Melanoma

Question 1

Define:

Answer 1

Malignancy arising from neoplastic transformation of melanocytes. The most deadly form of skin cancer.

Question 2

Aetiology/risk factors:

Answer 2

DNA damage due to UV radiation leading to neoplastic formation.

Short periods of intense UV radiation is a major cause such as sun beds

50% arise from naevi (moles)
50% arise from previously normal skin

Question 3

What are the features of superficial spreading melanoma:

Answer 3

70%

• Arises in a pre-existing naevus, expands in a radial fashion before a vertical growth phase
• Grow slowly, metastasise later

Question 4

What are features of nodular:

Answer 4

15%

• Arises de novo or from pre-existing moles
• AGGRESSIVE
• NO radial growth phase – vertical only
• Invade deeply and metastasise early

Question 5

What are features of lentingo maligna melanoma:

Answer 5

10%

• More common in ELDERLY with sun damage
• Evolves from pre-existing lentigo maligna
• Large flat lesions with irregular borders and brown in colour
• Progresses slowly
• Usually on the face

Question 6

What are features of acral lentingious:

Answer 6

5%

• Arise on palms, soles and subungual areas
• Most common type in NON-WHITE populations – equal frequency in black and white patients

Question 7

Epidemiology:

Answer 7

• Steadily increasing in incidence
• WHITE races have 20 x increased risk compared to non-whites
• UK incidence: 10/100,000/yr
• Increased >200% in last 20 years
• Commonly affects younger patients

Question 8

Symptoms:

Answer 8

Change in size, shape or colour of pigmented skin lesion

Redness

Bleeding

Ulceration

Crusting

Question 9

Signs:

Answer 9

Asymmetry 
Border irregular 
Colour variation 
Diameter >6mm 
Elevated 
Fast evolving

Question 10

Investigations:

Answer 10

Excisional biopsy - histological diganosis for Clark’s level and breslow thickness

Lymphoscintography

Sentinel lymph node biopsy

Staging - MRI, CT, US or CXR

LFTS - liver is common place of metastasis