Melanocyte diseases

Question 1

risk factors

Answer 1

FHx and PMH
sever sunburn (childhood), and UV exposure/sunburn
multiple dysplastic naevi, large congenital naevi
immunosuppression
fair skin (type I/II)

Question 2

melanocytic naevi types

Answer 2

freckles
congenital: hairy, prigmented
acquired: getting deeper
-junctional: dark macules
-compound: dark and warty papules
-intradermal: raised papule, paler colour
halo (pale ring) blue: extremities
atypical naevi: suspicious but benign; melanoma risk

malignant melanoma
-lentigo maligna
-MIS
-superficial spreading
nodular
lentigo maligna
acral

Question 3

melanoma features

Answer 3

ABCDE

asymmetry
border (irregular)
colour (irregular)
diameter (>7mm)
evolving and elevated

other: itching, bleeding, inflammation

Question 4

melanoma checklist

Answer 4

major: colour change, shape, size
minor: bleeding, inflammation, itching, >7mm

Question 5

melanoma types

Answer 5

in-situ: lentigo maligna, MIS

invasive: superficial spreading, nodular, lentigo maligna melanoma, acral

Question 6

in-situ melanoma

Answer 6

lentigo maligna: slow growth, changing colour/shape/size, sun-exposed
MIS: any site; ABCDE (histology confirms no invasion)

Question 7

superficial spreading melanoma

Answer 7

commonest (70%)
thin, radial growth
trunk (M), legs (F)
high intensity UV; young/middle-aged

Question 8

nodular melanoma

Answer 8

raised, thick, circ'd
vertical invasion
can be pale
trunk; young/middle-aged; high intensity UV
poor prognosis

Question 9

lenitgo maligna melanoma

Answer 9

slow growth
good prognosis
long cumulative UV, elderly, facial

Question 10

acral melanoma

Answer 10

palms/soles/nails; all skin types
rapid invasion
rarest
not related to sun
increasing incidence >20yo

Question 11

melanoma prognosis

Answer 11

Breslow thickness:
in situ 100% 5ys; 3mm 40% 5ys

Clarke score: intraepi/partial papillary/expanded papillary/reticular dermis/subcut

Male, older, head/neck, ulcerated

Question 12

melanoma DDx

Answer 12

seborrhoeic wart: matted, warty, ‘stuck on’, keratin plugs; no Rx
pigmented BCC: pearly edge
dermatofibroma: firm lesion, arms/legs
pyogenic granuloma: red lump, friable, rapid appearance
atypical mole

Question 13

melanoma Mx

Answer 13

histological confirmation agter excision

wide local excision: 1-2cm peripheral margin (1cm lateral for every 1mm depth)
?LN clearance or SN biopsy
no standard Rx for mets

F/U: local recurrence (usually subcut nodular)
5 years: 3-monthly for 3y, 6-monthly for 2y

sun protection and advice!

Question 14

benign lesions (melanoma mimics)

Answer 14

atypical molesblue naevus
seborrhoeic wart
pigmented BCC
dermatofibroma
pyogenic granuloma: C&C, lasers, cryo, imiquimod, excision