Malignant Melanoma


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  • Important to differentiate the navi from early malanoma 5% familial – genes arnd chrmosome 9p21 appears to be involved.
  • 1 major and 1 or more minor should be considered for exicion and diagnostic biopsy.
  • Malignant Melanoma

    2. 2. Outline <ul><li>Introduction </li></ul><ul><li>Aetiology </li></ul><ul><li>Types </li></ul><ul><li>Invasion and Metastasis </li></ul><ul><li>Risk Factors </li></ul><ul><li>Diagnosis and Staging </li></ul><ul><li>Treatment and Prevention </li></ul>
    3. 3. Skin: Epidermis - Melanocytes <ul><li>Melanocytes: </li></ul><ul><ul><li>In stratum basale </li></ul></ul><ul><ul><li>Pale “halo” of cytoplasm </li></ul></ul><ul><ul><li>Neural crest </li></ul></ul><ul><ul><li>Produce melanin and pass it on to nearby keratinocytes </li></ul></ul><ul><ul><li>Melanin covers nuclei of nearby keratinocytes </li></ul></ul><ul><ul><li>Skin colour depends on melanocytes activity, rather than the number present </li></ul></ul>
    4. 4. MALIGNANT MELANOMA <ul><li>A tumour arising from melanocytes of the basal layer of the epidermis </li></ul><ul><li>Less commonly – uveal tract (eye) and meningeal membranes </li></ul>
    5. 5. AETIOLOGY <ul><li>The cause is unknown. </li></ul><ul><li>Excessive exposure to sunlight </li></ul><ul><li>Genetic predisposition </li></ul>
    6. 6. RISK FACTORS FOR MELANOMA <ul><li>Large numbers of benign naevi </li></ul><ul><li>Clinically atypical naevi </li></ul><ul><li>Severe sunburn </li></ul><ul><li>Early years in a tropical climate </li></ul><ul><li>Family history of MM </li></ul>
    7. 7. Clinical features <ul><li>Occur anywhere on the skin </li></ul><ul><ul><li>Females (commonest is lower leg) </li></ul></ul><ul><ul><li>Males ( back). </li></ul></ul><ul><li>Early melanoma is pain free. The only symptom if present is mild irritation or itch. </li></ul>
    8. 8. AIDS IN CLINICAL DIAGNOSIS <ul><li>GLASGOW SYSTEM </li></ul><ul><li>Major: </li></ul><ul><li>Change in size </li></ul><ul><li>Irregular pigment </li></ul><ul><li>Irregular outline </li></ul><ul><li>Minor: </li></ul><ul><li>Diameter >6mm </li></ul><ul><li>Inflammation </li></ul><ul><li>Oozing/bleeding </li></ul><ul><li>Itch/altered sensation </li></ul><ul><li>AMERICAN ‘ABCDE’ </li></ul><ul><li>SYSTEM </li></ul><ul><li>A symmetry </li></ul><ul><li>B order </li></ul><ul><li>C olour </li></ul><ul><li>D iameter </li></ul><ul><li>E xamination </li></ul>
    9. 9. Evolving; a mole or skin lesion that looks different from the rest or is changing in size, shape, or color
    10. 10. TYPES OF MELANOMA <ul><li>Superficial spreading Malignant melanoma </li></ul><ul><li>Nodular melanoma </li></ul><ul><li>Letingo maligna melanoma </li></ul><ul><li>Acral malanoma </li></ul>
    11. 11. SUPERFICIAL SPREADING <ul><li>The most common type of MM in the white-skinned population – 70% of cases </li></ul><ul><li>Commonest sites – lower leg in females and back in males </li></ul><ul><li>In early stages may be small, then growth becomes irregular </li></ul>
    12. 12. NODULAR <ul><li>Commoner in males </li></ul><ul><li>Trunk is a common site </li></ul><ul><li>Rapidly growing </li></ul><ul><li>Usually thick with a poor prognosis </li></ul><ul><li>Black/brown nodule </li></ul><ul><li>Ulceration and bleeding are common </li></ul>
    13. 13. ACRAL LENTIGINOUS MELANOMA <ul><li>In white-skinned population this accounts for 10% of MMs, but is the commonest MM in nonwhite-skinned nations </li></ul><ul><li>Found on palms and soles </li></ul><ul><li>Usually comprises a flat lentiginous area with an invasive nodular component </li></ul>
    14. 14. SUBUNGAL MELANOMA <ul><li>Rare </li></ul><ul><li>Often diagnosed late – confusion with benign subungal naevus, paronychial infections, trauma </li></ul><ul><li>Hutchinson’s sign – spillage of pigment onto the surrounding nailfold </li></ul>
    15. 15. LENTIGO MALIGNA MELANOMA <ul><li>Occurs as a late development in a lentigo maligna </li></ul><ul><li>Mainly on the face in elderly patients </li></ul><ul><li>May be many years before an invasive nodule develops </li></ul>
    16. 16. DDx <ul><li>Superficial spreading melanomas </li></ul><ul><li>Benign melanocytic naevi. </li></ul><ul><li>Nodular melanomas </li></ul><ul><li>Vascular tumor </li></ul><ul><li>Histiocytoma </li></ul><ul><li>Latingo maligna melanoma </li></ul><ul><li>Seborrhic keratoses </li></ul>
    17. 18. PROGNOSTIC VARIABLES <ul><li>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) </li></ul>Breslow depth 5 year survival In situ 95-100% <1mm 95-100% 1-2mm 80-96% 2.1-4mm 60-75% >4mm 50%
    18. 19. <ul><li>Scalp lesions worse prognosis, then palms and soles, then trunk, then extremeties </li></ul><ul><li>Younger women appear to do better than either men at any stage or women over 50 </li></ul><ul><li>Ulceration of the tumour surface is a high risk factor </li></ul>
    19. 20. MANAGEMENT Surgical resection of tumour MOHS technique Lymph node dissection Chemotherapy Radiotherapy Immunotherapy
    20. 21. Prevention <ul><li>Reduce risk factor exposure: </li></ul><ul><li>Awareness (TV, leaflets, billboards) </li></ul><ul><li>Covering up (sunscreen, sunglasses, clothes) </li></ul><ul><li>Avoidance (less time in sun) </li></ul><ul><li>Screening (possibly feasible) </li></ul>
    21. 22. <ul><li>REFERENCES : </li></ul><ul><li>Clinical Dermatology , Rona M. Mackie </li></ul><ul><li>Dermatology an Illustrated Colour Text , David J. Gawkrodger </li></ul><ul><li>Dermatology , Emedicine </li></ul>