Malignant Melanoma Flashcards
What is malignant melanoma?
A cancer of the melanocytes (cells that produce the skin pigment melanoma). It is invasive and has the potential to metastasise
What is the leading risk factor for development of melanoma?
Sun exposure
What are some risk factors for the development of melanoma?
Excessive UV exposure
Skin type I (always burns, never tans)
History of multiple moles or atypical moles
Family history or previous history of melanoma
What are the different types of melanoma?
Superficial spreading
Nodular
Lentigo maligna
Acral lentiginous melanoma
Describe the features of superficial spreading melanoma
most common type
Irregular shape
Irregular colour
Progressively changing lesion
Common the the lower limbs in young and middle aged adults and is related to intermittent high intensity UV exposure
Describe the features of nodular melanoma
second most common type
Raised palpable nodule Friable (fragile) Pigmented Often vascular in appearance May have inflamed edge Common on the trunk in young and middle aged adults- related to intermittent high UV exposure
Describe the features of lentigo maligna melanoma
Common on the face and neck in elderly adults
Lentigo maligna is a precursor to melanoma- also called Hutchinson Freckle it is in-situ disease (hasn’t penetrated the basement membrane). This progresses to become invasive melanoma.
Very slow growth
Related to long-term cumulative UV exposure (chronic exposure)
Describe the features of Acral Lentiginous melanoma
Acral means at the end of limbs- seen on palms, soles, nail beds
No clear relationship with UV exposure
Very slow growing
Nail may change to a dark colour
Occurs in all ethnic groups at the same incidence
What are the ABCDE symptoms that raise concern of melanoma?
Asymmetry Borders that are irregular Colour irregularity Diameter >6mm Evolving changes over time- change in size or shape Symptoms of bleeding or itching
Also if it is different to any other moles.
What are the common sites of melanoma in men and women?
More common on the legs in women
More common in the trunk in men
Why should you be suspicious of any darkening or pigment changes in and around the nail?
This could be a sub-ungual melanoma
Be concerned for any vascular changes too as could be amelanotic. E.g. pyogenic granulomas should always be sent for pathological assessment.
How does melanoma cause death of patients?
It can invade beyond the basement membrane and then enter the lymphatics and blood allowing for spread to distal sites
What is a useful measurement for predictors of outcome and recurrence in melanoma?
Breslow Thickness
<0.76mm thick = Low risk
0.76-1.5mm= Medium risk
>1.5mm= High risk
This is because thickness of the melanoma relates to the degree of invasion
What system is used to classify melanomas?
TNM Staging
What is the management of melanoma?
Surgical excision with wide margins
Radiotherapy may be useful
Chemotherapy if there is evidence of metastatic disease
