Malignant Melanoma (13)

Question 1

What is malignant melanoma?

Answer 1

Malignant neoplasm of melanocytes mainly arising in skin, but can also occur in other sites like nasal cavities, retina, and gastrointestinal mucosa.

Question 2

What are some skin conditions associated with melanoma?

Answer 2

Xeroderma pigmentosa, albinism, giant congenital pigmented naevus, Fitzpatrick skin type 1, dysplastic naevus, multiple nevi.

Question 3

What are some risk factors of malignant melanoma?

Answer 3

Hutchinson’s melanotic freckles, immunocompromised patients, past history of melanoma, red hair, sun exposure.

Question 4

What are the genes responsible for familial MM?

Answer 4

CDKN2A and CDK4, MC1R, BRCA2.

Question 5

What are some poor prognostic factors of malignant melanoma?

Answer 5

Increased tumor thickness (Breslow thickness), increased depth of invasion, type of melanoma (nodular, amelanotic melanoma), presence of ulceration, presence of lymphatic or perineural invasion, presence of regional or distant metastasis, male, old age.

Question 6

What is the management for malignant melanoma?

Answer 6

Excision + Safety margin.

Question 6

What should be done if a lesion is excised with Breslow thickness 1.5 mm and margins 0.5 mm?

Answer 6

Re-excision.

Question 7

How is the size of the safety margin determined?

Answer 7

Question 8

What can be done to ensure adequate margins?

Answer 8

Frozen section, Mohs microsurgery.

Question 9

What is the management for regional lymphadenopathy after post excision?

Answer 9

Fine-needle aspiration cytology (FNAC), whole-body CT.

Question 10

What is the cause of painful swelling of the arm and dyspnea after post excision?

Answer 10

Axillary vein thrombosis → pulmonary embolism.

Question 11

How is DVT treated?

Answer 11

• Acute treatment with parenteral anticoagulation (LMWH, fondaparinux).
• Maintaining patients on anticoagulation for at least 6 months is the standard of practice.
• Warfarin, to keep INR 2-3, standard doses range between 1–10 mg per day for 6 months.
• Catheter-directed thrombolysis (CDTL) if clot is less than 14 days in duration or acute phlegmasia cerulea dolens inpatients with no contraindications to thrombolytic therapy.
• Indications for SVC filter placement are failure or contraindication to therapeutic anticoagulation or for presurgical prophylaxis in the setting of substantial thromboembolic risk factors.

Question 12

What are the risk factors for deep vein thrombosis?

Answer 12

Virchow’s triad: hypercoagulable state, venous stasis, endothelial injury.

Question 13

What is the management when suspecting PE?

Answer 13

• CTPA.
• SC LMWH if the patient is hemodynamically stable.
• Thrombolysis or embolectomy (massive embolism).

Question 14

How to differentiate melanoma from SCC?

Answer 14

Melanoma:
- from melanocytes
- Younger people
- Metastasis more common\
- Tend to be darker colour (blue/purple/brown)

Squamous cell Carcinoma:
- From keratinocytes
- Older people
- Metastasis less common
- Tend to reddish/pinl colour

Question 15

What are the differences between BCC and SCC?

Answer 15