Mole Flashcards

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1
Q

What features do you look for in a mole?

A
  • Asymmetry: you cannot find a plane in which one half of a mole or birthmark is the mirror image of the other
  • Border irregularity: blurred, notches, ragged
  • Colour variation: the colour is not the same all over and may include shades of brown or black or sometimes with patches of pink, red, white or blue
  • Darkness (melanomas are often very dark) or diameter >6mm across but melanomas can sometimes be smaller than this
  • Evolution: has the lesion changed in any way since you first noticed it?
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2
Q

What is a mole?

A

The scientific term for a mole is a melanocytic naevus. It is composed of melanocytes, cells that lie in the basal layer of the epidermis and within the dermis. Melanocytes produce pigment: either brown or black eumelanin or red phaeomelanin within skin, hair and eyes through a process called melanogenesis. Melanogenesis is hormonally regulated by melanocyte stimulating hormone (MSH) and a number of other factors. The clinical appearance of a naevus is dependent on the pattern of melanocyte distribution within the epidermis and dermis.

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3
Q

What are the types of moles?

A
  • Junctional naevus: melanocytes present at dermo-epidermal junction = brown colour and flat
  • Intradermal naevus: melanocytes present in dermis = skin coloured and raised
  • Compound naevus: melanocytes present at dermo-epidermal junction and within dermis = brown and raised
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4
Q

What sort of referrals can be done for moles?

A

All suspected melanomas are referred to 2 week wait cancer clinics via a HSC205 proforma. If a person has lots of moles (but not necessarily suspecting cancer) then refer within 13 weeks.

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5
Q

How do you determine which moles to refer?

A
  • Moley patient - 13 weeks for risk estimation and education
  • A new mole which is growing quickly in an adult - assessment within 2 weeks
  • A mole which has: 3 or more colours, lost its symmetry - assessment and biopsy within 2 weeks
  • A long-standing mole which is changing shape and colour - assessment within 2 weeks
  • Any new nodule which is growing and is pigmented or vascular in appearance - assessment and probably monitoring or biopsy of nail bed within 2 weeks
  • New pigmented line in nail - assessment and probably monitoring or biopsy of nail bed within 2 weeks
  • Something growing under a nail especially if there is vascular tissue or pigment - assessment and biopsy within 2 weeks
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6
Q

What do you look for if suspecting cancer?

A

Look for evidence of metastases:

  • Localised: cutaneous/SC nodules around the lesion
  • Regional: lymphadenopathy
  • Distant: hepatomegaly +/- splenomegaly
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7
Q

What is the treatment for malignant melanoma?

A

Only treatment for suspect malignant melanoma is excision with narrow margin (with a small no. of exceptions). This is an urgent procedure and the dermatologist will try to arrange this to happen the same day or within the week.
- Incisional/punch biopsies are not performed

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8
Q

What are the features of melanoma?

A
  • ~50% of melanomas develop in pre-existing moles, the rest arise de novo
  • Melanocytic naevi (moles) are both markers of risk of melanoma and potential precursors
  • Most melanomas are asymptomatic. Though some patients report bleeding or itching, these symptoms can occur in normal moles if they are caught or inflamed.
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9
Q

What are dysplastic naevi?

A

Dysplastic naevi are on a continuum of progression from benign naevus to melanoma. There are some people who have a genetic predisposition to several dysplastic naevi (familial dysplastic naevus syndrome), these patients have a greater risk of developing melanoma.

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10
Q

What puts people at high risk for melanoma?

A
  • People exposed to strong sunlight every now and then e.g. holidaying in a hot country are more at risk to melanoma than people who are very regularly exposed to sunlight e.g. people who work outdoors
  • Sunburn is high risk at all ages
  • Fair skin
  • FH of melanoma
  • Sunbeds - highest risk for <35yrs
  • The more moles - the higher risk of melanoma, especially those with unusually shaped or large moles (atypical mole syndrome)
  • IBD, HIV/AIDS, immunosuppressed, men with high BMI
  • > 100 melanocytic naevi
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11
Q

What is the link between black people and melanoma?

A

It is rare for black people to get melanoma - usually it will be a type that develops on the soles of the feet or palms of the hands (acral lentiginous melanoma). This can also grow under the nail.

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12
Q

What is Breslow thickness?

A
  • Measures distance in mm from the granular layer in the epidermis to the deepest level on invasion in the dermis. This is a major determinant of prognosis.
  • Specialists can then decide how much normal skin to remove around the melanoma (wide local excision)
  • Breslow thickness used for TNM staging and other features used too (evidence of mitosis, ulceration, lymph node involvement and evidence of distant metastases)
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13
Q

What adults are at risk for malignant melanoma?

A
  • Fair or freckled skin, which burns easily or tans poorly
  • A large number of moles (>100 in young people, >50 in older people)
  • Atypical moles (>6 or 7mm in diameter with irregular outline and colour variation)
  • History of severe sunburn, especially in childhood
  • Personal or FH of melanoma
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14
Q

What are major signs for melanoma?

A
  • If an existing or new mole is changing rapidly: over a period of weeks or months, rather than years
  • If a mole has an irregular outline
  • If a mole has different shades of black and brown
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15
Q

What are minor signs for melanoma?

A
  • If a mole is >7mm in diameter or is larger than a patient’s other moles
  • If a mole is inflamed or has a reddish edge
  • If a mole is bleeding, oozing or crusting
  • If a mole starts to feel different e.g. itching or painful
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