Diagnostic Skills - Stuff Flashcards
What are ABCDE of diagnosing CMM?
Assymetry Border Color variation Diameter Evolution
What is barlow’s depth?
Barlow’s depth is how deep the invasive carcinoma has gone - this is the most important factor is assessing risk (as well as mitotic rate)
What is dermascopy?
It is shining polarizing light on the lesion to magnify the skin lesion - 10-30% increase in diagnosis when using dermascopy
What is meant by ugly duckling sign?
If it looks different, if it is the odd one out, it could be CMM
What is Melanoma in Situ?
It is melanoma confined to the epidermis, it has not yet invaded the basement membrane
What is Superficial spreading melanoma?
Most common type of CMM
It has initial slow mitotic rate, before becoming invasive
These initially begin as asymptomatic brown or black spots that may have some ABCD variations.
Typically on the trunk or legs of white people aged 30-50
Nodular Melanoma ?
Second most common CMM. This is a vertically growing tumor. Looks kinda yucky. Can ulcerate or bleed also can be different colors Trunk neck or head
Lentigo maligna or Lentigo Maligna Melanoma?
These are due to excessive sun exposure and are typically seen in 60-80 year olds.
These take 5-15 years to become invasive, and usually only 3-5% of these become invasive.
They start off as irregular looking tan spots.
Sometimes these can be palpable (if feels like a bump, it is likely becoming invasive)
Amelanotic Melanoma?
As the name implies, it is a melanoma that does not have pigmentation (amelanotic).
It can mimic a lot of other benign and malignant conditions
Because it has no pigment, it many times it not diagnosed until late into the invasive phase, as opposed to other CMM’s that have pigmentation.
Acral-lentiginous melanoma?
Acral surfaces are those such on the soles of feet. So fingertips, elbow, knee, heel, etc… These lack hair follicles.
This melanoma is significant because it is the least common in white people. However it is the most common in Black and Asian people.
It’s good to know this one because some people tend to think Black’s don’t get CMM’s and won’t check them, but this is a common CMM that affects Blacks and Asians, so it should be remembered to check their acral surfaces for tumors.
Subungual Melanoma
This is melanoma of the nail.
Different stages of melanoma
0 - confined to epidermis 1 - smaller than 1 mm 2 - 1-4mm with no spread to lymph 3 - spread to lymph 4 - spread to other organs
so 0 and 1 have 90% survival, 2 has 50-80% 3 has 20-60% and 4 has like a 10-20% survival rate. these are 5 and 10 year rates.
Excision vs Incision?
Excision - takes out the whole tumor.
These are done with full punch bipsy, saucerization (deep shave), or elliptical excision
Incision only takes part of the tumor.
This is done with a partial punch or shave.
Superficial shave
This is a incision. This is used with epidermal lesions that have not invaded the dermis.
Also generally not done on pigmented lesions.
Used on non-pigmented lesions such as warts, papillomas, skin tags, etc…
Saucerization Biopsy (deep shave)
Thick disk removed with a curved blade. Shave goes into mid-dermis or sub-cutaneous fat.
This is considered excisional.
Cheaper than elliptical excision
