This document discusses melanoma and its characteristics. It notes that pigmentation is a hallmark of melanoma. Features suggestive of melanoma include changes in existing pigmented lesions or presence of irregular, asymmetrical, or multiple colored lesions over 6mm in diameter. Risk factors include white race, older age, and intense sunlight exposure. Pathology shows anaplastic malignant melanocytic cells. Types include lesions arising from nevi or de novo. Diagnosis and treatment options are also summarized.

2.  Pigmentation is a hallmark of melanoma
 Features suggestive of melanoma include
recent onset of a pigmented lesion, change
in an existing pigmented lesion, irregular
margins, asymmetrical shape, colour change
or presence of multiple colours, and
diameter greater than 6 mm in diameter.

3.  Risk factors:
- White race
- Older age
- H/o repeated intense sunlight exposure
 Pathology :
Anaplastic ,malignant appearing melanocytic
cells involve substantia propria.

4.  pre-existing naevus (junctional or compound)
 Primary melanoma (de novo)
 PAM with atypia
 Amelanotic tumours are pink and have a
characteristic smooth ‘fish-flesh’ appearance
- Difficult to diagnose.

6.  Ocular manifestations:
Dark brown elevated lesion –perilimbal
region –interpalpebral.
S/L : Reddish,brown stippled/homogeneous
dark brown ,intralesional
microcysts,prominent blood vessels
- focal nodular epibulbar mass.

7.  Simple observation
 Incisional biopsy – Complete excision &
cryotherapy
 Contact radiation
 Topical chemotherapy
 Exenteration – frank orbital invasion/
massive unresectable

8.  Symptom:
Visible spot /discolouration on iris/no
symptom
Risk Factors:
- H/o intense sustained sunlight exposure
- Conditions like Ocular melanocytosis
, Dysplatic nevus syndrome.
-

9.  Ocular manifestations:
- Localized dark brown to tan
- well circumscribed, cohesive ,intrinsic
vascularity /shaggy ,dispersive.
- Pupillary peaking
- Ectropion iridis
- Iris splinting

10.  Pathology :
Atypical melanocytic cells- prominent nucleoli
- N/C ratio
- mitotic figures
Fusiform shape – spindle cells
Spherical shape – epitheloid cells
 Diagnosis:
- Transpupillary /transconjunctival
transscleral transillumination
- Anterior segment photography
- Ultrasound biomicroscopy
- Biopsy [incisional/ Fine needle aspiration.

12.  Observation
 Excision [iridectomy /iridocyclectomy]
 Plaque radiotherapy
 Enucleation.

13.  Symptoms :
- Blurred vision
- Visual field defect
- Flashes
- Floaters
- no symptom

14.  CHOROIDAL
 Dark brown to golden solid tumour
 Biconvex ,lenticular on cross section
 Mushroom configuration[break tru bruch
membrane]
 Non rhegmatogenous RD –Clear serous sub
retinal fluid/bloody.
 Prominent clumps of orange lipofuscin
pigment.

15.  CILIARY BODY
 Elevated ,nodular dark brown –peripheral
fundus.
Pathology :
Anaplastic melanocytic cells – high N/C ratio
prominent nucleoli
mitotic figures
Spindle cells, mixed cells, Epitheloid cells,
Vascular loops & networks.

16.  B –SCAN: Solid acoustically dark [sonolucent]
biconvex or mushroom configuration
Acoustic brightness on cap
 A scan: Low amplitude internal reflectivity
stepwise decremental reduction in
echo spike amplitude
high amplitude at cap

17.  Fluorescein Angiography :
Dome shaped-
early phase – filling of retinal,intratumoural vessels
Late phase – Non uniform hyperfluorescent staining
Mushroom shaped-
Early phase – filling of intratumoural vessels
Late phase – Generalized staining of apical nodule ,
sub retinal fluid.

18.  MRI :
Hyperintense relative to dark vitreous on T1
Hypointense relative to bright vitreous on T2

23.  Enucleation
 Radiation therapy
 Observation
 Photocoagulation
 Non coagulative laser therapy
 Microsurgical resection
 Exenteration
 Hyperthermia therapy
 PDT
 Cryotherapy
 Chemotherapy

24.  Lentigo maligna
 Melanoma

25.  (melanoma in situ, intraepidermal melanoma /Hutchinson freckle)
Uncommon condition that develops in sun-damaged skin in elderly
individuals. Malignant change may occur, with infiltration of the
dermis.
 Histology - intraepidermal proliferation of spindle-shaped atypical
melanocytes that replace the basal layer of the epidermis
 Signs
A slowly expanding pigmented macule with an irregular border
Nodular thickening and areas of irregular pigmentation are highly
suggestive of malignant transformation
Treatment is usually by excision.

27. Histology shows large atypical melanocytes within the dermis
Signs
 Superficial spreading melanoma is characterized by a
plaque with an irregular outline and variable pigmentation
 Nodular melanoma is typically a blue-black nodule
surrounded by normal skin
3 Treatment is usually by wide excision and may include
local lymph node removal.

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