Malignant Melanoma Flashcards
Incidence
Most serious form of skin cancer
More common in women
More men die from it
Middle aged
Risk factors
UV exposure - intense intermittent on holiday, childhood burning on holiday, sunbeds
Skin colour - fair skin, light eyes and hair
Dysplastic naevi
Family history
Pathogenesis
Arises from melanocytes
White ‘halo’ area surrounding it
Some areas are thickened, some are thin
Important mutations
RAS
RAF
Important mutations - familial
CDK4
CDKN2A
Commonly affected areas
Sun exposed sites
Can be found in the eyes and meninges
Clinical presentation
A - asymmetry
B - borders; ill-defined, irregular
C - colour; multiple colours
D - diameter; >6mm, increasing in size
E - evolution; changes in size/shape/appearance/itchy/pain
New PIGMENTED lesion which develops in adulthood
Areas of regression - immune system begins to attack tumour and you are left with areas of scarring
Blood
Ulceration
Ugly duckling sign
Types (4)
Superficial spreading - commonest
Acral(palms or solea) / mucosal lentiginous
Lentigo maligna
Nodular
Types - Superficial spreading
Trunk and limbs
Start growing as macules
Lesions with RGP +/- VGP
Types - Acral/mucosal
Start growing as macules
Lesions with RGP +/- VGP
Types - Lentigo maligna
In situ (not spreading) melanoma
Commonly affects face and neck
Starts growing as macules
Lesions with RGP +/- VGP
Types - Nodular
Often affects trunk
Very aggressive once in vertical growth phase
Starts growing as nodules
Lesions with VGP only
Investigations
Dermascope
Biopsy (excision)
Prognosis
Breslow depth and ulceration (Breslow = deepest tumour from granular layer mm) pTis - melanoma in situ - 100% survival pT1 - tumour is <1mm - 90% survival pT2 - tumour is 1-2mm - 80% survival pT3 - tumour is 2-4mm - 55% survival pT4 - tumour is >4mm - 20% survival
Spread of melanoma
Regional lymph node metastases
Blood spread
