Malignant melanoma Flashcards
What is malignant melanoma
Melanocytic stem cells in basal layer cancer
5th most common UK cancer
Whos is more likely to get malignant melanoma
White skin - more adamge by UV as less melanin
Growth of melanoma
In situ
Invasive - spreads into dermis
Metastatic - spread to other tissues
Melanocytes benign growht -> moles and freckles
Subtyps of melanoma
Superficial spreading melanoma
Nodula melanoma
Lentigo maligna melanoma - precursor, years of growth
Acral lentiginous melanoma
Whats the most agressive type of melanoma
Nodualr - invade vertically, rapid growht of nodule in weeks to months
Often bleed or ulvcerate
What melanoma is often diagnosed at a late stage due to its location
Acral lentiginous melanoma - palms, soles, under nails
Flat pigemnted lesion that slowly grows
Risk factors for melanoma
History of skin cancer, melanoma or atypical naevi
FH
Pale skin - fitzpatrick type I +II
Red or light coloured hair
High freckle density
Light coloured eyes
History of sunburn
Sun exposure or tanning beds
Large amount of moles
Increasing age
Immunosupresison
Outdoor occupation
Genetic syndreoms eg xeroderma pigmentosum
Clinical features malignant melanoma
Change in prev mole, freckle or new lesion
Can be prink or red - amelanotic melanoma
Cover:
Location, date of onset and duration, size, cahnge in appearace, bleeding and ulveration
ABCDE criteria maligfnant melanoma
A: asymmetrical shape
B: border irregularity, including poorly defined margins
C: colour change and variation
D: diameter of the mole (most melanomas are >6mm)
E: evolving (such as changing in size, shape or colour)
Differnetial diagnosis for melanoma
Benign naevus (mole)
Lentigines
Seb K
Dermatobfibroma
Pigemnted BCC
Investigations for malignant melanoma
Visual inspection with dermatoscope
Suspicious lesions excised w 2-3mm margin
Full thickness skin biopsy confirms
CT/MRI for whole body and brain - advanced melanoma over IIb stage
Dermatoscopic features of melanoma
Atypical network (white or pigmentated)
Aggregated black or brown dots and globules
Features specific to the site of the melanoma (e.g. parallel pattern on palms and soles)
Staging of melanoma
0 - in situ
I - <2mm thickness
II - >2mm thickness or >1mm thickness with ulceraiton
3 - melanoma spread to invade local lymph nodes
4 - Mets to distant sites
What is breslows thickness
measures the thickness of invasive melanoma in millimetres from the granular cell layer to the deepest tumour cell.1
Management of melanoma
Surgical excision wide
Sentinel lymph node biopsy (test for spread) -> dissection or lymphadenectomy
Targeted therapy, immunotherap (unresectable stage III or IV) y, chemo (palleative)
