Melanoma exam Flashcards
What are the characteristic features of a bcc? How would you manage a bcc in an anatomically difficult area?
Pearly rolled edges, telangiectasia, central crater
Anatomically difficult area: moh’s micrographic surgery
What are the types of BCC?
Nodular (most common)
Superficial
Infiltrative
Noduloinfiltrative
Cystic
What is the most common type of BCC?
Nodular
What are the characteristic features of SCC?
Exophytic (outward) growth
Everted edges, areas ulceration, haemorrhage, necrosis
How are BCCs and SCCs managed?
If large/unsure diagnosis: punch biopsy, otherwise excision
BCC: 3-5mm margin
SCC <2cm: 6mm margin, >2cm: 1cm margin
Early BCC: can be managed with photodynamic therapy
Radiotherapy if Pt not suitable for surgery
What surgical margins would you consider for biopsy proven BCC?
3-5mm
What surgical margins would you consider for biopsy proven SCC?
If <2cm 6mm
If > 2cm 1cm
What are the red flag features in a patient with a pigmented lesion that would appear to be suspicious or signify malignant change?
A: Asymmetry
B: Bleeding
C: Colour variegation
D: Diameter (increasing)
E: Evolution/elevation (irregular border/itchy)
F: further (satellite lesions)
G: greater than 6mm
H: Halo (light pigmentation around lesion)
What are the types of melanocytic naevi?
Junctional (brown or black, flat)
Compound (elevated, slightly lighter)
Intradermal (lighter, dome shaped)
Describe junctional melanocytic naevus
Brown or black, flat
Describe compound melanocytic naevus
Slightly lighter, elevated
Describe intradermal melanocytic naevus
Lighter, dome shaped
Name some risk factors for developing a melanoma
UV (intense, intermittent e.g. sunbed)
Fhx melanoma
Fair skin
Immunosuppression
Albinism
Name some conditions that predispose to the development of a melanoma
Xeroderma pigmentosum (autosomal dominant)
Giant congenital melanocytic naevus
Multiple dysplastic naevi
What genes are associated with increased risk of melanoma?
CDKN2A and 4 (cycline dependent kinase)
BRAF
BRCA 2
In which layer of skin does a melanoma arise?
Stratum granulosum (granular layer epidermis)
In which layer of skin does a basal cell carcinoma arise?
Stratum basale
What is the embryological origin of melanocytes?
Neural crest cells (same as phaeochromocytoma)
What type of melanoma? how common?
Superficial spreading (60%)
What type of melanoma?
Nodular (20%)
What type of melanoma?
Amelanotic melanoma
What type of melanoma?
Acral (under nail bed, sole of foot)–> more common in dark skin
What type of melanoma?
Lentigo maligna (melanoma in situ)
What type of melanoma?
Ocular melanoma (most common type of eye cancer)
What types of melanoma are there?
Superficial spreading (most common, 60%)
Nodular (20%)
Amelanotic
Acral (under nail bed, sole of foot)–> more common in dark skin
Lentigo maligna (melanoma in situ)
Ocular (most common eye cancer)
What is the most common type of melanoma?
Superficial spreading
Which types of melanoma have the best and worst prognosis?
Superficial spreading: best
Nodular: worst
What type of tumour markers are used in diagnosis of melanoma?
S100B
HMB45
What would you do for mole suspicious for melanoma?
Excision biopsy with 2mm margins, histology
What might be the concerning features in the melanoma histopathology report?
-High vertical thickness (most important)
-High mitotic index
-Perineural invasion
-Perivascular invasion
-Perilymphatic invasion
What is the breslow thickness?
-Same as vertical thickness
-Granular layer of epidermis to nearest 0.1mm
-Determines excision margins
What is clarke’s level?
-Anatomical rather than prognostic measure: denotes level of skin invaded by tumour
Level 1: Melanoma confined to the epidermis (melanoma in situ)
Level 2: Invasion into the papillary dermis
Level 3: Invasion to the junction of the papillary and reticular dermis
Level 4: Invasion into the reticular dermis
Level 5: Invasion into subcutaneous tissue
What are the prognostic indicators for a melanoma and what features have the worst prognosis?
-Breslow thickness (same as vertical)
-Presence vs absence of lymph nodes
-Ulceration
Above worst prognostic indicators
-Type of melanoma (nodular worst, superficial spreading best)
-Site: head and neck bad as lymphatic spread wide
-Recurrent melanoma
Excision margins for breslow thickness
In situ–> 0.5cm
<1mm –> 1cm
1-2mm –> 1-2cm
2-4mm –> 2-3cm
>4mm –> 3cm
Above values: margins around the scar
Which type of BCC is this?
Nodular BCC (most common)
Which type of BCC is this?
Superficial BCC
What type of bcc is this?
Infiltrative
What type of bcc is this?
Nodular infiltrative
What type of BCC is this?
Cystic
What is the staging classification used in melanoma?
American joint committee on cancer (AJCC)–> depends on breslow thickness and ulceration
How would you manage pt with biopsy proven melanoma?
-<0.8mm: can discharge
->0.8mm: further WLE as per thickness
-Assess lymph nodes: LL –> groin, UL–> axilla
-No palpable LN: WLE, sentinel node biopsy
-Palpable LN: FNA. If tumour cells, staging CT
What is immunohistochemistry?
-Method of localising specific antigens in tissues or cells based on antibody antigen recognition
How does the an
What is immunohistochemistry in simple words?
It is a method of localising specific antigens in tissues or cells based on antigen antibody recognition
How does immunohistochemistry work?
The antibodies are usually linked to an enzyme or fluorescent dye. When the antibodies bind to the antigen in the tissue sample, the enzyme or dye is activated, and the antigen can then be seen under a microscope
What is the type of antigen-antibody reaction in immunohistochemistry?
Complement fixation
