Melanoma Flashcards
Melanocytic Naevi
Mole. Common benign skin lesion caused by proliferation of melanocytes (naevus cell)
Causes Melanocytic Naevi
Genetics
Sun exposure
Immunosuppression
BRAF inhbitors such as vemurafenib
Clinical features of Melanocytic Naevi
Found anywhere in the body
More common in fair skinned people
Usually asymptomatic
Flat or raised
Classification of Melanocytic Naevi
Junctional naevus (flat) Compound naevus (raised centre) Intradermal naevus (hairy) Blue naevus Starburst naevus
Who is at risk of Melanoma
People with >100 moles
Treatment for Melanoma
None or surgical
Malignant Melanoma
Skin cancer of the melanocytes due to uncontrolled melanocyte proliferation
Types of Melanoma
In situ melanoma = epidermis only
Invasive melanoma = spread to dermis
Metastatic melanoma = spread elsewhere
5th most common cancer
Melanoma
Risk factors for Malignant Melanoma
High UV exposure Skin type 1 Increasing age History of skin cancer Having lots of melanocytic naevi Having >5 atypical naevi Family history of melanoma Genetics (BRAF mutation)
Clinical features for Malignant Melanoma
Back in men
Legs in women
May be Itchy, painful, bleed, overlying crust
Amelanotic melanoma
Melanoma with pigment
Diagnosis of Melanoma (Using ABCDE and symptoms)
Asymmetry Borders (irregular) Colour (irregular, variation) Diameter (>6mm) Evolving (changing in size/shape/colour) Symptoms (bleeding, itching, pain etc)
7 point checklist: Major signs
- Change in size
- Change in shape
- Change in colour
7 point checklist: Minor signs
- Diameter >7mm
- Inflammation
- Altered sensation
- Crusting, bleeding, oozing
Differentials for Malignant melanoma
Melanocytic naevus
Squamous cell carcinoma
Basal cell carcinoma
Classification of Malignant Melanoma
Superficial dpreading
Lentigo maligna
Acral lentiginous
Nodular
Treatment for Malignant Melanoma
Surgery (wide local excision)
Removal of affected lymph nodes
Radiotherapy or chemotherapy
Treatment for widespread melanomas
Immunotherapy e.g. interleukin-2
Biologics e.g. vemurafinib (BRAF inhibitor), ipilimumab
Breslow Thickness
Measures risk of recurrence.
<1mm thick = low risk
1-4mm thick = intermediate risk
>4mm thick = high risk
Clark Level
Measures risk of metastasis. Level 1: in situ melanoma Level 2: invasion of papillary dermis Level 3: complete invasion of the papillary dermis Level 4: invasion of reticular dermis Level 5: invasion of subcutaneous tissue
Hutchinson’s sign:
When pigment extends to the skin. Sign that nodule is melanoma
