Melanoma FRCR CO2A Flashcards
origin of melanocytes and its migration
neural crest and migrates to basal layer of the epidermis and the uveal tract
Types of cutaneous melanoma
- superficial spreading
- nodular
- acral lentiginous
- lentigo maligna melanoma
Reason for rise in MM
- increased detection
- excessive recreational exposure to sunlight
peak incidence and commonly affected race
4th and 5th decade
white>non white (10 x)
RFs for Melanoma
- UV rad exp’
- skin type: fair skin with blond or red hair
- no of common naevi
- family hx
- CDKN2A : inherited germline mutation
6 . PUVA treatment
Protective Role
Vitamin D
Prevention strategies
- spend time in the shade between 11 am to 3 pm
- avoid getting sunburnt
- cover up with a hat, t shirt and sunglasses
- take extra care with sun protection for children
- SPF 15 sunscreen
Pathology of mlenoma
atypical melanocytes that infiltrates into the dermis
no of mitoses, LVSI and regression
feature of superficial spreading melanoma
- 70%
- pigmented lesions often flat or with slight elevation, irregular border and irregular pigmentation
- micro: dominant horizontal growth
Nodular melanoma features:
- 15% of cases
- raised, nodular lesion, blue - grey to completely amelanocytic
- a/w ulceration / bleeding
- micro : no or minimal horizontal growth but ext dermal invasion
Acral lentiginous melanoma features?
- 10 % of cases
- palms, soles, subungual regions (great toe, thumb)
- less related to UV exp
- micro: acanthosis of epidermis, atypical melanocytes
lenti maligna melanoma (LMM)
5%
older pts usually on face
chronic sun exposure
precursor lesion: Hutchinson’s freckle, 5 % progress to LMM
Breslow thickness
measures the depth of a melanoma tumor from the surface of the skin to the deepest point of the tumor cells, and is measured in millimeters
Breslow thickness staging
Tis: Melanoma cells are only in the very top layer of the skin (epidermis).
T1: Melanoma is 1mm thick or less.
T2: Melanoma is between 1mm and 2mm thick.
T3: Melanoma is between 2mm and 4mm thick.
T4: Melanoma is more than 4mm thick.
spread of Melanoma
skin, subcut tissues and LNs
local spread of melanoma
initially, horizontal growth f/b vertical growth through dermis
Satellite nodules and in transit nodules
satellites nodules: cut or subcut nodules less than 2 cm from primary tumor
in transit nodules: beyond 2 cm but not beyond the draining LNs
metastatic spread of melanoma
Lung
Liver Bone
Brain
small bowel
meninges
GB
adrenals
main c/f of cut melanoma
pigmented lesion with an irregular edge and irregular pigmentation
ABCDE rule for melanoma
examination rule
A: Asymmetry
B: Boder irregular
C: Color irregular
D: Diameter > 5 mm
E: Elevation
Revised 7 point check list
Major Features:
1. change in size of lesion
2. irregular pigmentation
3. irregular border
Minor features
1. inflammation
2. largest diameter 7 mm or greater
3. OOzing crusting or bleeding
D/D of melanoma
- basal cell papilloma
- pigmented BCC
- thrombosed angioma
- pyogenic granuloma
- Dermatofibroma
Investigations and Staging of melanoma
- Dermatoscopy:
- excision of the lesion s/times incisional
- C/E of LNs
margin requirement as per lesion size
< 1 mm: 1 cm
1 - 2 mm: 1-2 cm
2 - 4 cm : 2 - 3 cm
> 4 cm : 3 cm
