Dermatological Malignancies - Malignant Melanoma

Question 1

Types of Malignant Melanoma (4).

Answer 1

1. Superficial Spreading (Commonest) - grows horizontally first and then vertically.
2. Nodular - grows vertical (most aggressive).
3. Lentigo (arising from Lentigo Maligna - MIS).
4. Acial Lentiguous (Palms/Soles/Subungual).

Question 2

Examination of Malignant Lesion (5).

Answer 2

ABCDE :
A - Asymmetry.
B - Border Irregularity (Scalloped).
C - Colour Variation (Variegated = Multiple).
D - Diameter > 6mm.
E - Evolves Over Time.
* Ugly-Duckling Sign.

Question 3

Investigation of Malignant Melanoma (3).

Answer 3

1. Histology (Exicisonal Biopsy) : Diagnosis.
2. Breslow Thickness.
3. 2 Week Wait Referral to Dermatologist.

Question 4

What is Breslow Thickness?

Answer 4

Depth of tumour - prognostic indicator.

Question 5

Management of Malignant Melanoma (3).

Answer 5

Based on Breslow Thickness :

1. > 1mm : Sentinel Node Biopsy (Metastasis + Staging).
2. Surgery with Excision Margin (based on Staging).
3. If Metastatic, Adjuvant Immunotherapy or Chemotherapy.

Question 6

Prognosis of Malignant Melanomas.

Answer 6

1. Single Most Important Prognostic Indicator = Breslow Thickness.
2. Highly Aggressive = Metastasis and Poor Response to Chemotherapy/Radiotherapy.