Malignant Melanoma part 2 Flashcards
Malignant Melanoma Pathophysiology
malignant neoplasm of pigment-forming cells (melanocytes and nevus cells)
Malignant Melanoma incidence:
1/75 (Canada), 1/50 (US)
Malignant Melanoma risk factors
increasing age, fair skin, red hair, positive personal/family history, familial dysplastic
nevus syndrome, 1 large congenital nevus (>20 cm), any dysplastic nevi, >50 common nevi,
immunosuppression, sun exposure with sunburns, tanning beds
Malignant Melanoma
most common sites:
back (M), calves (F)
Malignant Melanoma. worse prognosis if:
male, on scalp, hands, feet, late lesion, no pre-existing nevus present
Malignant Melanoma Differential Diagnosis
benign: nevi, solar lentigo, seborrheic keratosis
• malignant: pigmented BCC
MM surgical management
excisional biopsy preferable, otherwise incisional biopsy
• remove full depth of dermis and extend beyond edges of lesion only after histologic diagnosis
MM management caution
beware of lesions that regress – tumour is usually deeper than anticipated
MM stage II medical management
high dose IFN
MM stage
III medical management
chemotherapy (cis-platinum, BCG) and high dose IFN
MM adjunctive treatment
radiotherapy may be used
MM metastatic melanoma management
newer chemotherapeutic, gene therapies, and vaccines starting to be used
Node Dissection for Lesions. Criteria
> 1 mm thick OR <1 mm and ulcerated OR >1
mitoses/mm2
Node Dissection for Lesions. Stage IB
Stage IB or higher melanoma patients should be offered a sentinel lymph node biopsy). Assess sentinel node at time of wide excision
Stage I . Tumour Depth. Stage. Approximate 5 Yr Survival
T1 <1.0 mm
Stage I T1a – T2a
5-yr survival 90%
