Melanoma

Question 1

Define a melanoma?

Answer 1

A cancer arising from melanocytes in the epidermis

Question 2

What are the risk factors for Melanoma?

Answer 2

• H/o skin cancer
• FH
• Fair skin (Type 1 & 2 skin)
• Living in tropical country >1yr
• Working outdoors
• Immunosuppression

Question 3

What approach do you take to diagnosing a melanoma?

Answer 3

ABCDE. Check For:

• Asymmetry
• Variable border (irregular, hard to define)
• Variable Colour
• Uneven diameter
• Evolution (colour/size changes in moles)

Look with a dermatoscope

If you suspect, biopsy it

Question 4

How would you treat a melanoma?

Answer 4

Surgical Excision followed with a sentinal lymph node biopsy to assess for spread

Chemo
Immunotherapy

Regular follow up and 2* prevention i.e. suncream, no tanning beds etc

Question 5

What kinds of therapies are there for metastatic melanoma?

Answer 5

Ipilimumab - inhibits CTLA-4 molecules

Pembrolizumab - Blocks PD-1

Vemurafenic - Blocks B-Raf Protein (requires B-raf mutation in the cancer)

Question 6

What are the main morphological types of melanoma?

Answer 6

Superficial spreading - Common (typical image of a melanoma)

Lentigo Maligna melanoma - Slow growing melanomas usually on the faces of older people whove had a lot of sun exposure over the years, look like stains on the skin

Nodular Melanoma - Faster growing, nodular and ulcerate easily

Acral Lentiginous Melanoma - unrelated to sun, they appear more in darker skin types. On the palms, soles and nails.

Ocular Melanoma