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Malignantmelanoma 091229021816-phpapp01


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Malignantmelanoma 091229021816-phpapp01

  1. 1. ‫الرحيم‬ ‫الرحمن‬ ‫ال‬ ‫بسم‬
  2. 2. By: Dr. Aliaa Alshorbagy
  3. 3.  Introduction  Aetiology  Types  Invasion and Metastasis  Risk Factors  Diagnosis and Staging  Treatment and Prevention
  4. 4. Structure of the skin
  5. 5.  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
  6. 6.  A tumour arising from melanocytes of the basal layer of the epidermis  Less commonly – uveal tract (eye) and meningeal membranes
  7. 7.  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 .
  8. 8.  The cause is unknown.  Excessive exposure to sunlight  Genetic predisposition
  9. 9. 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 .
  10. 10. 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.
  11. 11.  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.
  12. 12. 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
  13. 13. 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
  14. 14.  Superficial spreading Malignant melanoma  Nodular melanoma  Lentingo maligna melanoma  Acral melanoma
  15. 15.  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
  16. 16.  Commoner in males  Trunk is a common site  Rapidly growing  Usually thick with a poor prognosis  Black/brown nodule  Ulceration and bleeding are common
  17. 17.  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
  18. 18.  Rare  Often diagnosed late – confusion with benign subungal naevus, paronychial infections, trauma  Hutchinson’s sign – spillage of pigment onto the surrounding nailfold
  19. 19.  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
  20. 20. 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
  21. 21. Stages Of MelanomaStages Of Melanoma
  22. 22. 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)
  23. 23.  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%
  24. 24. 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
  25. 25. Surgical resection of tumour Lymph node dissection Chemotherapy Radiotherapy Immunotherapy
  26. 26.  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.
  27. 27.  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.