Opath Pigmented Lesions

Front 1

Sebhorrheic Keratosis

Back 1

Benign proliferation of epidermal basal cells, NOT oral, dermatosis papulos nigra (suborrheic keratosis in blacks), acanthosis, pseudocysts (keratin-filled invaginations), upward proliferation

Front 2

Ephelis (Freckle)

Back 2

Hyperpigmented macule of the skin, SSE with abundant melanin production in basal layer (same # of melanocytes), no elongation of rete ridges, NEVER elevated, sun-exposure effect

Front 3

Actinic Lentigo (Liver Spots, Age Spots)

Back 3

Due to sun-exposure, but doesn’t change color intensity (unlike ephelis), NOT oral, well-demarcated, but irregular borders, increased melanin, no malignancy

Front 4

Lentigo Simplex

Back 4

Benign cutaneous melanocytic hyperplasia w/in basal layer, no color change with sun, darker than ephelis, basal keratinocytes, melanin incontinence, multiple lesions associated w/ peutz jeghers syndrome

Front 5

Peutz-Jegher’s Syndrome

Back 5

Freckle-like lesions of hands, perioral skin and oral mucosa (buccal and labial mucosa) most affected, multiple circumscribed macules covered w/ intact mucosa, intestinal polyposis, Circumoral lentigines, GI adenocarcinoma

Front 6

Addison’s Disease

Back 6

Adrenal cortical insufficiency, diffuse hypermelanosis, multiple dark macules covered by intact mucosa, mral lesions are first indication of disease, “bronzing of the skin”

Front 7

Melasma (mask of pregnancy)

Back 7

Bilateral hyperpigmentation of sun-exposed skin of face and neck, associated with pregnancy, increased melanin deposition, wood lamp for melanin visualization (epidermal pigment is enhanced, dermal pigment is not), tx: sunscreens w/ zinc oxide or titanium dioxide

Front 8

Oral Melanotic Macule

Back 8

NOT associated w/ sun-exposure, flat, brown mucosal discoloration, lower lip macule less than 5mm, increase in melanin and melanocytes, melanin incontinence

Front 9

Oral Melanoacanthoma

Back 9

almost exclusively African Americans, dramatic enlargement within months, smooth darkly pigmented macule of buccal mucosa

Front 10

Café-au-lait Spot

Back 10

Flat, brown macules, >1.5cm in diameter, present in 1/10 ppl, 6+ spots present =neurofibromatosis, similar lesions seen in Albright Syndrome

Front 11

Acquired Melanocytic Nevi

Back 11

benign localized proliferation of neural crest derived cells, most common tumor, hard palate, over years produces slightly elevated soft papule, melanocytic nevus cell nests in basal layer and lamina propria, regress in midlife, can resemble melanoma -> biopsy

Front 12

Congenital Melanocytic Nevi

Back 12

larger than acquired form, hypertrichosis (excess hair), "bathing trunk" or "garment nevus" or "giant hairy nevus", infiltration of cells between collagen bundles, 3-15% undergo malignant transformation into melanoma

Front 13

Halo Nevus

Back 13

Melanocytic nevus with a pale HYPOpigmented border, autoimmune attack on melanocytes, affects trunk on 10-20 yr olds, often regress

Front 14

Blue Nevus

Back 14

Tyndall effect causes blue color, lesion on palatal mucosa, melanin particles in spindle-shaped melanocytes deep to epith in lamina propria, compound nevus, looks like melanoma -> biopsy

Front 15

Melanoma

Back 15

Malignant neoplasm of melanocytic origin, UV radiation, acute sun damage, BRAF gene mutations, ABCDE clinical diagnosis (asymmetry, border irregularity, color variation, diameter >6mm, evolving), invasion depth correlated w/ prognosis, Clark system and Breslow classification (more accurate) used to measure depth, BANS (back, posterior arm, neck, scalp)=worst prognosis

Front 16

Superficial Spreading Melanoma

Back 16

Most common, nodular, deeply pigmented exophytic lesion, spread of atypical melanocytes ALONG basilar portion of epidermis, invasion into higher epithelium, Pagetoid pattern, lateral spread

Front 17

Lentigo Maligna Melanoma

Back 17

From Lentigo meligna or Hitchinson’s Freckle (precursor lesions), Sun-exposure, fair-skined older ppl, melanoma in situ in a radial growth phase

Front 18

Acral Lentiginous Melanoma

Back 18

African Americans, Oral melanoma (poor prognosis), also palms, soles and under nails, atypical melanocytes IN the basal portion of epithelium, invasion into the superficial lamina dura, dendritic processes

Front 19

Vitiligo

Back 19

Autoimmune, onset after stress, sun-exposure or injury, NO melanocytes present in involved skin, thyroid dz is common in these pts

Front 20

Pityriasis (Tinea) Versicolor

Back 20

can be HYPO or HYPERpigmented, caused by a fungus, more obvious when patient is tan, “spaghetti and meatballs” (spores w/ short mycelium) seen with KOH stain