From moles to melanoma

Question 1

Describe and recognize common benign melanocytic tumors

Answer 1

Junctional - Proliferation of slightly altered melanocytes within the epidermis
Compound - Migration to the dermis
Intradermal - Loss of nevus cells in the epidermis

Question 2

What are the risk factors for melanoma?

Answer 2

UV radiation
Presence of dysplastic nevi
Family History of Melanoma
Personal History of Melanoma
Congenital melanocytic nevi
Fitzpatrick Skin Type 
Immune suppression
Age
Male gender (1:57) vs female gender (1:81)

Question 3

Describe familial melanoma syndrome.

Answer 3

i. CDKN2A gene 40%
1. CDKN2A encodes 2 genes from alternative frame reading, loss of INK4A functions lead to inhibition of RB and p53→cell cycle proliferation
ii. Atypical nevi, larger 5-10mm, with macular and popular components
iii. Numerous atypical nevi
iv. Family history→50% chance of developing melanoma by 50 yrs

Question 4

List the four types of melanoma and their main characteristics.

Answer 4

• Superficial spreading melanoma: intermittent sun exposure, classical back for men, legs for women, 40-50 yr olds
• Lentigo maligna melanoma: chronically sun damaged, head and neck, long radial growth. dark irregular ink spot.
• Nodular melanoma: 50 yr old, aggressive, sun exposed and non exposed, lacks radial growth phase, poor prognosis
• Acral lentiginous melanoma: common in ppl of color, non sun exposed areas

Question 5

What are the ABCDE’s of melanoma?

Answer 5

Assymetry
border irregularity
color variation or change
diameter
evolution

Question 6

What are the recommended treatments for melanoma?

Answer 6

Surgical resection
1.	Melanoma in situ: 0.5 cm margins
2.	Melanoma breslow 2cm: 2cm margins
Chemotherapy
Radiation therapy
Immunotherapy

Question 7

What are the indications for further work up of melanoma?

Answer 7

For melanomas thicker than 1.0mm or in tumors 0.76-1.00mm with ulceration or invasion to deep dermis, do sentinal lymph node biopsies