Derm Neoplasms

What skin types are considered melano-compromised?

1 and 2

What skin types are considered melano-competent?

3 and 4

What skin types are considered melano-protected?

5 and 6

What are the characteristics of skin type 1?

very fair

always burns in the sun

never tans

What are the characteristics of skin type 2?

fair

burns in the sun

tans with great difficulty

What are the characteristics of skin type 3?

fair

burns but tans gradually

What are the characteristics of skin type 4?

medium

hardly ever burns

tans with ease

What are the characteristics of skin type 5?

light brown

rarely burns

tans profusely

What are the characteristics of skin type 6?

dark brown

never burns in the sun

deeply pigmented

What nationality or nationalities is/are associated with skin type 1?

celtic

What nationality or nationalities is/are associated with skin type 2?

scandinavian

What nationality or nationalities is/are associated with skin type 3?

caucasian

What nationality or nationalities is/are associated with skin type 4?

mediterranean

hispanic

some asian

What nationality or nationalities is/are associated with skin type 5?

pakistani

indian

What nationality or nationalities is/are associated with skin type 6?

african

What kinds of UV radiation are carcinogenic?

ALL OF THEM

What are characteristics of sunburns caused by UVA?

delayed sunburn and penetrates the dermis

breaks down the collagen and causes wrinkling

What are characteristics of sunburns caused by UVB?

causes immediate sunburn

What are common precursors of SCC?

actinic keratosis

Bowen disease

What is the follow up regimen after Bowen removal?

every 3-6 months for 2 years, then decrease to annual visits

What is Vulvar Intraepithelial Neoplasia?

subtype of Bowen’s (SCC in situ)

bright red patches that itch or burn

What is Erythroplasia of Queyrat?

subtype of Bowen’s (SCC in situ)

located on glans of penis

What are junctional melanocytic nevi?

benign mole that appears in early childhood, reach maximum in young adulthood

brown pigment fully in the dermis

What are compound melanocytic nevi?

elevated and benign mole that is within dermis and epidermis

What are dermal melanocytic nevi?

benign flesh colored mole that is within the dermis

What characterizes FAMMM Syndrome?

dysplastic nevus syndrome with 2 blood relatives with melanoma or pancreas cancer

What is the cause of FAMMM syndrome?

CDKN2A tumor suppressor gene mutation

What should be done if a blue nevus is classified as cellular?

refer to derm for possible removal

What is the risk of developing melanoma for skin types 1 and 2?

about 3%

What is the risk of developing melanoma for skin types 3 and 4?

about 0.5%

What is the risk of developing melanoma for skin types 5 and 6?

about 0.1%

What is the risk of developing melanoma with dysplastic nevus syndrome?

10-50%

What is the risk of developing melanoma with FAMMM syndrome?

nearly 100%

What are the treatments for benign pigmented nevi?

monitor

can excise with laser if cosmetically undesirable

What are the treatments for dysplastic nevi?

surgical excision (no laser)

careful monitoring

What factors predispose an individual to melanoma?

precursor lesions

FHx of melanoma

certain phenotypes

blistering sunburns before 18

increased sun exposure between 10-24

What phenotypes are predisposing to melanoma?

blonde or red hair

blue or green eyes

lighter skin types

freckling tendency

What is the “A” in ABCDEs of detecting melanoma?

asymmetry

What is the “B” in ABCDEs of detecting melanoma?

border

What is the “C” in ABCDEs of detecting melanoma?

color

What is the “D” in ABCDEs of detecting melanoma?

diameter

What is the “E” in ABCDEs of detecting melanoma?

evolving

What are the types of malignant melanoma?

superficial spreading MC

nodular

lentigo maligna and lentigo maligna melanoma

acral lentiginous melanoma

amelanotic melanoma

What are differentiating characteristics of superficial spreading melanoma?

evolves over 1-5 years

located in upper back in men and lower extremity in women

What are differentiating characteristics of nodular melanoma?

evolves over 6-18 months

associated with nevus remnant

most common on trunk

What are differentiating characteristics of lentigo maligna melanoma?

evolve from lentigo maligna over 20 years

occur on head and neck

What are differentiating characteristics of acral lentiginous melanoma?

evolves over 2.5 years

more common in Black and Asian patients

What form of acral lentiginous melanoma has the best survival rate?

subungual type

What is mitotic rate used for in terms of determining treatment for melanoma?

used to determine need for sentinel lymph node biopsy

What is the process for sentinel node biopsy?

use radioactive substance or blue dye

remove any positively stained lymph nodes and send to pathology

What are the drawbacks of sentinel node biopsy?

false negatives

may still be cancerous cells in lymph node basin

What is the most common location for distant metastasis from metastatic melanoma?

skin, subQ tissue, distant lymph nodes

What classifies a local metastasis?

within 5cm of primary site

What classifies an in-transit metastasis?

more than 5cm from primary site

What are the locations of distant metastasis, from most to least common, in metastatic melanoma?

skin, subQ tissue, distant lymph nodes

lungs

liver

brain

bone

small intestine

What are the components of a chem panel in metastatic melanoma?

Alkaline phosphatase

AST/ALT

LDH levels

What mets are being evaluated by Alkaline Phosphatase levels?

bone and liver

What mets are being evaluated by AST/ALT levels?

liver

What mets are being evaluated by LDH levels?

lung and liver

When is an MRI indicated for malignant melanoma?

patient has known distant mets

considering IL2 for treatment

What is the most important factor indicating a need to biopsy a lesion or mole?

the lesion or mole is evolving or changing

What sunscreen should be used to avoid skin cancer?

SPF of 30 or above

contains avobenzone