Term
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Definition
- freckle
- lentigo
- melasma
- nevus
- malignant melanoma |
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Term
| Melanocytes produce ___, the skin pigment. Malignant melanoma is curable if caught early. |
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Definition
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Term
| This skin cancer only accounts for 4% of skin cancers, but is responsible for 77% of skin cancer deaths: |
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Definition
Melanoma
This is a deadly cancer that metastasizes quickly. From the Duke Journal of NeuroOncology, by the time metastasis are found in the brain, median survival time is 5.2 months. Thus it is important to learn about pigmented growths and decide which need biopsy for further diagnosis and treatment. |
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Term
| what enzyme is necessary for melanin synthesis? |
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Definition
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Term
| Melanocytes are __ cells found in the __ layer of the ___. These are the only kind of pigment forming cells. |
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Definition
- dendritic cells
- basal layer
- epidermis |
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Term
| Melanoncytes are __ cells that produce ___ that move along the tips of the dendrites and are transferred to __ by ___. |
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Definition
- dendritic
- melanosomes
- keratinocytes
- phagocytosis |
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Term
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Definition
| FRECKLES = sun induced hyperpigmented macules |
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Term
| With freckle (ephilid) formation, there is no increase in number of melanocytes, just the amount of __ in the __ layer of the ___ increases. |
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Definition
- melanin
- basal
- epidermis |
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Term
| Small, flat brown circumscribed macules that lack elevation or depression grouped on sun exposed areas |
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Definition
|
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Term
| differential diagnosis of freckles: |
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Definition
- lentigo
- junctional nevus
- lentigo simplex |
|
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Term
| freckles do/do not darken with sun exposure. |
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Definition
| freckles DO darken with sun exposure. |
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Term
| Lentigos/actinic lentigos are acquired later in life (middle age) and are ___ induced. These __ __ darken with sun exposure. |
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Definition
- sun induced
- do NOT
(these are induced by the sun, but do not get darker with further sun exposure) |
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Term
| A junctional nevus is acquired in ___ and is a mole at the junction of __ and ___ . These have a high risk of developing into ___ ____. |
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Definition
- childhood
- dermis and epidermis
- malignant melanoma |
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Term
| Lentigo simplex occurs in __ and is ___. It is ___ ___ by sun exposure and can occur anywhere on the body including areas unexposed to sun. They often develop on the __ and __. Patient will have a few, they are congenital or occur during childhood. |
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Definition
- childhood
- NOT caused
- lips and gums |
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Term
|
Definition
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Term
| Differential diagnosis for actinic lentigo? |
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Definition
- junctional nevus
- freckle
- seborrheic keratosis
- lentigo maligna |
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Term
| A lentigo maligna is an __ __ __ __ on sun exposed areas. Describe its appearance. |
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Definition
- in situ malignant melanoma
- appearance: haphazard network of black on a brown macule
- irregular colored irregular bordered macula on sun exposed areas |
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Term
| Therapy for lentigo is for cosmetic purposes only. List the 4 treatment options: |
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Definition
- Retin-A - lighten multiple lentigo
- Solage- lighten multiple lentigo
- Cryotherapy with liquid nitrogen or laser destruction
- sunscreens with spf of 30 or higher for prevention |
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Term
| Syndromes associated with multiple lentigines. Both of these are ___ inherited. |
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Definition
- Leopard syndrome
- Peutz-Jeghers syndrome
- dominantly inherited |
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Term
| Which syndrome associated with multiple lintigines is also associated with colon cancer? |
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Definition
|
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Term
| characteristics of Leopard Syndrome: |
|
Definition
- Lentigines
- ECG abnormalities
- Ocular hypertelorism
- Pulmonary stenosis
- Abnormal genitalia
- Retarded growth and development
- Deafness |
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Term
| Syndrome with multiple lentigines around mouth, eyes, lips, oral mucosa, hands and feet. Also associated with GI polyps. |
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Definition
Peutz-Jeghers syndrome
polyps> intussusception, hemorrhage, malignancy |
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Term
| Hyperpigmented well demarcated macule c geographic border of the nose and upper lip. It is exacerbated by sunlight, pregnancy and birthcontrol pills. More common in Asian and Hispanic women. |
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Definition
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Term
| Melasma tmt for cosmetic purposes: |
|
Definition
Hydroquinone cream 4% twice daily
Sunscreen SPF 30
Tretinoin cream 0.1% daily or every other day
Fluocinolone 0.01% + hydroquinone 4% + tretinoin 0.05% solution (Tri-Luma) twice daily
Azelaic acid cream 20%
Chemical peels |
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Term
| Bad side effect of treating melasma with hydroquinone cream over the long term? |
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Definition
| permanent darkening of the skin (need to figure out name) |
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Term
| even brown colored papule: |
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Definition
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Term
| A junctional nevus is ___ and has nevus cells confined to the __ of the ___. |
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Definition
- flat (macule)
-base of the epidermis |
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Term
| two types of nevi that are papules: |
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Definition
- compound nevi
- intradermal nevi |
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Term
| A compound nevus has nevus cells in the __ and __. |
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Definition
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Term
| An intradermal nevus has nevus cells only in the __. |
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Definition
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Term
| Moles commonly change or one can acquire more during pregnancy and puberty. |
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Definition
|
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Term
|
Definition
- junctional
- compound
- intradermal |
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Term
| pigmented nevi differential diagnosis: |
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Definition
- seborrheic keratosis (SK)
- dermatofibromas |
|
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Term
| scaly, waxy, stuck-on appearance: |
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Definition
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Term
| Compound and intradermal nevi that are flesh colored may be mistaken as : |
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Definition
- skin tag- often pedunculated
- basal cell carcinoma and neurofibroma. |
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Term
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Definition
|
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Term
| this type of skin cancer often has telangiectasia and a central depression with a rolled pearly border: |
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Definition
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Term
| Treatment for Seborrheic keratosis (SK) (for cosmetic reasons): |
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Definition
- cryotherapy
- curreting
- alphahydroxy acids
- shave biopsy if suspicious |
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Term
|
Definition
| benign fibrotic histiocytoma |
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Term
| 1 cm pink/dark brown FIRM button like papule: |
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Definition
| Dermatofibroma- REMEMBER DIMPLE SIGN WITH THIS |
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Term
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Definition
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Term
| 2mm skin colored, pedunculated papule on the neck/axilla/groin. |
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Definition
skin tag aka acrochordon
scissor snip excision c/s anesthesia. Larger can be shaved off/excised after local anesthesia. |
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Term
| pearly, noduloulcerative papule with dilated blood vessels. |
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Definition
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Term
| smooth round slightly scaling pink nodule most frequently found in children |
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Definition
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Term
| small blue nodules that begin early in life- can be confused with nodular melanoma- if suspicious, biopsy. |
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Definition
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Term
| Nevus usually present at birth that is 20 cm big or covers more than 5% of body's surface. Have a 6-12% of developing into malignant melanoma. |
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Definition
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Term
| a atypical mole or also called a dysplastic nevus. Clinically they are larger than 5mm, and have irregular borders and more than one color. A thorough family history of the patient should be taken, as they are associated with a familial form of malignant melanoma. In these families, all members with atypical moles developed a melanoma in their lifetime. However, 5% of healthy Caucasians have atypical moles and never develop melanoma. |
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Definition
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Term
| Guidelines for management and follow up of patients with multiple atypical moles (6): |
|
Definition
- biopsy at least 2 lesions to confirm diagnosis
- skin photographs, including close ups of suspicious lesions
- sun protection
- patient self examination periodically
- screen blood relatives for atypical nevi and melanoma
- frequency of follow up: yearly for patients with no FHx of melanoma, every 6 months for pts with personal or FHx of melanoma for 2 years and then yearly |
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Term
| The relative risk of melanoma increases as the number of nevi increases, a person with a lot of nevi have a greater risk of melanoma |
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Definition
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Term
|
Definition
- elliptical excision
- shave excision
- ALL REMOVED NEVI MUST BE EXAMINED BY A PATHOLOGIST |
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Term
| Brown papule with halo of sharply marginated oval/round hypomelanosis |
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Definition
|
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Term
| cause of Halo/Sutton's nevus: |
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Definition
| Results from an autoimmune response destroying the pigmented cells, often the nevus will disappear entirely. Tx c reassurance, often spontaneously regress. On rare occasions, may develop around a malignant melanoma, but if the central lesion is small round and brown, biopsy is not needed |
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Term
| Malignant melanoma key points (3): |
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Definition
Thin melanoma is curable
Prognosis is best predicted by the depth of invasion=Breslow thickness
Sentinel lymph node biopsy is prognostic, not therapeutic |
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Term
| Malignant melanoma prognosis is best predicted by the __ of invasion aka __ __. |
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Definition
- depth
- Breslow thickness |
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Term
| 4 types of malignant melanoma: |
|
Definition
- Superficial spreading
- Lentigo maligna
- Nodular
- Acral lentiginous |
|
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Term
|
Definition
- Assymetry
- Border irregularity- scalloped borders
- Color variations-black,red,brown,blue,whit
- Diameter (should be less than pencil eraser or 6 mm)
- Evolution-rapidly changing mole |
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Term
| most common type of melanoma: |
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Definition
| superfical spreading melanoma |
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|
Term
Incidence of malignant melanoma is increasing
It is occurring faster than any other cancer in the USA. Due to increased sunlight?
55,000 new cases a year
Majority in 15 to 50 year old age group
Estimated lifetime risk is 1 in 70 |
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Definition
| the incidence rate has increased dramatically, but the mortality rate has only minimally increased. May be due to more awareness and more biopsies being performed. |
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Term
| things to look for in history that may indicate melanoma: |
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Definition
- lesions that rapidly enlarge or change in color is seen with 70% of melanoma cases
- new lesion
- bleeding, itching
- family history |
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Term
| Lentigo maligna usually in older populatoin and common on __ and __. It is more common in the ___ population. |
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Definition
- head and neck
- Caucasian
(haphazard network of black on background of brown flat macule) |
|
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Term
| Tan, black, brown assymetrical plaque with scalloped borders and a centrally located red papule |
|
Definition
| superficial spreading melanoma |
|
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Term
| superficial spreading melanoma is commonly found on males __ and on females ___. |
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Definition
|
|
Term
| A blueberry like blue black nodule with sharply defined borders |
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Definition
nodular melanoma
These are rapidly growing and begins growing in the vertical growth phase so is less likely to be diagnoses in the premetastatic phase. Can metastasize to other organs in months. |
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Term
| nodular melanoma is __ growing. |
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Definition
|
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Term
| Ulceration in the center of the lesion, the most peripheral parts are macular and black: |
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Definition
| Acral lentiginous melanoma |
|
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Term
| Acral lentiginous melanoma is most common in __ and __. It is often found on the __, __, and distal portions of __ and __. IT IS VERY AGGRESSIVE AND QUICKLY METASTASIZES. |
|
Definition
- Asians and African Americans
- palms
- soles
- toes (nail beds)
- fingers (nail beds) |
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Term
| Black and whitish, irregularly shaped and bordered plaque with an erosion |
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Definition
| Acral lentiginous melanoma |
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Term
| least common type of the 4 melanomas: |
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Definition
| Acral lentiginous melanoma |
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Term
| Malignant melanoma differential diagnsosis: |
|
Definition
- Actinic lentigo
- Seborrheic keratosis
- Pigmented basal cell carcinoma
- Nevus
- Angioma
- Pyogenic granuloma
- Blue nevus
- Dermatofibroma
- Tinea nigra palmaris |
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Term
| When excising the melanoma, the deeper the melanoma, the larger the margins need to be. |
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Definition
|
|
Term
| excisional margins for melanoma in situ: |
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Definition
|
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Term
| Excisional margins for melanoma that is less than 2 mm deep: |
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Definition
|
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Term
| Excisional margin for melanoma that is greater than 2 mm deep? |
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Definition
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Term
| When should a Sentinel Node Biopsy be done? |
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Definition
When melanoma is greater than 1 mm thick.
To do this they inject radioactive tracer into site of the primary melanoma and then the sentinel or first draining lymph node of that tumor can be identified by lymphoscintigraphy. The radiotracer is taken up in the blood vessels and lymphatic system where the lymph nodes act like a collection filter. The radiotracer gives off gamma rays which is then detected by a probe. This node is removed and examined for metastatic melanoma- this step determines if the patient may benefit from lymphadenectomy and further therapy |
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|
Term
| metastatic melanoma requires __ and/or __. |
|
Definition
chemotherapy (Dacarbazine= DTIC)
radiation
radiation can also be used for large melanomas when excision would be difficult. |
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Term
| 2 immunologics approved for malignant melanoma treatment: |
|
Definition
- interferon alpha-2-beta aka Intron A
- interleukin 2 |
|
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Term
| Interferon alpha2b or Intron A, was approved for melanoma treatment in dec 1995 and was the first adjuvant therapy to surgery that has been shown to significantly increase relapse-free and overall survival in subjects with malignant melanoma. The product has previously received U.S. marketing clearance for treating hairy cell leukemia, AIDS-related Kaposi's sarcoma, condylomata acuminata, and chronic hepatitis B and C. |
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Definition
|
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Term
|
Definition
| It is an interferon, a group of naturally occurring proteins that were first discovered as a result of their ability to prevent viral replication. Additional research has determined that interferons have anti-tumor effects and are useful in fighting some types of cancer cells…….. |
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Term
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Definition
| protein that occurs naturally in your body and plays an important role in activating your immune system. PROLEUKIN therapy is a genetically engineered or recombinant version of IL-2. PROLEUKIN therapy possesses the same properties as naturally occurring IL-2 and helps activate the immune system to recognize and eliminate certain kinds of cancer cells. |
|
|
Term
| malignant melanoma chemo- response rate is 20-30%. Proleukin increase median survival by 11 months |
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Definition
|
|
Term
| malignant melanoma survival rate depends on: |
|
Definition
Survival is related to depth of invasion, thickness measured in millimeters
depth of invasion related to 5 year survival rate |
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Term
| Breslow Depth describes ___ __ of the melanoma in millimeters. Clark's Levels describe how far the melanoma has gone into the __ of the skin. |
|
Definition
top-bottom measurement
layers |
|
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Term
| Breslow Depth: Measurement from granular layer, the best indicator of prognosis and 5 year survival, directs management- size of margins needed. |
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Definition
|
|
Term
| Clarks Levels: Level in dermis that melanoma extends to, better indicator of severity where the skin is thin, like eyelid. |
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Definition
|
|
Term
| LOOK AT PAGE 81 IN BOOK AND KNOW ABOUT BRESLOW DEPTH AND CLARKS LEVELS REALLY WELL FOR TEST. |
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Definition
|
|
Term
| nodular melanoma grows __, while the other melanomas grow ___. |
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Definition
- vertically
- horizontally |
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Term
| The ___ growth of most melanomas makes surgical cure possible for superficial lesions. |
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Definition
|
|
Term
| With melanoma, in addition to checking __ __, be sure to also check __ and __. |
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Definition
- lymph nodes
- mouth
- eyes
REVIEW TABLE 6.4 FOR TEST. |
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Term
| With melanoma CAT scans/ MRIs/PET scans are not indicated unless history of headache, hemoptysis, something else in history or physical exam suggests metastasis to other organs |
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Definition
|
|
Term
| Guidelines for follow up with patients with malignant melanoma: |
|
Definition
- new or changing mole
- ROS
- examine complete skin surface, lymph nodes, liver, spleen, mouth, and, eyes
- more extensive studies based on signs and symptoms
- FOLLOW UP VISIT EVERY 6 MONTHS FOR 2 YEARS AND THEN ANNUALLY |
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|
Term
| Pathogenesis of melanoma is __. |
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Definition
|
|
Term
| Risk factors for melanoma: |
|
Definition
- sunlight/sunburn
- CDKN2A and CDKA gene mutations
- multiple nevi and dysplastic nevi
- familial atypical mole and melanoma syndrome |
|
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Term
| 70 year old Caucasian patient has a suspicious large, brown, black irregularly shaped macule on the face. You biopsy the lesion and while you await the pathology report, this is most likely what type of melanoma? |
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Definition
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Term
| A 50 year old Caucasian female comes to you for evaluation of a dark brown and black mole on her back that her husband states has doubled in size over the past 6 months. She thinks it is unsightly and wants you to remove it for her. What would be the best course of action? |
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Definition
| Excisional biopsy or deep shave biopsy |
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