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Malignant melanoma
Malignant melanoma
Malignant melanoma
Malignant melanoma
Malignant melanoma
Malignant melanoma
Malignant melanoma
Malignant melanoma
Malignant melanoma
Malignant melanoma
Malignant melanoma
Malignant melanoma
Malignant melanoma
Malignant melanoma
Malignant melanoma
Malignant melanoma
Malignant melanoma
Malignant melanoma
Malignant melanoma
Malignant melanoma
Malignant melanoma
Malignant melanoma
Malignant melanoma
Malignant melanoma
Malignant melanoma
Malignant melanoma
Malignant melanoma
Malignant melanoma
Malignant melanoma
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Malignant melanoma

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  • 1.  Pigmentation is a hallmark of melanoma  Features suggestive of melanoma include recent onset of a pigmented lesion, change in an existing pigmented lesion, irregular margins, asymmetrical shape, colour change or presence of multiple colours, and diameter greater than 6 mm in diameter.
  • 2.  Risk factors: - White race - Older age - H/o repeated intense sunlight exposure  Pathology : Anaplastic ,malignant appearing melanocytic cells involve substantia propria.
  • 3.  pre-existing naevus (junctional or compound)  Primary melanoma (de novo)  PAM with atypia  Amelanotic tumours are pink and have a characteristic smooth ‘fish-flesh’ appearance - Difficult to diagnose.
  • 4.  Ocular manifestations: Dark brown elevated lesion –perilimbal region –interpalpebral. S/L : Reddish,brown stippled/homogeneous dark brown ,intralesional microcysts,prominent blood vessels - focal nodular epibulbar mass.
  • 5.  Simple observation  Incisional biopsy – Complete excision & cryotherapy  Contact radiation  Topical chemotherapy  Exenteration – frank orbital invasion/ massive unresectable
  • 6.  Symptom: Visible spot /discolouration on iris/no symptom Risk Factors: - H/o intense sustained sunlight exposure - Conditions like Ocular melanocytosis , Dysplatic nevus syndrome. -
  • 7.  Ocular manifestations: - Localized dark brown to tan - well circumscribed, cohesive ,intrinsic vascularity /shaggy ,dispersive. - Pupillary peaking - Ectropion iridis - Iris splinting
  • 8.  Pathology : Atypical melanocytic cells- prominent nucleoli - N/C ratio - mitotic figures Fusiform shape – spindle cells Spherical shape – epitheloid cells  Diagnosis: - Transpupillary /transconjunctival transscleral transillumination - Anterior segment photography - Ultrasound biomicroscopy - Biopsy [incisional/ Fine needle aspiration.
  • 9.  Observation  Excision [iridectomy /iridocyclectomy]  Plaque radiotherapy  Enucleation.
  • 10.  Symptoms : - Blurred vision - Visual field defect - Flashes - Floaters - no symptom
  • 11.  CHOROIDAL  Dark brown to golden solid tumour  Biconvex ,lenticular on cross section  Mushroom configuration[break tru bruch membrane]  Non rhegmatogenous RD –Clear serous sub retinal fluid/bloody.  Prominent clumps of orange lipofuscin pigment.
  • 12.  CILIARY BODY  Elevated ,nodular dark brown –peripheral fundus. Pathology : Anaplastic melanocytic cells – high N/C ratio prominent nucleoli mitotic figures Spindle cells, mixed cells, Epitheloid cells, Vascular loops & networks.
  • 13.  B –SCAN: Solid acoustically dark [sonolucent] biconvex or mushroom configuration Acoustic brightness on cap  A scan: Low amplitude internal reflectivity stepwise decremental reduction in echo spike amplitude high amplitude at cap
  • 14.  Fluorescein Angiography : Dome shaped- early phase – filling of retinal,intratumoural vessels Late phase – Non uniform hyperfluorescent staining Mushroom shaped- Early phase – filling of intratumoural vessels Late phase – Generalized staining of apical nodule , sub retinal fluid.
  • 15.  MRI : Hyperintense relative to dark vitreous on T1 Hypointense relative to bright vitreous on T2
  • 16.  Enucleation  Radiation therapy  Observation  Photocoagulation  Non coagulative laser therapy  Microsurgical resection  Exenteration  Hyperthermia therapy  PDT  Cryotherapy  Chemotherapy
  • 17.  Lentigo maligna  Melanoma
  • 18.  (melanoma in situ, intraepidermal melanoma /Hutchinson freckle) Uncommon condition that develops in sun-damaged skin in elderly individuals. Malignant change may occur, with infiltration of the dermis.  Histology - intraepidermal proliferation of spindle-shaped atypical melanocytes that replace the basal layer of the epidermis  Signs A slowly expanding pigmented macule with an irregular border Nodular thickening and areas of irregular pigmentation are highly suggestive of malignant transformation Treatment is usually by excision.
  • 19. Histology shows large atypical melanocytes within the dermis Signs  Superficial spreading melanoma is characterized by a plaque with an irregular outline and variable pigmentation  Nodular melanoma is typically a blue-black nodule surrounded by normal skin 3 Treatment is usually by wide excision and may include local lymph node removal.
  • 20. THANK YOU

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