Melanoma and melancytic lesion

Question 1

Define Melanoma and melancytic lesion

Answer 1

Melanoma are malignant tumours of melanocytes -one of the most common skin cancers-usually in sun exposed areas

Melanocytic lesions-group of benign neoplasms and harmatomas of melanocytes-classically appear in childhood-classic brown spots

Question 2

Aetiology and risk factors of Melanoma and melancytic lesion

Answer 2

Melanocytic naevis–can be acquired or congenital. Acquired usually results from unknown aetiology causing proliferation, then stops.More common in skin typ1

Melanomas-mix of aetiologies (cancer) but in general are more common in sun-exposed areas-arms, trunk, face

4 big types-
Most common-appears in 40s-superficial spreading-torso for men, legs for women

Nodular-grows outwards (big mole)-any site, appear later in life

Lentigo-
Most commonly in over 60-head and neck and slow growth

acral lentigo-same as lentigo but on palms

Other types-amelanocytic

risk factors:
Sun exposure
FHx 
PMH of
Fitzpatrick skin type 1/2
large amount of melanocytes nave

Question 3

Epidiemology of Melanoma and melancytic lesion

Answer 3

The more sun exposed country the higher
UK-17 in 100 000 so not that common
5th most common cancer

Screening efforts have increased incidence

Melanocytic nave are literally in everyone, even if the congenital version is rare

Question 4

Signs and Sx of Melanoma and melancytic lesion

Answer 4

Hx of lesion-ABCDE (asymetry, border irregularity, colour, diameter >6mm, evolution)-changing lesion

itching, burning or pain can also be associated-big clue

Naevi-tend to be symetrical, flat, evenly pigmented, round/oval-can also be more raised
COngenital ones can be massive >20mm

Melanoma-
ABDCE-usually some of those
Pain, itch, burning

early lesions/superficial spreading-dark brown, flat,
does not resemble other melanocyte naevi
Asymetrical borders, fading borders, irregular pigment
Very rare to invade-usually in situ
More common in trunk/legs and younger patients

Nodular Melanoma-
Grows outwards-large and asymmetrical, raised from skin in weird shape. can be crusted, often weird pigmentation
Much more likely to be metastasise

lentigo/acral lentigo-also in situ-early form of melanoma
Often >6mm, irregular borders, but flat and with variable pigmentation-very similar to superficial spreading-
Most common on face and in elderly

Dermoscopy-just look with a lens-can help ABCDE approach

Question 5

Investigations of Melanoma and melancytic lesion

Answer 5

Dermoscopy-just look with a lens-can help ABCDE approach

Skin biopsy-essential in diagnosis
ideal if a full thickness removal of the whole lesion
if impossible, full thickness biopsy

imaging is useful for metastases