Carrozzo Anna Maria. Clinica e Diagnostica del Melanoma. ASMaD 2012
ANNA MARIA CARROZZO
ll melanoma è un tumore maligno cheorigina dai melanociti della cute e delle mucose, dai melanociti che costituiscono i nevie, molto più raramente, dai melanociti posti in sedi extracutanee(occhio, orecchio interno, meningi, mesenchima viscerale).
CRITERI CLINICI X IL RICONOSCIMENTOA asimmetriaB bordi irregolariC colori multipliD dimensioniE evoluzione intesa come cambiamento
FATTORI PROGNOSTICI Breslow-Clark n° Mitosi x campo Ulcerazione
CLARK Livello I: Melanoma in situ: il tumore ènellepidermide al di sopra di una lamina basale intatta; Livello II: il tumore invade il derma papillare;Livello III: il tumore arriva fino allinterfaccia tra derma papillare e derma reticolare, senza infiltrare questultimo; Livello IV: il tumore invade il derma reticolare; Livello V: il tumore invade il tessuto sottocutaneo.
Eleven Independent Clinicopathologic Prognostic Markers for Cutaneous Melanoma Age at Diagnosis Gender Growth phase (radial vs vertical) Thickness Level of invasion Presence of ulceration Presence and density of tumor infiltrating lymphocytes Regression Presence of microsatellites Presence of vascular and lymphatic invasion Presence and quantity of mitotic figures
La dermoscopia (o microscopia aepiluminiscenza) é una tecnicadiagnostica per esaminare in vivo lesionicutanee, ingrandite di 10-20 volte. Sitratta di unapparecchiatura che utilizza:olio che, applicato sulla lesione rende ilderma più trasparente; un obiettivo, cheposto a diretto contatto con la lesionetramite lolio potenzia lesame in vivodelle strutture della giunzione dermo-epidermica; una sorgente di luce e unalente dingrandimento.
Proliferazione melanocitaria atipica Intraepidermica suggestiva per formainiziale di melanoma in situ associata ad intensoinfiltrato infiammatorio del derma papillare- reticolare Margini di escissione chirurgica indenni
ATYPICAL MOLE SYNDROME AND DYSPLASTIC NEVI: IDENTIFICATION OF POPULATIONS AT RISK FOR DEVELOPING MELANOMAJ.H. Silva, B.C.Soares de Sa et Al. CLINICS 2011 MarchIn 1820, Norris described what is currently considered in a family predisposed to melanoma.In 1978 Clark reported an increase incidence of cutaneous melanoma in families with multiple melanocytic lesions, introducing the melanoma tumor progression model from melanocytic nevi, and used the term B_Kmole syndrome, from the initials of the patients surnames. Now the terms AMS,Dysplastic Nevus Syndrome and Familial Atypical Multiple-Mole Syndrome (FAMMS) have been employed.In 1985, Elder extended the theory of nevus-melanoma for sporadic dysplastic nevi as a possible precursor of sporadic melanoma
1984-2008 A.B.Ackerman"The perplexing story of the dysplastic nevus and the dysplastic nevus syndrome can be comprehended only in the context of understanding the consistent lack of a repeatable definition of dysplasia and the persistent failure to provide reliable criteria for clinical and histopathologic diagnosis of dysplastic nevus. As a consequence of these rickety underpinnings, it was inevitable that the edifice would collapse, and it did in less than 15 years. The epitaph for dysplastic nevus was written in 1992, and that was published in the Journal of the American Medical Association in 1992. In that report, the panel stated that the term dysplastic nevus had outlived its usefulness and should be abandoned. We concur and advise further that the concepts of dysplasia, dysplastic melanocytes, dysplastic nevus, and the dysplastic nevus syndrome not only be abandoned now, but that they also not be supplanted by equally opaque notions, such as cytologic and architectural atypia, nevus with histologic dysplasia, clinically atypical mole, and atypical mole syndrome.Resolving Quandaries in Dermatology, Pathology and Dermatopathology. pp 88. Promethean Medical Press/Waverly, 1995.
Several studies have shown that the presence of dysplastic nevi considerably increases the risk of developingmelanoma, which demonstrates that these lesions, aside from being precursors to disease are also important risk markers
Atypical moles differ from common acquired melanocytic nevi in several respects, including diameter and lack of pigment uniformity. Confusion exists because some atypical moles cannot be clinically distinguished from melanoma. The clinical and histologic appearances of atypical moles occurring in a familial setting appear to overlap with sporadically occurring atypical moles. The US National Institutes of Health Consensus Conference on the diagnosis and treatment of early melanoma defined a syndrome of familial atypical mole and melanoma (FAMM). The criteria for FAMM syndrome are as follows: The occurrence of malignant melanoma in 1 or more first- or second-degree relatives The presence of numerous (often >50) melanocytic nevi, some of which are clinically atypical Many of the associated nevi showing certain histologic features (see Histologic Findings)
Dysplastic nevus (atypical nevus)Gisele Gargantini Rezze, Alexandre Leon, Joao DupratAbstract: Atypical nevum (dysplastic) is considered an important factor associated with increased risk ofdeveloping cutaneous melanoma. It is believed that atypical nevi are precursor lesions ofcutaneousmelanoma.They may be present in patients with multiple melanocytic nevi (atypical nevus syndrome) or isolatedand in small numbers in a non-familial context. The disease usually begins at puberty and predominatesin young people. It has a predilection for sun-exposed areas, especially the trunk. The major challengein relation to atypical nevi lies in the controversy of defining its nomenclature, clinical diagnosis, dermoscopiccriteria, histopathological diagnosis and molecular aspects. This review aims at bringing knowledge,facilitating comprehension and clarifying doubts about atypical nevus. An Bras Dermatol. 2010;85(6):863-71.
VivaCamTM Macroscopic Camera OptionClinical Photographof a Lesion 3mm x 3mm VivaBlockTM 10mm x 10mm VivaCamTM Image
K. Busam, C. Charles, A. Marghoob, MSKCCImage taken at the papillary dermis of the biopsy-proven nevus component (A) of previousnevus shown in the previous slide. Notice the organized nests of nevomelanocytes within thesuperficial dermis, consistent with a benign lesion. 500 µm field of view.
ANIMAL MELANOMA: di recente codifica. E’ unMelanoma che sintetizza pigmento. E’ una varianteistopatologica rara, così chiamato per la prominenteproduzione di melanina, che appare simile ad unavariante di melanoma osservata nei cavalli grigiMELANOMA DESMOPLASTICO: forma rara diMelanoma, caratterizzato dalla tendenza ad infiltrare ivasi sanguigni, a diffondersi per invasioneperineurale e per l’alta frequenza con la qualerecidiva localmente.