Important to document these when doing well baby visits - they can be mistaken for bruising in possible abuse cases
Nevus of OTA (trigeminal V1 branch) is on the face.

Front 6

Blue Nevus

Back 6

Signs/Symptoms:
-Well-circumscribed blue/black FIRM, DOME-shaped papule/nodule. Onset in childhood
-Usually aquired
-Found on dorsum of the hand or feet (most common)
-Melanocytes hung up in migration they get hung up in the dermis causing tyndall effect that gives blue appearance (reflection of light)

Diagnosis:
Also, there are Cellular blue nevis: blue/gray or black nodules or plaques
-1-3 cm
-Butt/sacrococcygeal>scalp, face, and feet

Malignant blue nevi (rare): Commonly arises from cellular blue nevi

Treatment:
-Don't need to do anything if <1cm or typical
-If larger or atypical, then resect (or if it is a cellular blue nevi)

Front 7

Common Acquired Melanocytic Nevus

Back 7

*Very Important*
Nevocellular Nevus: mole
Junctional Nevus:
brown macule with melanocytic nests at the junction of the epidermis and dermis; melanocytic lesion
Intradermal nevus:
Skin-colored or light brown papule with nests of melanocytes in the dermis; fleshy domes well defined and soft
Coumpound Nevus:
Brown papule with combined histologic features of junctional and intradermal nevi; soft domed and well circumscribed

Diagnosis:
Junctional --> Coumpoud --> Intradermal (typical progression)
*These are all melanocytic*

Indications for removal
-Changing lesion - you need histology to diagnose
-Atypical clinical appearance suspicious for melanoma
-Cosmetic reasons
-Repeated irritation

Front 8

Halo Nevus

Back 8

Signs/Symptoms:
-White halo around nevus
-lymphs are getting rid of lesion but cause vitiligo (loss of pigment)
-need to look everywhere because there may be a malignant lesion
-mole will disappear in 4-6 mo. but loss of pigment won't go away.
-Junctional, compound, intradermal

Treatment:
-Individualized and it depends on clinical setting
-Look at the center and have the patient return in 4 months since the lesion should disappear
-If it doesn't disappear, biopsy and check histology
-Pts. >40yo should be examined closely for melanoma.

Front 9

Nevus Spilus

Back 9

Signs/Symptoms:
-Speckled (looks like cafe-au-lait with speckles)
-Onset in childhood
-Segmented or zosteriform distribution
-On trunks usually
-Darker foci have melanocytic nests
-lighter background histologically looks like lentigo

Treatment:
Close observation, maybe resection

Front 10

Spitz Nevus

Back 10

*important*
Signs:
-well-circumscribed, RED or PIGMENTED (not brown), domed papules or nodules
-Children/young adults
-homogenous color/well defined margins
-Telangiectasia is a frequent finding
-Head/Neck common location
-Prominent epitheloid/spindled melanocytes
-Mimic melanoma histology (often misdiagnosed)

Treatment: Need to remove these in all cases to avoid possibilities of it being a melanoma

Front 11

ABCDs of Moles

Back 11

A- Asymmetry (shape, color, one half unlike the other)
B - Borders (edges irregular, scalloped)
C- Color (haphazard display of colors, brown black, gray, pink or white)
D - Diameter (>6 mm, pencil eraser)
*E-Enlargement (rapid enlargement or elevation)