Melanoma Flashcards
Layers of epidermis?
Come, Let’s Get Sun Burnt! (Acronym)
C- stratum corneum
L- lucidum
G- granulosum
S- spinosum
B- basale
Risk factors for melanoma?
MM-RISK M- moles (>5 atypical moles, >50 altogether), dysplastic nevi R- red hair, freckles I- immunosuppression, inability to tan, fair skin S- sun exposure K- kindred (family history)- Xeroderma pigmentosum, Wiskott-Aldrich Syndrome
Spitz nevus- What is it?
juvenile melanoma, spindle cell melanoma, epithelioid cell melanoam rapidly growing pink or brown benign lesion arising mostly in children, though adult lesions ahve spitzoid features hard to distinguish histologically from melanoma -Treatment: WLE
ABCDEs of melanoma physical examination
A- asymmetry B- borders C- colour (variegated) D- diameter (>6 mm is concerning) E- edges/evolution
At what diameter does melanoma become concerning?
6 mm
Components of physical examination necessary for melanoma?
1) melanoma lesion itself- ABCDEs 2) lymph node basins- either axilla or groin, head and neck 3) in transit or satellite lesions, total body skin examination
Three types of biopsies
-incisional -excisional -shave
5 Histological subtypes of melanoma?
Melanoma LANDS on your skin
L- lentigo
A- acral
N- nodular
D- desmoplastic
S- superficial spreading
Characteristics of each subtype of melanoma?
Lentigo- often on face, slow progression, better prognosis, superficial, older patients
2) Acral lentiginous melanoma (ALM)- “Get down with the acral”
- classified by anatomic site of origin
- blacks, palms and soles, subunguals (Hutchinson sign- subungual)
- often diagnosed late
- subungual acral lentiginous melanomas are often mistaken for subungual hematomas (delay in diagnosis)- can do punch biopsy through nail itself or perform digital block and nail removal
3) Nodular melanoma- progresses to invasive more quickly
4) Desmoplastic melanoma is specific type of amelanotic melanoma
- commonly arises on head and neck
- neurotropism- often affects nerves
5) Superficial spreading- most common type
- raised popular lesions that develop vertical growth pattern early in course
- poor prognosis- greater average tumour thickness and frequent ulceration
Stepwise progression of melanoma from
1) common melanocytic nevus
2) dysplastic nevus
3) radial growth phase of melanoma
4) vertical growth phase of melanoma
5) metastatic melanoma
Single most important prognisticator or regional lymph node status in melanoma?
What are some other prognosticators?
-single most important prognosticator is regional lymph node status
Other prognosticators:
- Breslow thickness- thicker is worse
- ulceration- robust predictor
- age- older is worse
- anatomic location of primary tumour- trunk/head/neck worse than extremity
- gender- men have worse prognosis
- mitotic rate- Ki-67 associated with ribosomal proliferation
Breslow thickness- what is classified as thin, intermediate, or thick melanoma?
Thin- less than or equal to 1 mm
Intermediate- 1-4 mm
Thick: greater than or equal to 4 mm
What are satellite vs in transit lesions?
Satellite lesions/satellitosis: areas of melanoma located within 2 cm of primary lesion
In-transit melanoma: deposits >2 cm away from primary lesion but before draining LN basin
think of something being in transit as farther away from original site (>2 cm)
T-staging for melanoma?
Tis- does not cross basement membrane (i.e. confined to epidermis)
T1- <1 mm
T2: 1.01 - 2 mm
T3: 2.01 - 4 mm
T4: >4 mm
What are recommended margins of wide local excision for melanoma?
In situ = 0.5 cm margin
<1 mm = 1 cm margin
1-2 mm = 1-2 cm
>2-4 mm = 2 cm margin
>4 mm thickness
*Remember 1 for 1, and 2 for 2”
2 mm thick needs 2 cm
