Melanoma

Front 1

What is the MCC of XP?

Back 1

1. Defect in DNA repair--- endonuclease

Front 2

From where do melanocytes originate?

Back 2

1. Neural crest

Front 3

What are the ssx of lentigo maligna?

Back 3

1. Irregular-shaped tan or brown macule

2. Enlarges to bizarre coloration, size, and shape

3. Noninvasive

Front 4

How do you tx lentigo maligna?

Back 4

1. Cryosurgery

2. Laser

3. 5-FU

4. Imiquod

Front 5

When does lentigo maligna become lentigo maligna melanoma?

Back 5

1. When there macule becomes palpable nodule

Front 6

What are the ssx of atypical melanocytic nevus?

Back 6

1. 5-10 mm or larger

2. Irregular macular lesion with various colors

Front 7

What is the lesion number risk associated with a dysplastic nevus?

Back 7

1. >3 lesions increases risk of melanoma from 3 to 43 times

Front 8

What are the ssx of a dysplastic nevus?

Back 8

1. Variegated tan, brown, pink coloration

2. Macular

3. 5-12 mm with irregular borders

4. "Fried egg"

Front 9

What mutations lead to dysplastic nevi?

Back 9

1. CDKN2A tumor suppressor

2. p16

3. CDK4

Front 10

What is the histology of a dysplastic nevus?

Back 10

1. Elongated, clubbed rete ridges

2. Bridging of rate ridges

3. Should phenomenon

4. Lamellar concentric fibroplasia

Front 11

How do you tx dysplastic nevi?

Back 11

1. Excision

2. Photograph often

3. Sunscreen and monthly self-exam

Front 12

What are the ssx of dysplastic nevus syndrome?

Back 12

1. Melanoma in 1/2 degree relative

2. >50 melanocytic nevi

3. Dysplastic nevi on histologic exam

Front 13

What are the danger signs for skin nevi?

Back 13

1. Asymmetry

2. Border

3. Color

4. Diamter >6 mm

Front 14

What should you do if you see a suspected ABCD lesion?

Back 14

1. Bx--- punch or excisional

2. When in doubt, cut it out

Front 15

What are the MCC of melanoma?

Back 15

1. UV radiation exposure

2. CDKN2A on chromosome 9--- p16 and p14 proteins

Front 16

What are the ssx of acral lentiginous melanoma?

Back 16

1. Brown or black macules on glabrous skin

2. MC on soles of foot/palm

Front 17

Back 17

1. Hutchinson's sign--- black discoloration at proximal nailfold

2. Acral lentiginous melanoma

Front 18

What are the ssx of superficial spreading melanoma?

Back 18

1. Slow growing brown or black macular lesion with irregular border

2. Macular/papular

3. Lower legs in women

4. Arise from pre-existing nevus

Front 19

What are the ssx of nodular melanoma?

Back 19

1. Brown or black papules that slowly and frequently ulcerates

2. Occurs denovo

3. More aggressive

Front 20

What are the ssx of amelanotic melanoma?

Back 20

1. Nonpigmented variant

2. Can be confused with benign or less aggressive malignant tumors

Front 21

What are the dermascopic features suggestive of malignant melanoma?

Back 21

1. Atypical pigment network

2. Blue/whitish veil

3. Regression structures--- white or blue-gray areas

Front 22

What is Breslow's depth?

Back 22

1. Measured from granular layer to point of deepest invasion of tumor cells

2. Better than Clark's

Front 23

What is Clark's level?

Back 23

1. Describes depth of invasion

2. Level I- epidermis

3. Level II- from epidermis into papillary dermis

4. Level III- from epidermis and fill papillary dermis

5. Level IV- extend into reticular dermis

6. Level V- extend through dermis into underlying subQ fat

Front 24

What lesions have poorer prognosis in melanoma?

Back 24

1. Lesions on scalp, hands, and feet

Front 25

How do you tx malignant melanoma?

Back 25

1. Excision--- standard of care

2. Elective lymph node dissection

3. Chemo

4. Immunotx

Front 26

What is one independent predictor of survival for distant metastatic melanoma?

Back 26

1. LDH--- measured in stage IV

Front 27

When is sentinel node bx recommended in melanoma?

Back 27

1. T2, T3 T4 melanomas

2. T1b

3. Not shown to demonstrate overall benefit