Melanoma

Question 1

What is melanoma?

Answer 1

Malignant growth of melanocytes

Question 2

What are the types of melanoma?

Answer 2

Cutaneous

Non-cutaneous

Question 3

What are melanocytes?

Answer 3

Pigmented cells in the epidermis - produce melanin

Question 4

What layer of the epidermis to melanocytes originate?

Answer 4

Stratum basale

Question 5

What is the embryological origin of melanocytes?

Answer 5

Neural crest

Question 6

What are the risk factors for melanoma?

Answer 6

UV radiation 
Skin type - Fitzpatrick 1/2
Sunburn in childhood
Immunosupression 
Genetics

Question 7

What genes predispose to melanoma?

Answer 7

BRAF

CDK4

Question 8

What are precursor lesions to melanoma?

Answer 8

Benign naevus (mole)
Dysplastic naevus (pre-malignant)
Solar lentigo

Question 9

What are differentials for melanoma?

Answer 9

Benign naevus (mole)
Dysplastic naevus (pre-malignant)
Spitz naevus
Blue naevus

Question 10

What is a spitz naevus?

Answer 10

Benign lesion that looks like a melanom

Question 11

What is a blue naevus?

Answer 11

Incomplete melanocyte migration that has the tyndall effect

Question 12

What is the tyndall effect?

Answer 12

Incomplete scattering of light which gives a blue appearance

Question 13

What are the clinical features of melanoma?

Answer 13

Moles

• change in size
• change in shape

Question 14

What are the subtypes of melanoma?

Answer 14

Superficial spreading 
Nodular 
Acral lentiginous 
Desmoplastic 
Lentigo maligna

Question 15

What checklist is used for melanoma?

Answer 15

Glasgow 7-point checkpoint

Major features

• change in size
• irregular shape
• change in colour

Minor criteria

• Diameter >6mm
• inflammation
• oozing
• change in sensation

Question 16

What is superficial spreading melanoma?

Answer 16

Most commo type

Features

• growing moles over flat surface
• arms, legs, chest, back

Question 17

What is a nodular melanoma?

Answer 17

Invasive form of melanoma

Features

• red/black lump
• bleeds/oozes
• sun-exposed skin

Question 18

What is acral lentiginous melanoma?

Answer 18

Melanoma arising on palms or soles

Features

• Discolouration
• Hutchinson’s sign

Question 19

What is Hutchinson’s sign?

Answer 19

Subungual discolouration

Discolouration of nailbed

Question 20

What is desmoplastic melanoma?

Answer 20

Rare form of invasive melanoma

Features

• sun-exposed areas
• enlarged area of thickened skin
• variable pigmentation

Question 21

What is lentigo maligna melanoma?

Answer 21

Malignant cells confined to epidermis

Features

• growing mole
• chronically sun-exposed skin

Question 22

How is the histology of melanoma commented on?

Answer 22

Breslow thickness
Ulceration
Mitotic index

Question 23

What is Breslow thickness?

Answer 23

Vertical depth from stratum granulosum

Question 24

What does ulceration suggest?

Answer 24

Aggressive tumour phenotype

Question 25

What does mitotic index show?

Answer 25

Indicator of cell turnover

Question 26

How is melanoma staged?

Answer 26

AJCC system

Stage 0 = in situ melanoma
Stage 1 = thin melanoma <2mm
Stage 2 = thick melanoma >2mm, or >1mm with ulceration
Stage 3 = Melanoma spread to local lymph nodes
Stage 4 = distant mets

Question 27

How is melanoma managed?

Answer 27

Surgical

• wide local excision
• sentinel lymph node biopsy

Medical
- adjuvant chemoradiotherapy

Question 28

What is used to indicate WLE margin?

Answer 28

Breslow thickness

in situ = 5mm
<=2mm - 10m
>2mm - 20mm