Dr Patrick Treacy shares some of his most challenging cases.
This month he talks about treating Cutaneous Malignant Melanoma. Melanoma, also known as malignant melanoma, is a type of cancer that develops from the pigment-containing cells known as melanocytes. They typically occur in the skin but may rarely occur in the mouth, intestines, or eye. In women they most commonly occur on the legs, while in men they are most common on the back. Sometimes they develop from a mole with concerning changes including an increase in size, irregular edges, change in color, itchiness, or skin breakdown
Split earlobe injuries are relatively common in individuals with pierced ears. They result from various forms of trauma, including babies pulling earrings, spousal abuse, and heavy earrings. Complete lobe clefts usually occur from either sudden pull injuries or from chronic traction.
Dr Patrick Treacy shares some of his most challenging cases. This month he ta...Dr. Patrick J. Treacy
A 61-year-old Irish female, presented with complete pulled earlobes bilaterally as a consequence of possible low placement of original piercings and pendulous ear-rings. She wanted repair of the defect so she could begin to wear her earrings again. The patient was in no distress the defect had caused scar tissue along the involved cleft.
2.tahrir n. aldelaimi article the evaluation of impacted third molars using...MohammedAbdulhammed
Tahrir N. Aldelaimi's ( dean of college of dentistry / Anbar University ) Published paper Show plagiarized paragraph (High light ) from article belong to Faiez N. Hattab, Ma'amon A. Rawashdeh and Mourad S. Fahmy
Reconstruction with free fibula graft for osteoradionecrosis of mandible ca...Indian dental academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
Split earlobe injuries are relatively common in individuals with pierced ears. They result from various forms of trauma, including babies pulling earrings, spousal abuse, and heavy earrings. Complete lobe clefts usually occur from either sudden pull injuries or from chronic traction.
Dr Patrick Treacy shares some of his most challenging cases. This month he ta...Dr. Patrick J. Treacy
A 61-year-old Irish female, presented with complete pulled earlobes bilaterally as a consequence of possible low placement of original piercings and pendulous ear-rings. She wanted repair of the defect so she could begin to wear her earrings again. The patient was in no distress the defect had caused scar tissue along the involved cleft.
2.tahrir n. aldelaimi article the evaluation of impacted third molars using...MohammedAbdulhammed
Tahrir N. Aldelaimi's ( dean of college of dentistry / Anbar University ) Published paper Show plagiarized paragraph (High light ) from article belong to Faiez N. Hattab, Ma'amon A. Rawashdeh and Mourad S. Fahmy
Reconstruction with free fibula graft for osteoradionecrosis of mandible ca...Indian dental academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
Osteoradionecrosis is one of the most serious oral complications of head and neck cancer treatment.
It is a severe delayed radiation-induced injury, characterized by bone tissue necrosis and failure to heal for at least 3 months.
ORN is an inflammatory condition of bone that occurs after the bone has been exposed to therapeutic doses of radiation usually given for a malignancies.
Dr. Rahul VC Tiwari - Fellowship In Orthognathic Surgery - Jubilee Mission Medical College Hospital and Research Center, Thrissur, Kerala - 20TH PUBLICATION - IJADS
Peripheral Ossifying Fibroma-A case report with Cone Beam CT featuresiosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
Peripheral ossifying fibroma (POF) is a non-neoplastic enlargement of the gingival, which is one of the main
benign, reactive hyperplastic inflammatory lesions of the gingiva occurring in young adults. It has a very high
recurrence rate of around 7-45%. For this reason, a longer patient follow-up is very important in POF. Peripheral
ossifying fibroma comprises about 9% of all gingival growths. POF has similar clinical presentations with different
lesions which makes it difficult to reach at a correct diagnosis. In this article, we are reporting a case of peripheral ossifying fibroma (POF) in a 16-year-old female patient.
Key Words: Fibrous hyperplasia, Peripheral ossifying fibroma,
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
Dr Patrick Treacy shares some of his most challenging cases. This month he talks
about treating post endoscopic thoracic sympathectomy “gustatory sweating” with
botulinum toxin A
Osteoradionecrosis is one of the most serious oral complications of head and neck cancer treatment.
It is a severe delayed radiation-induced injury, characterized by bone tissue necrosis and failure to heal for at least 3 months.
ORN is an inflammatory condition of bone that occurs after the bone has been exposed to therapeutic doses of radiation usually given for a malignancies.
Dr. Rahul VC Tiwari - Fellowship In Orthognathic Surgery - Jubilee Mission Medical College Hospital and Research Center, Thrissur, Kerala - 20TH PUBLICATION - IJADS
Peripheral Ossifying Fibroma-A case report with Cone Beam CT featuresiosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
Peripheral ossifying fibroma (POF) is a non-neoplastic enlargement of the gingival, which is one of the main
benign, reactive hyperplastic inflammatory lesions of the gingiva occurring in young adults. It has a very high
recurrence rate of around 7-45%. For this reason, a longer patient follow-up is very important in POF. Peripheral
ossifying fibroma comprises about 9% of all gingival growths. POF has similar clinical presentations with different
lesions which makes it difficult to reach at a correct diagnosis. In this article, we are reporting a case of peripheral ossifying fibroma (POF) in a 16-year-old female patient.
Key Words: Fibrous hyperplasia, Peripheral ossifying fibroma,
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
Dr Patrick Treacy shares some of his most challenging cases. This month he talks
about treating post endoscopic thoracic sympathectomy “gustatory sweating” with
botulinum toxin A
When it comes to create and deliver the best features for target users, usability discussions can go on endlessly.
But there are other features to implement in the release, and at some point, this new release must be shipped.
So how to make sure you have achieved the minimum usability to avoid rejection.. and even foster adoption?
What does it take to make your assessment and reduce the risk of any further negotiation?
This is what this talk intends to provide - an explanation of a method and a team-spirit to adopt.
Malignant melanoma is one of the most aggressive neoplasms of the skin. It originates from the melanocytes, which are cells derived embryologically from the neural crest and migrate to the epidermal basal layer. It is characterized by producing pigmentation as well as being susceptible to metastasis. We report the case of a 36-year-old female patient with advanced clinical stage and distant commitment. The biopsy confirmed the presence of Grade III invasive nodular cutaneous melanoma in the left subscapular region with lymph node metastasis with reactive hyperplasia. An exploratory research is carried out with the bibliographic review in scientific journals with evidence level II–IV. In portals PubMed, Redalyc, BVS, and UpToDate. 81241 met criteria 2248 of which 629 were chosen for having access to the full text and of these 496 are more current (as of 2008), and in the end, 27 articles were selected that met all the inclusion criteria to this article. Due to the increase in the incidence of this disease in recent years and its poor prognosis in short to medium term, it is important to know and follow-up on patients with known risk factors for this disease such as the presence of previous nevi, with emphasis on measures of prevention.
Melanoma of the Palate: A Case Report and Literature Reviewasclepiuspdfs
Mucous melanoma accounts for 1% of melanomas. The palate and the labial mucosa are the most affected. It is a dark prognostic tumor, the treatment associated with surgery and radiotherapy in the localized stages. We report the case of a palate melanoma in a 47-year-old patient without distant metastases.
Please find the power point (ppt.) on everything that you need to know about Malignant melanoma in very simple language by Sunil kumar Daha from very reliable references. Especially focused on surgical interventions. Thank you
CARCINOMA OF THE ORAL CAVITY. Diagnosis and management.tDr. RIFFAT KHATTAK
The Oral Cavity, with it's seven subsites,is a host of multiple epithelial, mesenchymal & glandular structures. Thus, if exposed to multiple risk factors, either in isolation or in combination, could undergo drastic histological changes leading to malgnancies. A thorough clinical examination, diagnosis and timely intervention followed by rehabilitation of the patient, via a multi disciplinary approach is the mainstay of treatment.
Hello! Today we prepared for you a biology capstone project example. If you need more go to https://www.capstonewritingservice.com/biology-capstone-project-ideas/
Chapter 2 of the ICD-10-CM contains the codes for most benign and all malignant neoplasms. Certain benign neoplasms, such as prostatic adenomas, may be found in the specific body system chapters.
Similar to Dr Patrick Treacy treating Cutaneous Malignant Melanoma (20)
Dr Treacy is considered one of the most influential aesthetic
practitioners in the world, having forever altered the field of
aesthetic medicine. With anecdotes taken from his extraordinary memoir – and reveals why he finally decided to lift the mask.
A 53-year-old Irish female presented with an intractable trigeminal neuralgia pain in the region of her left maxillary nerve (V2) who did not respond to pharmacotherapy including pregabalin 300mgs bd and gabapentin 300mgs bd. She had been admitted to hospital for one month for intravenous oxycodone hydrochloride. She had also more than fifty nerve blocks in the previous years and had undergone stereotactic gamma knife radiosurgery which had work for five months but later resulted in uncontrollable dysesthesia pain in the region of her left maxillary nerve. She defined this as a continual unpleasant sensation of something 'crawling' under her skin in her left periorbital. There was a sensation of intense pain in her left external nasal area and that of electric shock, burning, and pins and needles and left mental area.
One of aesthetic medicines most notable characters,
Dr Patrick Treacy shares some of his favourite anecdotes
from his extraordinary memoir and reveals why he finally
decided to lift the mask.
Although having a facial disfigurement secondary to trauma, a birthmark, a birth defect or some abnormality does not affect a patient’s health; society deems it often leads to stigmatisation and limitations of opportunities afforded to others.
Dr Patrick Treacy shares some of his most challenging cases. This month he talks about treating cutaneous warts. Warts appear in various forms on different sites of the body and include common warts (verruca vulgaris), plane or flat warts, myrmecia, plantar warts, coalesced mosaic warts, filiform warts, periungual warts, anogenital warts (venereal or condyloma acuminata), oral warts and respiratory papillomas.
Dr Patrick Treacy on devices for dealing with post-pregnancy baby weightDr. Patrick J. Treacy
Pregnancy leads to many changes in a woman’s
body, mainly through the interaction of steroid
hormones, lactogen and cortisol on the underlying
tissues and structures. The growing foetus itself
causes mechanical change also by stretching
skin, muscle and fascia and demanding an increased
calorific supply. The amount of extra weight gained
during pregnancy varies among women.
Dr Patrick Treacy on combining therapies for optimal outcomes in treating the...Dr. Patrick J. Treacy
This paper looks at the possibility of combining five
established therapies in an attempt to address
common concerns related to facial ageing. The
therapies included microneedling, low dose
Ultralase laser, (PRP) plasma rich protein growth
factors, Omnilux 633 light and neurotoxins. The technique is
called the DUBLiN face-lift as an acronym of the procedures
involved. D Dermaroller U Ultralase Laser B Blood growth
factors Li Light (near red 633) N Neurotoxin.
The author compared this method to fractionalised laser
skin resurfacing (FLSR) in terms of reduction of photoageing
and overall aesthetic effect. Neurotoxin was used in
both studies.
Dr Patrick Treacy shares some of his most challenging cases. This month he talks about treating facial popular sebaceous hyperplasia. Sebaceous hyperplasia is a disorder of the sebaceous glands in which they become enlarged, producing yellow, shiny bumps on the face
Dr Patrick Treacy discusses dermal filler complications and how to deal with ...Dr. Patrick J. Treacy
At present, there’s a paucity of literature regarding both the prevention and management of serious events, despite the fact that these complications are the very things that patients and physicians both continually fear. Many physicians, (including myself), feel that corporate prefer not to address these issues and they are driven underground. Over the years, many of my colleagues have referred me their more serious problems and I consequently have developed a certain experience in this area. This insight into complications of dermal filler use will serve to highlight both of these problems and try to help one manage these complications if they should ever happen to you.
This month sees the publication of Dr Patrick Treacy’s memoirs. Vicky Eldridge reveals what readers can expect from this fascinating insight into the life of one of the industry’s best-known doctors
‘Behind The Mask’ – The Extraordinary Story of The Irishman who Became Michae...Dr. Patrick J. Treacy
Dr. Patrick Treacy is a well-known face within the Aesthetic industry, both in the UK and Ireland, as well as the World. A loveable, Irish rogue with a charming, boyish smile and a cheeky demeanour, Patrick, (what better
name for an Irishman is there) is also a very accomplished and knowledgeable medical professional and humanitarian.
Dr Patrick Treacy on Diagnosis and Treatment of Malignant Melanoma Dr. Patrick J. Treacy
A 23-year-old Siberian female patient presented with a changing lesion on her abdomen. The patient stated the lesion was present for about two years and it started
off from within a freckle, which started to grow larger and somewhat darken in appearance. It had the clinical appearance of a melanoma and the dermoscopy three-point checklist (designed to allow non-experts not to miss detection of melanomas) was used to determine whether this had a high likelihood of malignancy. It included:
Asymmetry: asymmetry of colour and structure in one or
two perpendicular axes
Atypical network: pigment network with irregular holes
and thick lines
Blue-white structures: there was some evidence of blue-
white veil and regression structures
Dr Patrick Treacy looks back at the history of one
of the most impactful products in the field of aesthetic
medicine, botulinum toxin. He writes ...without knowing it, Justinus Kerner laid the opening shots in the greatest contribution of biology to the world of cosmetic medicine – he was actually describing the neurological action of botulinum toxin, later to be known to a different world in another century as Botox®
Squamous cell carcinoma is the second-most common
cancer of the skin (after basal cell carcinoma but more
common than melanoma). It usually occurs in areas exposed to the sun. Sunlight exposure and immunosuppression are risk factors for SCC of the skin, with chronic sun exposure being the strongest environmental risk factor
Dr. Patrick Treacy looks at the history of lasers in Aesthetic Medicine Dr. Patrick J. Treacy
Following the death of the inventor of the laser, Charles Townes, Dr Patrick Treacy looks back at the history of this groundbreaking technology and examines how its use in aesthetics has evolved. Dr Patrick Treacy is CEO Ailesbury Clinics, chairman of the Irish Association of Cosmetic Doctors and Irish regional representative of the British College of Aesthetic Medicine (BCAM). He is also president of the World Trichology Association. Dr Treacy has won a number of awards for his contributions to facial aesthetics and hair transplants including the AMEC Award in Paris in 2014. Dr Treacy also sits on the
editorial boards of three international journals and features regularly on international television and radio programmes. He is scientific committee for AMWC Monaco 2015, AMWC Eastern Europe 2015, AMWC Latin America 2015, RSM ICG7 (London) and Faculty IMCAS Paris 2015 and IMCAS China 2015.
Following the death of the inventor of the laser, Charles Townes, Dr Patrick ...Dr. Patrick J. Treacy
Following the death of the inventor of the laser,
Charles Townes, Dr Patrick Treacy looks back at
the history of this groundbreaking technology and
examines how its use in aesthetics have evolved
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
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Pharynx and Clinical Correlations BY Dr.Rabia Inam Gandapore.pptx
Dr Patrick Treacy treating Cutaneous Malignant Melanoma
1. S K I N / D E R M AT O L O G Y
45Aesthetic Medicine • July/August 2015
SPONSORED BY CASE FILESwww.aestheticmed.co.uk
Dr Patrick Treacy shares some of his most challenging cases.
This month he talks about treating s Cutaneous Malignant Melanoma
Dr Treacy’s
CASEBOOK
A
23-year-old Siberian female patient
presented with a changing lesion on her
abdomen. The patient stated the lesion was
present for about two years and it started
off from within a freckle, which started
to grow larger and somewhat darken in appearance.
It had the clinical appearance of a melanoma and the
dermoscopy three-point checklist (designed to allow
non-experts not to miss detection of melanomas) was
used to determine whether this had a high likelihood of
malignancy. It included:
Asymmetry: asymmetry of colour and structure in one or
two perpendicular axes
Atypical network: pigment network with irregular holes
and thick lines
Blue-white structures: there was some evidence of blue-
white veil and regression structures
It was decided the likely diagnosis was a superficial
spreading melanoma and to remove the lesion with a
1cm clearance and work in association with a multi-
disciplinary team. However, it is recommended that
a patient who presents with signs and symptoms
suggestive of melanoma should be referred to a
consultant dermatologist or consultant plastic surgeon
and lesions suspicious of melanoma should not be
removed in primary care.
HISTOPATHOLOGY CONFIRMED THE DIAGNOSIS
Macroscopy: Skin, left inframammary: Skin ellipse, 15 x
9 x 3mm with irregular pigmented lesion, 5 x 7mm, 1cm
from nearest margin.
Microscopy: Skin, left infra-mammary, skin ellipse:
Malignant melanoma, superficial spreading subtype
- Clark level III. Breslow thickness: 1mm. No ulceration
identified No regression identified. Lymphovascular
invasion is not identified. Perineural invasion is not
identified. Mitotic rate is two per 10. Microsatellite
lesions are not identified. Melanoma arises in the
naevus. Margins: - Closest margin (radial): 1cm. Deep
margin: 4mm Prof K Sheahan
2. 46 Aesthetic Medicine • July/August 2015
SPONSORED BYCASE FILES www.aestheticmed.co.uk
S K I N / D E R M AT O L O G Y
Please advise on captions
HISTOPATHOLOGY EXPLAINED
The pathologist’s report above includes
a macroscopic description (the naked
eye view), of the specimen and a
microscopic description. The
following features suggest an
invasive melanoma.
Diagnosis of primary
melanoma
Breslow thickness to the
nearest 0.1 mm
Clark level of invasion
Margins of excision i.e. the
normal tissue around the
tumour
Mitotic rate – a measure of how
fast the cells are proliferating
Whether or not there is ulceration
The report includes comments about
cell type and its growth pattern,
invasionofbloodvesselsornerves,inflammatoryresponse,
regression and whether there is associated in-situ disease
Breslow thickness is reported for invasive melanomas.
It is measured vertically in millimetres from the top of
the granular layer (or base of superficial ulceration) to
the deepest point of tumour involvement. It is a strong
predictor of outcome; the thicker the melanoma, the more
likely it is to metastasize.
CLARK LEVEL
Clark level indicates the anatomic plane of invasion. The
deeper the Clark level, the greater the risk of metastasis.
It is useful in predicting outcome in thin tumours, and less
useful for thicker ones
TYPES OF MELANOMA
Melanomas are described according to their appearance
and behaviour. Those that start off as flat patches (i.e. have
Level 1 In situ melanoma
Level 2 Melanoma has invaded papillary dermis
Level 3 Melanoma has filled papillary dermis
Level 4 Melanoma has invaded reticular dermis
Level 5 Melanoma has invaded subcutaneous tissue
a horizontal growth phase) include:
(1)Superficialspreadingmelanoma(SSM)-70%ofall
melanomas
(2)Lentigomalignamelanoma(sundamaged
skinofface,scalpandneck)
(3) Acral lentiginous melanoma (on
soles of feet, palms of hands or under
the nails) (*subungual melanoma)
These superficial forms of
melanoma tend to grow slowly,
but at any time, they may begin to
thicken up or develop a nodule (i.e.
progress to a vertical growth phase).
Melanomas that quickly invade
deeper tissues include:
(1) Nodular melanoma (presenting as
a rapidly enlarging lump) 15–30% of all
melanomas
(2) Spitzoidmelanoma(anodulethatresemblesaSpitznaevus)
(3) Mucosalmelanoma(arisingonlips,eyelids,vulva,penis,anus)
(4) Neurotropic and desmoplastic melanoma (fibrous
tumour with a tendency to nerves)
Histologic factors that affect metastatic potential
include ulceration of the tumour, mitotic rate, presence
of lymphovascular invasion, microsatellites, regression,
perineural invasion, and the presence of lymphocytes
infiltrating the tumour.
WHO IS AT RISK OF MELANOMA?
The main risk factors for developing superficial spreading
melanoma include:
Affluence, Increasing age, female
Fair skin that burns easily. Red or light coloured hair,
Light coloured eyes and light coloured skin (Anglo-Celtic)
(Gandini S et al 2005).
Multiple (5) atypical nevi (moles that are histologically
dysplastic) (Garbe C et al 1994).
Many benign melanocytic naevi person (Ferrone CR et al
2005).
Giant congenital melanotic naevi ≥20cm in diameter
Previousinvasivemelanomaormelanomainsitu(Goggins
WB et al 2003).
Family history of melanoma. Two first-degree relatives
affected (Florrell Sr et al 2005).
UVB (280- 320nm) solar radiation (causing sunburn) is the
The primary mode
of treatment for localised
cutaneous melanoma is surgery.
Surgical margins of 5mm are
currently recommended for
melanoma in situ, and margins
of 1cm are recommended for
melanomas ≤1 mm in depth
3. S K I N / D E R M AT O L O G Y
47Aesthetic Medicine • July/August 2015
SPONSORED BY CASE FILESwww.aestheticmed.co.uk
Please advise on captions
principle cause of melanoma.
UVA may be involved in the pathogenesis of melanoma
(Wang SQ et al 2001).
CHECKING FOR A MELANOMA
Glasgow 7-point checklist
The ABCDs of Melanoma
STAGING OF MELANOMA
Melanoma staging means finding out if the melanoma has
spread from its original site in the skin. The stages are:
TREATMENT OF MELANOMA
The primary mode of treatment for localized cutaneous
melanoma is surgery. Surgical margins of 5mm are
currently recommended for melanoma in situ, and
margins of 1cm are recommended for melanomas ≤1 mm
in depth1. For tumors of intermediate thickness (1–4
mm Breslow depth), randomized prospective studies
show that 2cm margins are appropriate, although 1cm
margins have been proven effective for tumors of 1-2mm
thickness.2,3 Margins of 2cm are recommended for
cutaneous melanomas greater than 4mm in thickness
(high-riskprimaries)topreventpotentiallocalrecurrence
in or around the scar site.
Numerous adjuvant therapies have been investigated
for the treatment of localized cutaneous melanoma
following complete surgical removal. Adjuvant interferon
(IFN) alfa-2b is the only adjuvant therapy approved
by the US Food and Drug Administration for high-risk
melanoma.4 While early-stage melanomas can often be
cured with surgery, more advanced melanomas can be
much harder to treat. But in recent years, newer types
of immunotherapy and targeted therapies have shown a
great deal of promise and have changed the treatment of
this disease.
Major features Minor features
• Change in size • Diameter 7mm
• Irregular shape • Inflammation
• Irregular colour • Oozing
• Change in sensation
A Asymmetry
B Border irregularity
C Colour variation
D Diameter over 6 mm
E Evolving (enlarging, changing)
Stage Characteristics
Level 1 In situ melanoma
Level 2 Melanoma has invaded papillary dermis
Level 3 Melanoma has filled papillary dermis
Level 4 Melanoma has invaded reticular dermis
Level 5 Melanoma has invaded subcutaneous tissue
4. 48
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Aesthetic Medicine • July/August 2015
S K I N / D E R M AT O L O G Y
REFERENCES
(1) NIH Consensus conference. Diagnosis and treatment of early melanoma.
JAMA. 268(10):1314–9. 9.
(2) Balch CM, Urist MM, Karakousis CP, Smith TJ, Temple WJ, Drzewiecki K, et al.
Efficacy of 2-cm surgical margins for intermediate-thickness melanomas (1
to 4 mm). Results of a multi-institutional randomized surgical trial. Ann Surg.
1993;218(3):262–7.
(3) Veronesi U, Cascinelli N, Adamus J, Balch C, Bandiera D, Barchuk A, et al. Thin
stage I primary cutaneous malignant melanoma. Comparison of excision with
margins of 1 or 3 cm. N Engl J Med.1988;318(18):1159–62.
(4) Veronesi U, Adamus J, Aubert C, Bajetta E, Beretta G, Bonadonna G, et al. A
randomized trial of adjuvant chemotherapy and immunotherapy in cutaneous
melanoma. N Engl J Med. 1982;307(15):913–6.
(5) Rager EL, Bridgeford EP, Ollila DW. Cutaneous melanoma: update on
prevention, screening, diagnosis, and treatment. Am Fam Physician.
2005;72(2):269–76.
(6) Whiteman DC, Whiteman CA, Green AC. Childhood sun exposure as a risk
factor for melanoma: a systematic review of epidemiologic studies. Cancer
Causes Control. 2001;12(1):69–82.
(7) Anderson WF, Pfeiffer RM, Tucker MA, Rosenberg PS. Divergent cancer
pathways for early-onset and late-onset cutaneous malignant melanoma.
Cancer. 2009 Sep 15;115(18):4176-85. doi: 10.1002/cncr.24481. PubMed PMID:
19536874; PubMed Central PMCID: PMC2741537.
(8) Cohn-Cedarmark G, Rutqvist LE, Anderson R et al. Long-term results of a
randomised study by the Swedish Melanoma Study Group on 2-cm versus
5-cm resection margins for patients with cutaneous melanoma with a tumour
thickness of 0.8-2.0mm.Cancer 2000; 89: 1495-1501.
(9) Revised U.K. guidelines for the management of cutaneous melanoma 2010. JR
Marsden, JA Newton-Bishop, L Burrows, M Cook, PG Corrie, NH Cox, ME Gore,
P Lorigan, R MacKie, P Nathan, H Peach, B Powell, C Walker, BJD, Vol. 163, No. 2,
August 2010 (p238-256)
(10) Wang SQ, Setlow R, Berwick M, Polsky D,Marghoob AA, Kopf AW, Bart RS.
Ultraviolet A and melanoma: a review. J Am Acad Dermatol 2001; 44: 837-846.
(11) The prevention, diagnosis, referral and management of melanoma of the skin:
concise guidelines (Newton Bishop J, Bataille V, Gavin A, Lens M, Marsden
J, Mathews T, Ormerod A, Wheelhouse C). Royal College of Physicians and
British Association of Dermatologists. Concise guidance to good practice
series, No 7. London : RCP, September 2007
(12) Cutaneous melanoma: update on prevention, screening, diagnosis, and
treatment. Rager EL, Bridgeford EP, Ollila DW Am Fam Physician. 2005 Jul 15;
72(2):269-76.
(13) Abrahamsen HN, Hamilton-Dutoit SJ, Larsen J, Steiniche T. Sentinel lymph
nodes in malignant melanoma: extended histopathological evaluation
improves diagnostic precision. Cancer 2004; 100: 1683-1691.
(14) Balch CM, Buzaid AC, Soong SJ et al. Final version of the American Joint
Committee on Cancer staging system for cutaneous melanoma. J Clin Oncol
2001; 19: 3635-3648.
(15) Annual report to the nation on the status of cancer, 1973-1999, featuring
implications of age and aging on U.S. cancer burden. Edwards BK, Howe HL,
Ries LA, Thun MJ, Rosenberg HM, Yancik R, Wingo PA, Jemal A, Feigal EG
Cancer. 2002 May 15; 94(10):2766-92.
(16) Gandini S, Sera F, Cattaruzza MS, Pasquini P, Picconi O, Boyle P, Melchi CF.
Meta-analysis of risk factors for cutaneous melanoma: I. Common and atypical
naevi. Eur J Cancer 2005; 41: 28-44.
(17) Wang SQ, Setlow R, Berwick M, Polsky D,Marghoob AA, Kopf AW, Bart RS.
Ultraviolet A and melanoma: a review. J Am Acad Dermatol 2001; 44: 837-846.
DrPatrickTreacy is CEO Ailesbury Clinics, chairman of the Irish Association of Cosmetic Doctors and Irish
regional representative of the British College of Aesthetic Medicine (BCAM). He is also president of
the World Trichology Association. Dr Treacy has won a number of awards for his contributions to facial
aesthetics and hair transplants including the AMEC Award in Paris in 2014. Dr Treacy also sits on the
editorial boards of three international journals and features regularly on international television and
radio programmes. He is scientific committee for AMWC Monaco 2015, AMWC Eastern Europe 2015,
AMWC Latin America 2015, RSM ICG7 (London) and Faculty IMCAS Paris 2015 and IMCAS China 2015.
IMMUNOTHERAPY
Drugs that block CTLA-4: Ipilimumab targets CTLA-4,
a protein that normally suppresses the T-cell immune
response, which helps melanoma cells survive. Ipilimumab
has been shown to help people with advanced melanomas
live longer. Combining ipilimumab with GM-CSF is better
than using ipilimumab alone. The combination has fewer
serious side effects.
Drugs that block PD-1 or PD-L1: Melanoma cells also
use pathways in the body to avoid being detected, and a
protein called PD-L1 on their surface helps them evade the
immune system. Two drugs that block PD-1, pembrolizumab
(Keytruda) and nivolumab (Opdivo), are now approved to
treat advanced melanoma.
Melanoma vaccines: These are experimental therapies
that have not yet been proven to be helpful.
CONCLUSION
Skin cancer is the most common malignancy in the
United Kingdom and Ireland.5 Malignant melanoma
is the most deadly cutaneous neoplasm. Numerous
risk factors for development of melanoma have been
identified, including white skin, fair hair, light eyes, sun
sensitivity and a tendency to freckle. Other factors,
include family history of melanoma, dysplastic nevi,
increased numbers of typical nevi, large congenital
nevi and immunosuppression. Although sun exposure
is a risk factor for melanoma, cutaneous melanomas
can also arise in areas of the body not exposed to the
sun. Sun exposure in childhood and having more than
one blistering sunburn in childhood are associated
with an increased risk of melanoma.6 Most melanomas
arise as superficial tumors confined to the epidermis.
The prognosis for melanoma is closely related to the
thickness of the tumour. In order to effectively treat
melanomas, drugs that target proteins that normally
suppresses the T-cell immune response or block ones
that help them evade the immune system provide
the best chance for treating patients with advanced
melanoma. In early studies, combination drugs have
shrunk tumors in about one half of pateints with
melanoma. AM