Melanocyte diseases Flashcards
risk factors
FHx and PMH
sever sunburn (childhood), and UV exposure/sunburn
multiple dysplastic naevi, large congenital naevi
immunosuppression
fair skin (type I/II)
melanocytic naevi types
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
melanoma features
ABCDE
asymmetry border (irregular) colour (irregular) diameter (>7mm) evolving and elevated
other: itching, bleeding, inflammation
melanoma checklist
major: colour change, shape, size
minor: bleeding, inflammation, itching, >7mm
melanoma types
in-situ: lentigo maligna, MIS
invasive: superficial spreading, nodular, lentigo maligna melanoma, acral
in-situ melanoma
lentigo maligna: slow growth, changing colour/shape/size, sun-exposed
MIS: any site; ABCDE (histology confirms no invasion)
superficial spreading melanoma
commonest (70%)
thin, radial growth
trunk (M), legs (F)
high intensity UV; young/middle-aged
nodular melanoma
raised, thick, circ'd vertical invasion can be pale trunk; young/middle-aged; high intensity UV poor prognosis
lenitgo maligna melanoma
slow growth
good prognosis
long cumulative UV, elderly, facial
acral melanoma
palms/soles/nails; all skin types rapid invasion rarest not related to sun increasing incidence >20yo
melanoma prognosis
Breslow thickness:
in situ 100% 5ys; 3mm 40% 5ys
Clarke score: intraepi/partial papillary/expanded papillary/reticular dermis/subcut
Male, older, head/neck, ulcerated
melanoma DDx
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
melanoma Mx
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!
benign lesions (melanoma mimics)
atypical molesblue naevus seborrhoeic wart pigmented BCC dermatofibroma pyogenic granuloma: C&C, lasers, cryo, imiquimod, excision