Malignant Melanoma Shiiiitt

Question 1

Superficial spreading (Pagetoid)

Answer 1

• has a long radial phase
• most common type

Question 2

Lentigo maligna melanoma (Hutchinson’s melanotic freckle)

Answer 2

• has a very long radial phase
• existing as the pre-malignant lesion lentigo maligna before it starts invading the basement membrane (sometimes referred to as in-situ melanoma)

Question 3

Nodular ab initio

Answer 3

• Has no radial phase
• most aggressive type

Question 4

Acral lentiginous

Answer 4

• short radial phase
• occurs in patients with darker skin tones at higher frequency
• involves the palms/soles

Question 5

Subungual

Answer 5

Melanoma growing under the nail

Question 6

Amelanotic

Answer 6

Means “without melanin” = usually pink or light brown

Question 7

What is malignant melanoma?

Answer 7

A type of skin cancer originating from the melanocytes - abnormal melanocyte growth -> pigmented lesions on the skin -> become invasive and metastasise

Question 8

Investigations for melanomas

Answer 8

• 1: Excisional biopsy of the lesion with a 2mm margin
• 2: Sentinel lymph node biopsy if the Breslow thickness is >1mm
• 3: PET or CT scans may be necessary in the presence of clinical suspicion for metastases

Question 9

How is Breslow thickness measured

Answer 9

mm from top of the granular level in the epidermis to the deepest point the tumour extends

Question 10

What are the margins for excision of a melanoma, depending on the Breslow thickness

Answer 10

• Melanoma in situ: 5 – 10 mm
• Melanoma < 1 mm: 10 mm
• Melanoma 1–2 mm: 10 – 20 mm
• Melanoma > 2 mm: 20 mm

Question 11

Management of Malignant melanomas

Answer 11

• excision of melanoma (with margins dependent on Breslow thickness)
• Lymph node clearance if involved
• Radiotherapy (some cases)
• Adjucant immunotherapy/chemotherapy in metastatic disease (stage III/IV) such as Pembrolizumab
• Mole mapping and lifestyle advice to prevent recurrence