Melanoma Flashcards
Types of melanoma
- Superficial spreading 2. Acral lentinginous 3. Lentigo 4. Nodular
Superficial spreading: common?, features
Most common form >70% Flat pigmented macule, asymmetrical Changing in shape, size and colour Risks: Intermittent intense sunburn on trunk and limbs
Features of acral letiginous
Not due to sun exposure Soles, palms, toes, fingers, nails More common in dark skinned individuals
Features of Lentigo
Associated with solar keratosis Uneven pigment, facial freckle, change in size, shape and colour High total UV exposure head and neck 1. Lentigo maligna = in situ phase 2. Lentigo maligna melanoma is the invasive stage
Features of nodular
Poor prognosis More rapid growth, vertical growth ++
Risk factors
- Genetic 2. Phenotypes->blonde with red hair 3. Sunlight exposure++ 4. Pre-existing melanocytic lesion 5. History of skin cancer 6. ++Freckles 7. Sun bed 8. Immunosuppression
Clinical features
altered pigmented lesion (ABCDE signs) (common) >50 benign melanocytic naevi (common) atypical naevi (common) melanocytic lesion that does not resemble surrounding melanocytic naevi (‘ugly duckling’) (common) pigmented lesion, asymmetric appearance, ill-defined/irregular borders, colour variation (common) spontaneous bleeding or ulceration of a pigmented lesion (uncommon) constitutional symptoms (uncommon) bluish-white veil (uncommon) persistent single-nail melanonychia striata (uncommon) Hutchinson’s sign (uncommon) fixed lymphadenopathy (uncommon) in-transit metastases (uncommon)
ABCDE of melanoma
Asymmetry Border irregularity Colour variation Diameter >6mm Evolution
Examination
- Examine lesion 2. Look for lymphadenopathy 3. Look for other lesions, including freckles etc 4. General examination
Investigations
- Dermatoscopy 2. Excisional biopsy ->2mm margins down to fat ->Only partial/punch/shave if excisional too difficult Consider->depending on result 1. SLN biopsy 2. LDH 3. CXR 4. Chest/abdo/pelvic CT 5. Brain imaging 6. BRAF
Management
- Confirmed-> wide local excision 2. If >in situ with no LN involvement consider sentinal node biopsy 3. In metastatic Surgical excision of regional LN High dose interferon’ Regional node radiation Clinical trial Stage 4: systemic immunotherapy, chemotherapy
Guidelines for wide local excision
- Insitu-> 5mm margin 2. 1cm margin 3. 1-4mm-> 1-2cm 4. >4mm-> 2cm
Staging
Stage 0 In situ melanoma
Stage 1 Thin melanoma 2 mm in thickness
Stage 2 Thick melanoma >2mm
Stage 3 Melanoma spread to involve local lymph nodes
Stage 4 Distant metastases have been detected
Patient instructions
- Monitor skin and LN monthly, see doctor if any changes 2. F/U routine with dermatologist / 3-12 months 3. Skin care->Slip, slop, slap
Patient presents with black spot
- Show me, when did you notice 2. How did you find it 3. Sudden/gradual 4. Have you always had spot there 5. Change in colour, size, spread, pain, bleeding, itching, other spots 6. Any trauma 7. Hx of skin cancer 8. How much sun exposure, burnt often, sunscreen, hat 9. Ever check skin for cancers Spread 10. Breathless, jaundice, abdominal pain 11. Back pain 12. Dizzy, fits, faints, blackouts, HA, numbness, weakness 13. Impaired vision 14. Urinary changes 15. Weight loss, lumps in groin/armpit Risk factors 16. Fair skin, red hair, blue/green eyes 17. Sun exposure, short intense 18. FHx 19. Other skin lesions->compound nevi, lentigo, solar keratoses, dysplastic nevi Other 20. Past medical history 21. Family history 22. Social 23. Drugs, smoking, alcohol 24. Allergies Differentials: Malignant melanoma, BCC, seberrheoic keratoses, benign nevus
