Melanoma

Question 1

Describe the four common subtypes of malignant melanoma

Answer 1

• Superficial spread: Commonest (70%); radial growth; invades late
• Nodular: Raised; aggressive vertical growth; ulcerates and bleeds
• Lentigo maligna: In situ; slow growth and nodular
  
  • Affects face, neck, arms.
• Acral lentiginous: Affects nail beds, palms and soles
  
  • Commonest in darker skin, least common overall

Acral = distal portion of limbs

Lentiginous = small pigmented sport with a defined edge.

Question 2

Provide four risk factors for melanoma

Answer 2

• Personal or FHx of skin cancer; strong FHx
• Increasing age
• Fitzpatick skin type I and II: burns easily
• Red, blonde or light hair; blue/green eyes; freckles
• History of sunburn; indoor tanning or sun beds
• 50+ moles; atypical moles; 100+ moles
• Giant (>20cm) congenital melanocytic naevus
• Immunosuppressed

Bold = higher risk

Question 3

Outline the ABCDE method of describing a suspicious melanoma

Answer 3

Bold = major suspicious feature

• Asymmetrical shape
• Border irregularity
• Colour irregularity
• Diameter >6mm
• Evolution of lesion: ^eg. change in size and/or shape

Symptoms - bleeding, itching etc

Question 4

Outline the weighted 7-point checklist for identification of melanoma

Answer 4

Urgent (2ww) referral if score 3+ or strong concerns

• Major features: Two points each
  
  • Change in size
  • Irregular colour
  • Irregular shape or border
• Minor features: One point each
  
  • Largest diameter 7+mm
  • Inflammation
  • Oozing or crusting of the lesion
  • Change in sensation, including itch

Question 5

How does melanoma present differently in men and women?

Answer 5

• Women: occurs more commonly in legs
• Men: occurs more commonly in trunk

Question 6

What is the management of skin lesions with low suspicion (score of 1 or 2) of melanoma?

Answer 6

Monitor skin lesion, return if any changes

Review in 8 weeks

Question 7

Outline the management of a skin lesion with high suspicion (score 3+) of melanoma

Answer 7

Urgent 2 week wait referral to dermatologist, plastic surgeon, or specialist with experience of melanoma

Question 8

How is psoriasis and malignant melanoma linked?

Answer 8

UVB phototherapy is used to treat psoriasis by slowing the growth of cells. UV light can cause mutations of keratinocytes and melanocytes which predispose to skin cancer.

Question 9

Outline treatment options for melanoma

Answer 9

• Curative surgical excision
• Palliative options: surgery; chemotherapy; radiotherapy

Question 10

How is risk of recurrence for melanoma assessed?

Answer 10

Breslow thickness

• <0.75mm: low risk
• 0.75 - 1.5mm: medium risk
• >1.5mm: high risk