Malignant Melanoma Flashcards
What is malignant melanoma?
A malignant tumour arising from the melanocytes in the skin.
What are the subtypes of malignant melanoma?
Superficial spreading
Nodular
Lentigo maligna
Acral lentiginous
What is the most common type of malignant melanoma?
Superficial spreading
What is a superficial spreading melanoma?
A flat pigmented lesion with asymmetrical or irregular borders. Grows horziontally.
What is nodular melanoma?
A red-brown nodule that may ulcerate and bleed easily. Grows vertically.
What is lentigo maligna?
An irregularly shaped macule that has slow horizontal growth. Commonly seen on the faces of elderly patients.
What is acral lentiginous melanoma?
Seen on the nails, palms or soles, typically in people with darker skin pigmentation
What are the risk factors for malignant melanoma?
Increasing age
Family history
Pale skin
Red/blonde hair
UV exposure
Previous skin cancer
Immunosuppression
What are the presenting features of a malignant melanoma?
ABCDE
- Asymmetry
- Border - irregular
- Colour - non-uniform
- Diameter - >6mm
- Evolution - changing shape, size and colour
What is the diagnostic criteria for malignant melanoma?
Lesions that score 3 or more points are suspicious.
Major criteria (2 points each):
- Change in size
- Irregular shape or border
- Irregular colour
Minor features (1 point each):
- Largest diameter 7mm or more
- Inflammation
- Oozing or crusting of the lesion
- Change in sensation
What investigations are used in the diagnosis of malignant melanoma?
Dermoscopy
Excision biopsy
Sentinel lymph node biopsy
What is the staging of malignant melanoma?
Stage 0 - confined to epidermis
Stage 1 - breslow thickness < 2mm, no nodal involvement or metastasis
Stage 2 - breslow thickness 1-2mm with ulceration, or >2mm with or wihtout ulceration, no nodal involvement or metastasis
Stage 3 - Any thickness, involvement of nearby skin or local lymph nodes
Stage 4 - any thickness, distant lymph node involvement, or metastasis to other organs
What is the management of early stage melanoma?
Full thickness excision
Topical imiquimod
What is the management of advanced stage melanoma?
Lymph node dissection or lymphadenectomy
Radiotherapy
Resection of metastasis
Chemotherapy
Where does melanoma commonly metastasise to?
Lymph nodes
Brain
Bones
Liver
Lung
GI tract
