melanocytic skin lesions

Question 1

assessment system for a skin lesion? what is concerning for melanoma? key history questions?

Answer 1

A - asymmetry
B - border irregular 
C - colour - 3+ colours 
D - diameter > 6mm
E - evolving/regressing over weeks-months

*some melanomas don’t fit the rule

duration - concerning if new or changed
changes to colour, size, shape
associated symptoms eg itching, bleeding

Question 2

types of mole (melanocytic naevus)

Answer 2

junctional - brown + flat
intradermal - skin coloured + raised
intermediate - central skin coloured/raised, periperhal brown/flat
compound - brown + raised

Question 3

suspected melanoma - 2ww criteria

Answer 3

score 3+

major features (2pt):
size - change
shape - irregular/changed
colour - irregular/changed

minor (1pt) - DIOS:
diameter > 6mm
inflammation
oozing
sensation change

Question 4

melanoma - examination signs of mets

Answer 4

localised - cutaneous / subcut nodules around lesion
regional - lymphadenopathy
distant - hepato / splenomegaly

Question 5

suspected malignant melanoma - investigation + management

Answer 5

excision biopsy with narrow margin - same day or week
when biopsy results available, determine if further re-excision of margins is needed (based on breslow)

± sentinel node mapping
± isolated limb perfusion
± block dissection of regional node groups

Question 6

malignant melanoma - RFs

Answer 6

fair / freckled skin
hx severe sunburn esp childhood
fh
immunosuppression

50-100+ moles
moles >6mm, irregular outline + colour

Question 7

what score is used to assess melanoma prognosis?

Answer 7

breslow thickness - depth of invasion

Question 8

breslow thickness: margins of excision based on lesion thickness

Answer 8

lesion 0-1mm - 1cm
lesion 1-2mm - 1-2cm
lesion 2-4mm - 2-3cm
lesion >4 - 3cm