Melanoma Flashcards
1
Q
What type of growth phase do most melanomas begin with?
A
- horizontal growth phase
- this is where melanocytes form nests along the basal layer
- later they will migrate and form nests in the upper layers of the epidermis
- this growth can last 15 years
2
Q
What is the second growth phase of melanomas called?
A
- vertical growth phase
- melanocytes descend across the basal lamina and into the dermis
- during this phase nodules can become raised on the skin’s surface
- can invade blood and lymphatics
3
Q
Epidemiology
A
- 15 to 19 years, M:F equal
- 30 to 40 years, M:F 1:2
- 1 in 56 women and 1 in 37 men
- men predominantly on the trunk
- women mainly on the lower extremities
4
Q
Risk for melanoma increases when?
A
- increased sun exposure (UVB)
- fair-skinned
- red haired, blue eyed (triple incidence)
- increased age (peak at 40 years)
- patients with melanoma have a 5% risk of developing a second melanoma
- patients with dysplastic nevus syndrome
- 8 times the risk if theres a family history
- linked to intense and intermittent sun exposure
5
Q
ABCDEs of melanoma
A
Review this slide
6
Q
What are the melanoma subtypes and their prevalences
A
- Superficial spreading (70%)
- Nodular (15-20%)
- Lentigo maligna (10-15%)
- Acral lentiginous (<5%)
7
Q
Superficial spreading
A
AKA radical spreading melanomas
- intermittent sun exposure
- trunk and extremities
- occurs in 40-50 years of age
- slow evolution of change in a mole, followed by a period of rapid growth
8
Q
Nodular
A
- appear at middle age (50s-60s)
- early vertical growth, raised, protrudes, bleeds easily
- can arise without pre-existing nevus
- face, chest, back
9
Q
Lentigo maligna
A
AKA Hutchunson’s Freckles
- large, flat, tan with irregular border
- gets darker as it grows
- face, ears, arms
- chronic sun exposure
- 60s-70s
10
Q
Acral lentiginous
A
- 35 to 60% asians, hispanics, African descent
- palms, soles, subungual areas
- average age is 60 years
- not linked to sun exposure
- dark brown or black flat spot
11
Q
Diagnosis
A
- physical exam and history
- dermoscopy
- excisional biopsy
- FNA or SLNB and PET
- baseline CXR (lung mets)
- lab work (melanin in urine, blood including LDH for mets to liver)
- CT (chest, abdo, pelvis) thickness>4mm
- MR (mets to brain or spinal cord)
12
Q
Routes of spread
A
- local-via satellite nodules, subcutaneous tissue
- lymphatic-local regional lymph nodes
- Hematogenous-liver, lung, bone, brain
- Rare-GI tract, adrenal gland
13
Q
Micro staging systems
A
Review lecture notes
Clark’s-depth of invasion
Breslow’s-bulk of disease
14
Q
TNM staging
A
Early stage: stages 0-2c
Locoregional: stage 3
Metastatic: stage 4
Review TNM staging notes
15
Q
What is the primary treatment
A
Surgery
Small lesions (0-1.5 mm): 1 cm margin Intermediate lesions (>1.5-4 mm): 1-2 cm margin Larger lesions (>4 cm): 3 cm margin laterally and into fascia
