Melanoma

Question 1

Mole V melanoma check?

Answer 1

ABCDE Checklist
Asymmetry
Border (irregular/indistinct)
Colour (varied)
Diameter (inc or >6mm)
Enlargement/elevation/evolution

Question 2

What is lentigo maligna?

Answer 2

Malignant melanoma in situ (normal and malignant melanocytes confined to the epidermis)

Question 3

Appearance lentigo maligna?

Answer 3

2-6cm tan/brown/black uniformly flat macule or patch with irregular borders. Lesions grow radially and produce complex colours.

Question 4

Malignant transformation of lentigo maligna?

Answer 4

10% evolve into lentigo maligna melanoma

Question 5

What is lentigo maligna melanoma?

Answer 5

15% of all melanomas.

Malignant melanocytes invading into the dermis. A/w pre-existing solar lentigo, not pre existing naevi.

Question 6

Appearance lentigo maligna melanoma?

Answer 6

Flat brown stain like gradually enlarging. Changes from uniform brown to dark brown with black and blue over time.

Question 7

What is superficial spreading melanoma?

Answer 7

60-70% melanomas.

Atypical melanocytes initially spreading laterally in epidermis then invade dermis.

Question 8

Appearance superficial spreading melanoma?

Answer 8

Irregular, indurated, enlarging plaques with r/w/b discolouration, focal papules or nodules. Ulcerate and bleed with growth.

Question 9

What is a nodular melanoma?

Answer 9

Atypical melanocytes that initially grow vertically with little lateral spread.
“EFG”: elevated, firm, growing

Question 10

Appearance nodular melanoma?

Answer 10

Uniformly ulcerated, blue-black, sharply delineated plaque or nodule. May be pink or colourless (amelanotic melanoma)

Question 11

What is an acrolentiginous melanoma?

Answer 11

5% of melanomas.

Ill-defined dark brown, blue-black macule on palmar, plantar or subungal skin.

Question 12

RFx for melanoma?

Answer 12

No SPF is a SIN

• Sun exposure
• Pigment traits (blue eyes, fair skin)
• Freckling
• Skin reaction to sunlight (increased incidence of sunburn)
• Naevi (dysplastic naevi)

Question 13

Pathophysiology of melanoma?

Answer 13

Malignant neoplasm of pigment forming cells (melanocytes and naevus cells).

Question 14

Common sites of melanoma?

Answer 14

• Back (M)

- Calves (F)

Question 15

Factors indicating worse prognosis in melanoma?

Answer 15

• Male
• On scalp, hands, feet
• Late lesion
• No pre-existing naevus present

Question 16

Mx melanoma?

Answer 16

Excisional biopsy; remove full depth of dermis and extend beyond edges of lesion only after histologic diagnosis.
-High does IFN for stage II-III disease.