Melanoma

Last updated 20.09.12

 

Index

 

Definition

-  Malignancy of melanocytes (skin cancer)

 

Features

-  Skin most commonly involved

-  Most common sites

-  Legs in women

-  Backs in men

-  May also effect eyes or mucosa

-  Australia has highest incidence in world

-  Early detection leads to improved survival

 

ABCD Rule

-  Asymmetrical

-  Borders are irregular

-  Color is variable

-  Diameter >6mm

 

Associated S/S

-  Pigmented lesion

-  Warning signs

-  New or changing lesion (majority de novo rather than from existing mole)

-  Ugly duckling sign: prominent pigmented lesion which stands out amoust others

-  Rapidly growing nodule

-  Lesion which concerns pt

-  Lesions w dermatoscopic changes on F/U

-  Lesions which lack dermatoscopic correlation

 

Types

-  Superficial Spreading Melanoma

-  Most common form

-  Usullay appears as irregular pigmented macule or papule

-  Dermoscopy

-  Multiple colors

-  Architectual disorder

-  Radial streaming

-  Branched streaks

-  Pseudopods

-  Peripheral black dots

-  Blue-white structures

-  Nodular Melanoma

-  Aggressive tumours over weeks

-  May ulcerate

-  Various colors: black, red, hypomelanotic

-  May be Dx as BCC

-  EFG

-  Elevated

-  Firm

-  Growing rapidly

-  Dermoscopy

-  Less useful

-  Acral Lentiginous Melanoma

-  Most common form in dark skinned pts

-  Palms, soles or nail bed

-  Dermoscopy

-  Parallel ridge pattern

-  Lentigo Maligna

-  Severly sun damaged skin

-  Usually older pts

-  In situ melanoma w delay before invasion

-  Dermoscopy

-  Annular, granular pattern

-  Asymetric pigmented follicular openings

-  Rhomboidal structures

-  Desmoplastic Melanoma

-  Rare & aggressive

-  Sometimes scar like, most non-pigmented

 

Ix

-  Dermoscopy

-  Excisional biopsy

-  Breslow thickness

-  Margins 

 

Mx

-  Excision of any suspicious pigmented lesion OR refer for specialist opinion

-  Excision down to fat w 2mm+ lateral margins

-  ONLY Bx (shave, punch) if complete excision too difficult

-  If Histo confirms Melanoma then --> wide local excision

-  Wide Local Excision

-  Within 6 weeks of original excision unless incomplete excision --> ASAP

-  Recommended margins are constantly reviewed

-  In situ: 5mm margins

-  <1mm thick: 1cm margins

-  1-4mm thick: 1-2cm margins

-  >4mm thick: 2cm margins

-  +/- Radiotherapy

-  Mx of metastasis

-  Melanoma unit

-  Oncologist

 

 

 

Refernces

 

eTG: Melanoma