Melanoma

Question 1

Define Melanoma

Answer 1

Malignant tumour arising from melanocytes of the epidermis

Question 2

Aetiology of Melanoma

Answer 2

Genetic: sun-sensitive skin (fair type and susceptibility to burn), specific melanoma-related genes e.g. CDKN2A, xeroderma pigmentosum

Environmental factors: excessive exposure to solar and artificial UV radiation e.g. tanning beds

t is estimated that only 25% to 42% of melanomas arise in pre-existing naevi

History of sunburns and intermittent high-intensity sun exposure

Question 3

What is the common invasion and metastases for melanomas

Answer 3

There is local invasion e.g. into the dermis

Common sites of metastases: lung, bone, brain, liver

Question 4

Risk factors for melanoma

Answer 4

UV light
Family history 
Lighter skin 
Personal history of skin cancers
Fitzpatrick skin type I or II
Red/blonde hair 
High freckle density 
Sun bed use
Light eye colour 
Immunosuppression
Xeroderma pigmentosum

Question 5

Symptoms of melanoma

Answer 5

Altered pigmented lesion (ABCDE)

• Asymmetry
• Colour/pigmented
• Diameter >6mm
• Evolution (size/shape)
• May bleed, itch, ulcerate, crust over

> 50 benign melanocytic naevi
Atypical naevi
Constitutional symptoms

Question 6

Describe the following types of melanoma:

Superficial Spreading
Nodular
Lentigo maligna
Acral lentiginous

Answer 6

Superficial Spreading
Most common (60-70%)
Any site, preference for torso

Nodular
Second most common
Domed shape with rapid growth
Any site

Lentigo maligna
Flat lesions, often on the face, Most common in older people

Acral lentiginous
Palms, soles and nail beds

Solar Lentigo
Multiple brown patches on the back

Question 7

Signs of melanoma on examination

Answer 7

Bluish-white veil
Persistent single-nail melanonychia striata
Hutchinson’s sign
Fixed lymphadenopathy

Question 8

Investigations for Melanoma

Answer 8

Dermatoscopy: Melanocytic lesion with abnormal appearance concerning for melanoma
Skin biopsy: Abnormal melanocytic proliferation in the epidermis and/or dermis typical of melanoma

Serum LDH: ?mets

CXR/CT CAP/PET/CT: ?mets

Sentinel lymph node biopsy: ?mets