Melanoma

Question 1

What is melanoma?

Answer 1

malignancy arising from neoplastic transformation of melanocytes, the pigment-forming skin cells.
Leading cause of death from skin disease.

Question 2

What are the 4 types of melanoma?

Answer 2

Lentigo maligna
Superficial
Nodular
Acral lentiginous malignant

Question 3

Describe lentigo maligna melanoma

Answer 3

5-15%
Usually elderly
Slow growing
a patch of lentigo maligna develops a papule or nodule, signalling invasive tumour.

Question 4

Describe superficial melanoma

Answer 4

Most common ~60%
Large flat irregularly pigmented lesion which grows laterally before vertical invasion develops.
Arises in a pre-existing naevus

Question 5

Describe nodular melanoma

Answer 5

15-30%
Usually >50y
Most aggressive type.
Rapidly growing pigmented nodule which bleeds or ulcerates.
Rarely, are amelanotic + can mimic pyogenic granuloma.

Question 6

Describe acral lentiginous malignant melanoma

Answer 6

5-10%
Most common type in dark skinned
arises as pigmented lesions on the palm, sole or under the nail
Usually presents late.

Question 7

What causes melanoma?

Answer 7

DNA damage caused by UV radiation leads to neoplastic transformation

Question 8

List 4 risk factors for melanoma

Answer 8

Previous invasive melanoma
Many naevi
UV exposure
Fair skin

Question 9

What signs do you look for in melanoma on examination?

Answer 9

A: asymmetry 
B: border irregularity 
C: colour variation 
D: diameter > 7 mm 
E: elevation/ evolution

Question 10

What is used to diagnose melanoma?

Answer 10

full-thickness excisional biopsy

Question 11

What is used to stage melanoma?

Answer 11

Clark Scale + Breslow thickness

TNM

Question 12

What is used to check for metastasis?

Answer 12

Sentinel lymph node biopsy
CXR
Liver US
CT head, abdo, pelvis

Question 13

Why are LFTs measured in melanoma?

Answer 13

Liver is a common site of metastasis