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RB Y2 Dermatology > Melanoma > Flashcards

Melanoma Flashcards

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Dermatology Board Prep flashcards
1
Q

where do melanomas arise from

A

melanocytes

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2
Q

where are melanocytes found in the skin

A

scattered along the basal layer of the epidermis

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3
Q

why is melanoma the most serious form of skin cancer

A
  • metastasis can occur early - number of deaths even in young people
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4
Q

risk factors

A
  • Pale skin
  • Previous invasive melanoma or melanoma in situ
  • Increasing age
  • Previous BCC or SCC
  • Multiple melanocytic naevi
  • Sun sensitivity
  • Immunosuppression
  • Atypical mole syndrome
  • Lentigo maligna
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5
Q

outline the 3 phases of melanoma growth

A
  • in situ - tumour is confined to the epidermis
  • invasive - tumour has spread to the dermis
    • they may now spread via lymphatics or blood stream
  • metastatic - has spread to other tissues
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6
Q

how may tumours spread in situ

A

may spread out within the epidermis - the horizontal growth phase

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7
Q

what does melanoma survival depend on

A

Breslow depth - the deepest tumour from the granular layer in mm

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8
Q

Breslow depth prognostic values

A
  • pTis-melanoma is in-situ-100% survival
  • pT1-tumour < 1mm-90% survival (still in epidermis?)
  • pT2-tumour is 1-2mm-80% survival
  • pT3-tumour is 2-4mm-55% survival
  • pT4-tumour > 4mm thick-20% survival
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9
Q

what sign is used to identify melanomas

A

ugly duckling sign

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10
Q

ABCDE rules

A

Asymmetry, Border, Colour, Diameter (>6mm), Evolution.

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11
Q

why are nodular melanomas so bad

A

they have a vertical growth phase

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12
Q

how does melanoma appearance change in horizontal and vertical growth phase

A

Melanoma is normally flat during the horizontal growth phase and becomes thickened and raised during the vertical phase

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13
Q

which types of melanoma are associated with horizontal and vertical growth phases

A
  • Horizontal growth phase: SSM, lentigo maligna melanoma and acrallentignous melanoma.*
  • Vertical growth phase: nodular, spitzoid, mucosal*
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14
Q

what is the most common type of horizontal melanoma

A

superficial spreading melanoma

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15
Q

presentation of SSM

A
  • slowly enlarging flat area of discoloured skin
  • irregular shape
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16
Q

outline the course of SSM

A
  • malignant cells remain in situ for a longer period of time - months to decades
  • have a primary horizontal (radial) growth phase
  • some can become invasive, a nodular melanoma can arise within one
17
Q

how may deep and invasive SSM present

A

they may itch , sting or blled

18
Q

Acral/Mucosal Lentiginous Melanoma

A
  • characterised by their site of origin: palms of hands, soles of feet or subungually
  • relatively rare in comparison to other types
19
Q

who are Acral/Mucosal Lentiginous Melanoma more common in

A

people with darker skins

20
Q

are Acral/Mucosal Lentiginous Melanoma related to sun exposure

A

they may not be

21
Q

course of Acral/Mucosal Lentiginous Melanoma

A
  • remain in situ for years, non invasive
  • nodular melanoma can arise within them
22
Q

appearance of Acral/Mucosal Lentiginous Melanoma

A
  • Start off with a smooth surface, which later may become thicker with an irregular dry/warty surface
  • May ulcerate or bleed
23
Q

what is lentigo maligna melanoma related to, hence who and where is it seen

A
  • sun exposure
  • seen on sun damaged face/neck/scalp in older people
  • risk relates to sun damage, more common in outdoor workers, solar damage, older people and keratinocyte skin damage (e.g. BCC, SCC)
24
Q

what is the precursor to lentigo maligna melanoma

A
  • lentigo maligna - Hutchison’s freckle
  • this is where a large facial mole undergoes central melanomatous change, the cells are still confined to the epidermis - in situ
25
Q

how does lentigo maligna present

A
  • slow growing macular area of pigmentation seen in elderly people, commonly on the face
26
Q

what is the risk of developing invasive malignant melanoma from lentigo maligna

A
  • slightly increase risk, increasing with larger lesions
  • but there is a lower risk than there is with other forms of melanoma in situ
27
Q

when is a lentigo maligna melanoma diagnosed

A

when the malignant melanoma cells have entered the dermis and deeper layers of skin

28
Q

presentation of lengtio maligna melanoma

A
  • Large size (>6mm), irregular, variable pigmentation and smooth surface
29
Q

nodular malignant melanoma

A
  • Most aggressive type, grows rapidly from the start. Presents as rapidly growing pigmented nodule which bleeds or ulcerates.
  • Has a vertical growth phase, which is more dangerous than the horizontal growth phase
30
Q

what contributes to prognosis, along with Breslow depth

A

ulceration

31
Q

what suffix is used in tumour staging to represent ulceration

A

B

32
Q

treatment options for melanoma

A
  • primary excision
  • advanced disease may require chemo, immunotherapy or genetic therapies
33
Q

how much around the lesion must be cleared

A
  • If in-situ then clear by circa 5mm
  • If invasive but <1mm thick: 1cm clearance
  • If invasive and >1mm thick: 2cm clearance
34
Q

indications for sentinel node biopsy

A

>1mm thick or thinner with mitoses

35
Q

mitotic rate

A

reflects cellular proliferation within the primary tumour, is an important predictor of survival

36
Q

which mutation is often found in acral melanomas, and which drug targets it

A

c - kit mutation, imatinib

37
Q

which mutation is often found in melanomas on intermittently sun exposed skin

A

BRAF, stimulates MAPK pathway which stimulates cell division

38
Q

drugs that target BRAF

A

dabrafenib and vemurafenib

39
Q

what may improve responses to BRAF inhibitors etc

A

MEK inhibitor eg Tramatenib

RB Y2 Dermatology (22 decks)

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