Melanoma Flashcards
What is melanoma?
A malignancy originating from the melanocytes of the skin
What are some risk factors for melanoma?
- Multiple atypical moles
- Female (2:1)
- Middle age
- UV exposure
- Genetics
- Skin prototype
What are the 2 phases of melanoma growth?
Radial growth phase (Horizontal)
Vertical growth phase
What is meant by radial growth phase?
This is the growth of a melanoma as a macule, either in situ or with dermal micro invasion, spreading out but not down
What is meant by vertical growth phase?
The invasion of the melanoma into the dermis, forming an expansile mass with mitoses
Which growth phase of melanoma can metastasise?
Vertical growth phase
What are some genetic factors of melanoma?
BRAF mutation
MEK ans ERK up-regulation in the tumour driving proliferation
What are some presentations of melanoma?
A - Asymmetry
B - Irregular border
C - Variable colour
D - Diameter >6mm
E - Elevation and evolution
What are the major diagnostic criteria of melanoma?
Lesion that changes in shape, size and colour
What are the minor diagnostic criteria of melanoma?
Diameter >6mm, bleeding, sensory changes, inflammation
What are the 4 sub-types of melanoma?
Superficial
Nodular
Lentigo maligna melanoma
Acral metastatic melanoma
What is meant by the ugly duckling sign in melanoma?
Look for the mole amongst the others that stands out and is different
What is meant by lentigine (Lentigo)?
This is a slow, radially growing macule that remains for many years
What is meant by lentigo maligna?
This is when a lentigine begins to grow vertically, forming a melanoma
Name the condition
Melanoma
Name the condition
Melanoma - Erratic pigment network (Abnormal projection of dermis into the epidermis)
Name the condition
Superficial spreading melanoma - Asymmetry of shape and colour, irregular border, large, slightly elevated in the centre
Name the condition
Nodular melanoma
Name the condition
Nodular melanoma
Name the condition
Nodular melanoma
Name the condition
Lentigine formation (Lentigo)
Name the condition
Lentigo maligna melanoma
Name the condition
Melanoma
What are some mole features that are suspicious of melanoma?
- Change in shape
- Irregular pigmentation
- Bleeding
- Development of satelite nodules
- Ulceration
- New pigmented lesion in adulthood
How should a melanoma be managed?
Primary excision to give clear margins
Diagnosis using histology
Secondary excision based on Breslow thickness
What is meant by Breslow thickness?
The depth from the granular layer of the epidermis to the deepest point of the tumour
What are the stages of Breslow thickness and their prognosis?
- pTis-melanoma is in-situ-100% survival
- pT1-tumour < 1mm-90% survival
- pT2-tumour is 1-2mm-80% survival
- pT3-tumour is 2-4mm-55% survival
- pT4-tumour > 4mm thick-20% survival
What are some indicators of adverse prognosis?
Ulceration
High mitotic rate
Lymphovascular invasion
Satelite nodes
Sentinel lymph node involvement
How is ulceration denoted with breslin thickness?
By adding the suffix ‘b’ (E.g. pT3b is a tumour between 2-4mm with ulceration)
Describe the features of superficial spreading melanoma?
- Large, flat, irregularly pigmented lesion
- Commonest in trunk and limbs
- Grows laterally before vertical invasion develops
Describe the features of nodular melanoma?
- The most aggressive type
- Occurs on varied sites but often trunk
- Presents as a rapidly growing pigmented nodule, which bleeds or ulcerates
Describe the features of lentigo maligna melanoma
- Invasive tumour that develops within pre-existing lentigo maligna
- Occurs on sun damaged face/neck/scalp
Describe the features of acral metastatic melanoma
Arise as pigmented lesions on the palm or sole or under the nail, and usually present late
