Melanoma

Question 1

Define melanoma.

Answer 1

Melanoma is a malignant tumour arising from melanocytes. It is among the most common forms of cancer in young adults and typically presents as a new or changing deeply pigmented skin lesion.

Question 2

Explain the aetiology/risk factors of melanoma.

Answer 2

FHx of melanoma
Personal hx of melanoma
Personal hx of skin cancer (including actinic damage)
Hx of atypical naevi
Fitzpatrick skin type I or II (light-coloured skin)
Red or blond hair colour
High freckle density
Sun exposure
Sunbed use
Immunosuppression
Xeroderma pigmentosum

Question 3

Summarise the epidemiology of melanoma.

Answer 3

The age-adjusted incidence of melanoma per 100,000 population is 21 in the US, 17 in the UK, and 50 in Australia. Australia has the highest prevalence of melanoma in the world. It is more common in men than women.

Question 4

Recognise the presenting symptoms of melanoma. Recognise the signs of melanoma on physical examination.

Answer 4

Altered pigmented lesion (ABCDE signs)
>50 benign melanocytic naevi
Atypical naevi
Melanocytic lesion that does not resemble surrounding melanocytic naevi (‘ugly duckling’)
Pigmented lesion, asymmetric appearance, ill-defined/irregular borders, colour variation

Question 5

Identify appropriate investigations for melanoma and interpret the results.

Answer 5

Dermatoscopy
Skin biopsy

Question 6

What is the management for melanoma?

Answer 6

Surgical excision + lymph node biopsy

System radiotherapy and chemotherapy if metastasised

Question 7

What are complications associated with melanoma?

Answer 7

Local surgical sequelae

Complications of sentinel node biopsy

Lymph node dissection sequelae

Local recurrence

Local sequelae of metastatic disease

Metastatic disease treatment sequelae

Question 8

What is the prognosis for melanoma?

Answer 8

Approximate 5-year survival rates by stage:

Stage 0 (in-situ melanoma): >98%

Stage I (Breslow’s depth <1 mm and no nodal or metastatic disease): 90% to 95%

Stage II (localised disease, intermediate to thick depth): 45% to 78%

Stage III (nodal metastases): 69% to 26%

Stage IV (metastatic): without treatment, overall prognosis is bleak, ranging from 3% to 10% depending on the extent and sites of metastasis.