Malignantmelanoma 091229021816-phpapp01
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  • Important to differentiate the navi from early malanoma <br /> 5% familial – genes arnd chrmosome 9p21 appears to be involved. <br />
  • 1 major and 1 or more minor should be considered for exicion and diagnostic biopsy. <br />

Malignantmelanoma 091229021816-phpapp01 Malignantmelanoma 091229021816-phpapp01 Presentation Transcript

  • ‫الرحيم‬ ‫الرحمن‬ ‫ال‬ ‫بسم‬
  • By: Dr. Aliaa Alshorbagy
  •  Introduction  Aetiology  Types  Invasion and Metastasis  Risk Factors  Diagnosis and Staging  Treatment and Prevention View slide
  • Structure of the skin View slide
  •  Melanocytes: In stratum basale Pale “halo” of cytoplasm Neural crest Produce melanin and pass it on to nearby keratinocytes Melanin covers nuclei of nearby keratinocytes Skin colour depends on melanocytes activity, rather than the number present
  •  A tumour arising from melanocytes of the basal layer of the epidermis  Less commonly – uveal tract (eye) and meningeal membranes
  •  MM is the only common life – threatening problem in dermatology.  Primary cutaneous melanoma may develop in precursor melanocytic nevi (common acquired, congenital and atypical types ), although more than 50 % of cases are believed to arise without apreexisting pigmented lesion .
  •  The cause is unknown.  Excessive exposure to sunlight  Genetic predisposition
  • EpidemiologyEpidemiology  Melanoma accounts for only 4 % of all skin cancers , however ,it causes the greatest number of cancer-related deaths .the incidence of MM is increasing more rapidly that of any other cancer, making it the 5th most common invasive cancer in men and women .
  • 1-Excessive sun exposure. 2-Race : MM is more common in white races . 3-Previous cutaneous MM. 4- Family history of MM. 5- Increase numbers of acquired nevi. 6- Presence of potential precursors of MM e.g dyeplastic nevi and CMN.
  •  Occur anywhere on the skin Females (commonest is lower leg) Males ( back).  Early melanoma is pain free. The only symptom if present is mild irritation or itch.
  • GLASGOW SYSTEM Major:  Change in size  Irregular pigment  Irregular outline Minor:  Diameter >6mm  Inflammation  Oozing/bleeding  Itch/altered sensation AMERICAN ‘ABCDE’ SYSTEM  Asymmetry  Border  Colour  Diameter  Examination
  • Evolving; a mole or skin lesion that looks different from the rest or is changing in size, shape, or color Evolving; a mole or skin lesion that looks different from the rest or is changing in size, shape, or color
  •  Superficial spreading Malignant melanoma  Nodular melanoma  Lentingo maligna melanoma  Acral melanoma
  •  The most common type of MM in the white- skinned population – 70% of cases  Commonest sites – lower leg in females and back in males  In early stages may be small, then growth becomes irregular
  •  Commoner in males  Trunk is a common site  Rapidly growing  Usually thick with a poor prognosis  Black/brown nodule  Ulceration and bleeding are common
  •  In white-skinned population this accounts for 10% of MMs, but is the commonest MM in nonwhite-skinned nations  Found on palms and soles  Usually comprises a flat lentiginous area with an invasive nodular component
  •  Rare  Often diagnosed late – confusion with benign subungal naevus, paronychial infections, trauma  Hutchinson’s sign – spillage of pigment onto the surrounding nailfold
  •  Occurs as a late development in a lentigo maligna  Mainly on the face in elderly patients  May be many years before an invasive nodule develops
  • Superficial spreading melanomas: Benign melanocytic naevi Superficial spreading melanomas: Benign melanocytic naevi Nodular melanomas Vascular tumor Histiocytoma Nodular melanomas Vascular tumor Histiocytoma Latingo maligna melanoma Seborrhic keratoses Latingo maligna melanoma Seborrhic keratoses
  • Stages Of MelanomaStages Of Melanoma
  • Level I: Lesions involving only the epidermis (in situ melanoma); not an invasive lesion. Level II: Invasion of the papillary dermis but does not reach the papillary-reticular dermal interface. Level III: Invasion fills and expands the papillary dermis but does not penetrate the reticular dermis. Level IV: Invasion into the reticular dermis but not into the subcutaneous tissue. Level V: Invasion through the reticular dermis into the subcutaneous tissue. Clark Classification (Level of Invasion)
  •  The Breslow thickness is the single most important prognostic variable (distance in mm of the furthest tumour cell from the basal layer of the epidermis) Breslow depth 5 year survival In situ 95-100% <1mm 95-100% 1-2mm 80-96% 2.1-4mm 60-75% >4mm 50%
  • Scalp lesions worse prognosis, then palms and soles, then trunk, then extremities Younger women appear to do better than either men at any stage or women over 50 Ulceration of the tumour surface is a high risk factor
  • Surgical resection of tumour Lymph node dissection Chemotherapy Radiotherapy Immunotherapy
  •  Keep out of the strong midday sun (between 10 am and 3 pm)  Remember clothing is an effective sunscreen (particularly fine woven cotton clothing)  Use hats in the sun, particularly broad brimmed hats  Use a sunscreen to protect from UVR.
  •  Sunscreens should be liberally applied and reapplied every two hours if exposure to the sun continues.  Protect children and infants from strong sunlight at all times. Use a sunscreen with a high sun protection factor number (>15) .  Avoid using sunbeds and sunlamps.