2. MALIGNANT MELANOMA
❖ IS A CANCER OF MELANOCYTES, WHICH PRODUCE
MELANIN.
❖ OTHERWISE CALLED AS SKIN CANCER.
❖ MELANOMA HAS THE ABILITY TO METASTASIS TO
ANY ORGAN INCLUDING BRAIN & HEART.
3. INCIDENCE
► IT IS 10 TIMES MORE COMMON IN FAIR SKINNED
PEOPLE THAN DARK.
► INCIDENCE ALSO INCREASE DUE TO THE
DEPLETION OF OZONE LAYER & INCREASED
EXPOSURE TO UV RAYS.
► MORE COMMON IN PEOPLE WHO STAY OUTSIDE
OR WORK INDOOR & ALSO HAVE VACATIONS AT
AREAS OF INTENSE SUN EXPOSURE & HAVE
BLISTERING SUNBURN.
5. RISK FACTORS
► CHRONIC UV EXPOSURE WITHOUT SUN PROTECTION.
► OVER EXPOSURE TO ARTIFICIAL LIGHT SUCH AS TANNING BED.
► FAIR SKINNED PEOPLE , FRECKLING , BLOND HAIR OR BLUE EYES.
► GENETIC PREDISPOSITION
► A HIGH NO: OF MOLES OR LARGE MOLES (DYSPLASTIC NEVI)
► IMMUNOSUPPRESSIVE MEDICINES
► EXPOSURE TO ENVIRONMENTAL HAZARDS INCLUDING HERBICIDES
► PAST HISTORY OF MELANOMA
► OVER AGE 50
► XERODERMA PIGMENTOSUS
6. PATHOPHYSIOLOGY
▪ MELANOCYTES CELLS LOCATED AT OR NEAR BASAL LAYER
▪ MELANIN DARK COLOR PIGMENT
▪ MELANIN MADE IN GRANULES & TRANSFERRED TO
KERATINOCYTES
▪ MALIGNANT MELANOMA CAN DEVELOP WHERE THERE IS PIGMENT
BUT ABOUT 1/3 OF THEM ARE IN EXISTING NEVI
7. PATHOPHYSIOLOGY
TUMOR DEVELOP & USUALLY 6MM IN DIAMETER & SYMMETRIC
LESIONS ARE FLAT & BENIGN
WHEN THEY PENETRATE THE DERMIS & MIX WITH BLOOD &
LYMPH VESSELS
LESIONS GOT CAPACITY TO METASTASIZE.
TUMOR DEVELOPED A RAISED OR NODULAR APPEARANCE & OFTEN HAVE
SMALLER NODULES SATELLITE LESIONS AROUND PERIPHERY
8. CLINICAL MANIFESTATION
CARDINAL MANIFESTATION
❑ IF LESION GROW SO FAST & DOUBLES ITS SIZE THAN
ITS INFLAMMATION NOT MELANOCYST.
❑ IF GOES VERY SLOWLY THAT NO ONE CAN CURE OF
CHANGE THEN ITS BENIGN.
❑ IF SIZE DOUBLES IN 3-8 MONTHS & HAVE CHANGE IN
DIAMETER , BLEEDING,ITCHING, A CHANGE IN COLOR
OR PALPABLE LYMPH NODE OCCUR .
MELANOMA USUSALLY HAVE
❑ VARIOUS SHADES OF
BROWN, BLACK OR BLUE
WITHIN ONE LESION
❑ IRREGULAR RAISED
SURFACE
❑ AN IRREGULAR PERIMETER
❑ ULCERATION OF SURFACE
❑ CRUSTING
10. SUPERFICIAL SPREADING MELANOMA
❑ IT IS THE MOST COMMON IN 70% OF SKIN CANCER.
❑ LESIONS ARE FLAT & SCALY OR CRUSTY,
ASYMMETRICAL & 2cm in diameter.
❑ MAINLY FOUND ON TRUNK, BACK OF MEN & LEG OF
WOMEN AT 50 YRS OF AGE.
❑ COLOR OF LESION RANGES FROM JET BLACK TO
DARK BLUE TO WHITE .
❑ LOOKS LACY & MAY HAVE AREAS OF NO COLOR.
12. 2) LENTIGO MALIGNANT MELANOMA
❑ ARISE FROM PRECURSOR LESION LENTIGO
MALIGNA.
❑ HIGH IRREGULAR BORDER, HETEROGENEOUS
COLORATION & BECAUSE OF ITS LONG RADIAL
GROWTH PHASE – A LARGE DIAMETER.
❑ METSTASIS IS COMMON.
❑ APPEARS ON FACE OF WHITE WOMEN
14. 3) NODULAR MELANOMA
❑ LESIONS ARE RAISED, DOME SHAPED , BLUE , BLACK OR
RED NODULES ON HEAD, NECK, TRUNK THEY MAY OR
MAY NOT EXPOSED TO SKIN.
❑ LESIONS OF DIAMETER 1-2cm.
❑ LESION MAY LOOK LIKE BLISTERS, ULCERATE & BLEED.
❑ IT GROWS EXCESSIVELY & DIFFICULT TO DIAGNOSE
BEFORE IT METASTASIZE.
16. 4) ACRAL LENTIGINOUS
MELANOMA
❑ ALSO CALLED AS MUCOCUTANEOUS
MELANOMA.
❑ LESS COMMON IN FAIR SKINNED PEOPLE.
❑ LESIONS COMMONLY OCCUR IN PALMS, NAIL
BUDS, & SOLES OF FEET, & LESION PROGRESS
FROM TAN, BROWN ON BLACK FLAT NODULES &
HAVE DIAMETER 3mm.
20. ► Clark’s micro staging describe the assessment of the level of invasion of
a malignant melanoma & maximum tumor thickness.
21.
22. MANAGEMENT
1. IMMUNOTHERAPY
❑ INTERFERONS, INTERLEUKINS, MONOCLONAL ANTIBODIES , BCG,
LEVAMISOLE,TRANSFER FACTORS & TUMOR VACCINES ARE USED TO
TREAT MELANOMA.
2. RADIATION THERAPY
❑ EFFECT OF RADIATION THERAPY DEPEND UPON SITE , LOCATION,
THICKNESS & TYPE OF MELANOMA.
❑ HIGH DOSE OF A RADIATION THERAPY IS GIVEN IF TUMOR IS SMALL.
❑ RADIATION THERAPY IS USED FOR METASTSTIC TUMOR OF BRAIN,
BONE, LYMPH NODES, GI TRACT, SKIN & SUBCUTANEOUS TISSUE.
23. MANAGEMENT
❑ NEW METHODS OF TREATMENT
GENETHERAPY , IMMUNE THERAPY
❑ SURGICAL MANAGEMENT
A) EXCISIONAL BIOPSY TAKEN FROM LESION & LESION IS EXCISED – THICK
LESION REQUIRES 1-3cm MARGIN EXCISION. & 0.5-1cm MARGIN ALSO EXCISED
WITH LESION.
❑ REGIONAL LYMPH NODES ARE COMMON SITE FOR METASTASIS .
B ) ELECTIVE LYMPH NODE DISSECTION (ELND) IN THE TREATMENT OF
LOCALIZED MELANOMA.
