Surgery - Skin Flashcards
Where are melanocytes?
Epidermis
Staging of melanoma
- T represents how thick the melanoma is, this will tell you prognostic factor
- Breslow was only depth (in mm) before (no ulceration or mets)
- Clark has lower predictive value and was used with Breslow’s depth but described where in anatomical invasion of skin
o 1 = epidermis; 2 = papillary dermis; 3 = papillary-reticular dermis junction; 4 = reticular dermis; 5 = subQ fat
Melanoma Stage IA
T1a, N0, M0
< 1mm, (-) ulceration
Melanoma Stage IB
T1b, N0, M0 OR
T2a, N0, M0
< 1 mm + ulceration
OR
1-2 mm (-) ulceration
Melanoma Stage IIA
T2b, N0, M0
OR
T3a, N0, M0
1-2 mm + ulceration
OR
2-4 mm (-) ulceration
Melanoma Stage IIB
T3b, N0, M0
OR
T4a, N0, M0
2-4 mm + ulceration
OR
> 4 mm (-) ulceration
Melanoma Stage IIC
T4b, N0, M0
> 4mm + ulceration
Melanoma Stage III
+ nodes
Melanoma Stage IV
Distant mets (lung, liver, bone, heart, brain…..loves small bowel mucosa)
Dx SCC or Basal cell
Full thickness incisional bx done at edge of lesion including normal skin
Preferred adjuvant systemic therapy for metastatic melanoma?
IFN beta
Tx basal cell carcionma
Local excision
+ margins - reexcise to clear margins
Margins should be 2-4 mm
+ topical 5-FU or radiation
Tx squamous cell carcinoma
More dangerous than basal
Excision w/ 1cm tumor-free margins
Lymph node excision is palpable
+ 5-FU or radiation
What is most significant finding in addition to histo findings + TNM stage for melanoma?
Ulceration
Ulcerated lesions have 1/3 reduction in survival
Lentigo maligna melanoma
Usually on face
Superficial spreading (not as invasive)
Favorable prognosis
