This document discusses melanoma, the most fatal form of skin cancer. It covers the incidence and risk factors of melanoma including genetics, sun exposure, and skin phenotype. The clinical features and subtypes of melanoma like superficial spreading, nodular, lentigo maligna, and acral lentiginous melanoma are described. Diagnosis involves methods like the ABCDE rule and biopsy for suspicious lesions. Staging uses the TNM system and prognostic factors include tumor thickness and mitotic rate. Management involves wide local excision of primary tumors and sentinel lymph node biopsy for involved nodes. Long term surveillance after treatment monitors for recurrence.
Melanoma
Cutaneous Melanoma
also known as malignant melanoma, is a type of cancer that develops from the pigment-containing cells known as melanocytes.
Classification Of Melanoma
I : De novo melanoma
A. Melanoma in situ (MIS)
B. Lentigo maligna melanoma (LMM)
C. Superficial spreading melanoma (SSM)
D. Nodular melanoma (NM)
E. Acral-lentiginous melanoma (ALM)
F. Melanoma of the mucous membranes
G. Desmoplastic melanoma
II Melanoma arising from precursors
Melanoma arising in dysplastic nevomelanocytic nevi
B. Melanoma arising in congenital nevomelanocytic nevi
C. Melanoma arising in common NMN
Etiology And Pathogenesis
The etiology and pathogenesis of cutaneous melanoma are unknown.
Epidemiologic studies demonstrate a role for genetic predisposition and sun exposure in melanoma development.
The major genes involved in melanoma development reside on chromosome 9p21.
Etiology
UVR, mostly of the UVB spectrum (290–320 nm) that induces mutations in suppressor genes. The propensity for multiple BCC may be inherited. Associated with mutations in the PTCH gene in many cases.
Predisposing Factors
Genetic markers (CDKN2a mutation)
Skin type I/II
Family history of dysplastic nevi or melanoma
Personal history of melanoma
Ultraviolet irradiation, particularly sunburns during childhood and intermittent burning exposures
Number (>50) and size (>5 mm) of melanocytic nevi
Congenital nevi
Number of dysplastic nevi (>5)
Dysplastic melanocytic nevus syndrome
Immune suppression (debatable)
Number (>50) and size (>5 mm) of melanocytic nevi
Congenital nevi
Number of dysplastic nevi (>5)
Dysplastic melanocytic nevus syndrome
Immune suppression (debatable)
Six Signs of Malignant Melanoma (ABCDE Rule):
A- Asymmetry in shape—one-half unlike the other half.
B- Border is irregular—edges irregularly scalloped, notched, sharply defined.
C- Color is not uniform; mottled—haphazard display of colors; all shades of brown, black, gray, red, and white.
D- Diameter is usually large.
E- Elevation is almost always present and is irregular—surface distortion is assessed by side-lighting. others use E for Enlargement— a history of an increase in the size of lesion is one of the most important signs of malignant melanoma.
Lentigo Maligna Melanoma (LMM)
Melanoma
Cutaneous Melanoma
also known as malignant melanoma, is a type of cancer that develops from the pigment-containing cells known as melanocytes.
Classification Of Melanoma
I : De novo melanoma
A. Melanoma in situ (MIS)
B. Lentigo maligna melanoma (LMM)
C. Superficial spreading melanoma (SSM)
D. Nodular melanoma (NM)
E. Acral-lentiginous melanoma (ALM)
F. Melanoma of the mucous membranes
G. Desmoplastic melanoma
II Melanoma arising from precursors
Melanoma arising in dysplastic nevomelanocytic nevi
B. Melanoma arising in congenital nevomelanocytic nevi
C. Melanoma arising in common NMN
Etiology And Pathogenesis
The etiology and pathogenesis of cutaneous melanoma are unknown.
Epidemiologic studies demonstrate a role for genetic predisposition and sun exposure in melanoma development.
The major genes involved in melanoma development reside on chromosome 9p21.
Etiology
UVR, mostly of the UVB spectrum (290–320 nm) that induces mutations in suppressor genes. The propensity for multiple BCC may be inherited. Associated with mutations in the PTCH gene in many cases.
Predisposing Factors
Genetic markers (CDKN2a mutation)
Skin type I/II
Family history of dysplastic nevi or melanoma
Personal history of melanoma
Ultraviolet irradiation, particularly sunburns during childhood and intermittent burning exposures
Number (>50) and size (>5 mm) of melanocytic nevi
Congenital nevi
Number of dysplastic nevi (>5)
Dysplastic melanocytic nevus syndrome
Immune suppression (debatable)
Number (>50) and size (>5 mm) of melanocytic nevi
Congenital nevi
Number of dysplastic nevi (>5)
Dysplastic melanocytic nevus syndrome
Immune suppression (debatable)
Six Signs of Malignant Melanoma (ABCDE Rule):
A- Asymmetry in shape—one-half unlike the other half.
B- Border is irregular—edges irregularly scalloped, notched, sharply defined.
C- Color is not uniform; mottled—haphazard display of colors; all shades of brown, black, gray, red, and white.
D- Diameter is usually large.
E- Elevation is almost always present and is irregular—surface distortion is assessed by side-lighting. others use E for Enlargement— a history of an increase in the size of lesion is one of the most important signs of malignant melanoma.
Lentigo Maligna Melanoma (LMM)
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
Melanoma, the most serious type of skin cancer.
This presentation presents the skin cancer, basal cell carcinoma, Squamous cell carcinoma, and its symptoms, treatment, case
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
Melanoma, the most serious type of skin cancer.
This presentation presents the skin cancer, basal cell carcinoma, Squamous cell carcinoma, and its symptoms, treatment, case
In 2011, the treatment armamentarium dramatically expanded with the approval of the anti-CTLA4 antibody ipilimumab and the BRAF inhibitor vemurafenib. Oncology nurses who care for patients with melanoma are beginning to administer these new agents and have numerous questions regarding their efficacy, different response patterns, unique toxicity profiles, how they may be integrated into current treatment regimens, and how to educate patients on their benefits and risks.
Downloadable slide decks are a great tool for self study and teaching purposes. They are non-certified resources available to enhance your knowledge.
Review a downloadable slide deck by Peg Esper, MSN, MSA, RN, APN-BC, AOCN®, covering the most clinically relevant new data reported from Metastatic Melanoma: An Oncology Nurse Workshop on Novel Treatments, Adverse Event Management, and Patient Education.
Target Audience
This activity has been designed to meet the educational needs of oncology nurses involved in the treatment of patients with advanced melanoma.
Slide Deck Disclaimer
This slide deck in its original and unaltered format is for educational purposes and is current as of May 2012. All materials contained herein reflect the views of the faculty, and not those of IMER, the CE provider, or the commercial supporter. These materials may discuss therapeutic products that have not been approved by the US Food and Drug Administration and off-label uses of approved products. Readers should not rely on this information as a substitute for professional medical advice, diagnosis, or treatment. The use of any information provided is solely at your own risk, and readers should verify the prescribing information and all data before treating patients or employing any therapeutic products described in this educational activity.
For more information:
http://imeronline.com/gxpsites/hgxpp001.aspx?11,52,304,O,E,0,,744;561;8362
Dr Ian Katz, Dermatopathologist, from Southern Sun Skin Cancer Clinic and Southern Sun Pathology, discusses the pro and cons of using shave biopsies in clinical skin cancer practice.
A presentation created by Dr. Henry N. Ho, Medical Director, Head and Neck Program, Florida Hospital Cancer Institute, discussing everything you need to know about head and neck melanoma.
Presentación basada en el libro Lecciones de Dermatología del Maestro Dr. Amado Saúl Cano, para cátedra de Dermatología de la Facultad de Medicina de UAEMex
A malignant tumor of melanocytes, most commonly arising from cutaneous melanocytes; can also develop from melanocytes residing elsewhere. Epidemiology of melanoma, Epidemiology of melanoma, Clinical picture of melanoma, Diagnosis of melanoma, Histopathology of melanoma, Staging of melanoma, Prognosis of melanoma, Treatment of melanoma, Follow-Up of melanoma.
Melanoma – Prevention, Detection and TreatmentSummit Health
Sun safety needs to start at an early age in order to reduce the risk for skin cancer. In this lecture, you will learn about prevention, diagnosis, sun safety tips and new treatments for skin cancer to help you and your family reduce your risk.
Melanoma Prevention, Detection, and Treatment - 5.17.18 - Dr. Eric Huang and ...Summit Health
Sun safety needs to start at an early age in order to reduce the risk for skin cancer. Learn from Summit Medical Group MD Anderson Cancer Center specialists about prevention and ways to reduce your risk, diagnosis and innovations in skin cancer treatments.
Dr. Ana Ciurea presents the basics of melanoma preventio, screening and diagnosis at the MRF's Patient Symposium at MD Anderson Cancer Center on January 31, 2015.
#Skin malignancy is the most common malignancy in fair-skinned populations.
#Skin malignancies are either non-melanoma or melanoma.
#A persistent skin lesion that does not heal is highly suspicious for malignancy and should be examined by a health care provider.
# Early detection and treatment can often lead to a highly favourable prognosis.
classification of soft tissue injuries. gustilo anderson classification, tscheren classification, hanover fracture scale and ao soft tissue grading system, types of wounds. orthopedic open fracture classification for management of soft tissue injuries
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Integrating Ayurveda into Parkinson’s Management: A Holistic ApproachAyurveda ForAll
Explore the benefits of combining Ayurveda with conventional Parkinson's treatments. Learn how a holistic approach can manage symptoms, enhance well-being, and balance body energies. Discover the steps to safely integrate Ayurvedic practices into your Parkinson’s care plan, including expert guidance on diet, herbal remedies, and lifestyle modifications.
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micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
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.
Local Advanced Lung Cancer: Artificial Intelligence, Synergetics, Complex Sys...Oleg Kshivets
Overall life span (LS) was 1671.7±1721.6 days and cumulative 5YS reached 62.4%, 10 years – 50.4%, 20 years – 44.6%. 94 LCP lived more than 5 years without cancer (LS=2958.6±1723.6 days), 22 – more than 10 years (LS=5571±1841.8 days). 67 LCP died because of LC (LS=471.9±344 days). AT significantly improved 5YS (68% vs. 53.7%) (P=0.028 by log-rank test). Cox modeling displayed that 5YS of LCP significantly depended on: N0-N12, T3-4, blood cell circuit, cell ratio factors (ratio between cancer cells-CC and blood cells subpopulations), LC cell dynamics, recalcification time, heparin tolerance, prothrombin index, protein, AT, procedure type (P=0.000-0.031). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and N0-12 (rank=1), thrombocytes/CC (rank=2), segmented neutrophils/CC (3), eosinophils/CC (4), erythrocytes/CC (5), healthy cells/CC (6), lymphocytes/CC (7), stick neutrophils/CC (8), leucocytes/CC (9), monocytes/CC (10). Correct prediction of 5YS was 100% by neural networks computing (error=0.000; area under ROC curve=1.0).
Adv. biopharm. APPLICATION OF PHARMACOKINETICS : TARGETED DRUG DELIVERY SYSTEMSAkankshaAshtankar
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2. MELANOMA
• Incidence is increasing
• Lifetime probability of developing melanoma
• 1/37 men
• 1/56 women
• Five-year survival rates depend upon the stage of the
disease at the time of diagnosis
• Rare in children and adolescents
dr.basit@live.com
3. RISK FACTORS
• Genotype
• Personal history of skin cancer
• Family history
• Atypical nevi
• Common nevi
• Phenotype
• Sun exposure
click
dr.basit@live.com
4. SUN EXPOURE
• Higher rates with extensive or repeated intense exposure
to sunlight
• Greater penetration of UV light into the skin results in a
higher risk
• Incidence is highest in equatorial areas and decreases
proportionately with distance from the equator
dr.basit@live.com
5. • Decrease in recreational sun exposure following the
diagnosis of primary melanoma, can significantly diminish
the chance of a second primary melanoma
dr.basit@live.com
6. • UV-A versus UV-B irradiation
• UV-A 320-400 nm
• UV-B 290-320 nm
• PUVA therapy (Psoralen)
• Late increase in the risk of melanoma
dr.basit@live.com
7. TIMING AND PATTERN OF SUN EXPOSURE
• Nonmelanoma cancers are associated with cumulative
sun exposure
• Melanomas are associated with intense, intermittent sun
exposure and sunburns
dr.basit@live.com
8. • Tanning beds (since 1920)
• Deep tan – status symbol
• WHO (2009) UV-A from tanning beds as human carcinogen
dr.basit@live.com
9. CLINICAL FEATURES
• Superficial tumors that are confined to the epidermis
• Horizontal or "radial" growth phase
• “Vertical" growth phase
dr.basit@live.com
11. SUPERFICIAL SPREADING MELANOMA
• The most common subtype
• Over 60% are diagnosed as thin, highly curable tumors of
less than 1 mm thickness
• Can occur in any anatomic location
• Variably pigmented macule or plaque with an irregular
border, ranging from a few millimeters to several
centimeters in diameter
dr.basit@live.com
12. • Multiple shades of red, tan, brown, blue, black, gray, and
white can be appreciated
• Histologically
• Asymmetric, poorly circumscribed, lack cellular maturation
dr.basit@live.com
13. • In the radial phase of growth, there is haphazard growth
of neoplastic melanocytes with single-cell spread
throughout the layers of the epidermis
• Transition to vertical growth phase occurs when the
largest nest in the dermis exceeds that in the epidermis
dr.basit@live.com
15. NODULAR MELANOMA
• Vertical growth phase melanomas
• 15 to 30 percent of all melanomas
• Darkly pigmented, pedunculated or polypoid nodule
• Histologically
• Dermal growth occurs in isolation or, occasionally
• Neoplastic cells within the dermal growth may appear epithelioid or
spindled
• Mitoses are frequent and often atypical
dr.basit@live.com
17. LENTIGO MALIGNA MELANOMA
• Most commonly arises in sun-damaged areas of the skin in
older individuals
• Begins as a freckle-like tan-brown macule
• Transformation is slow
• Once it is fully evolved, color variegation can be striking
dr.basit@live.com
18. • Histologically
• During the radial growth phase, the atypical melanocytes are usually
polygonal in shape with hyperchromatic, angulated nuclei
• Multinucleated giant melanocytes ("star-burst giant cells") may be
present at the basal layer of the epidermis
• The hallmark of the vertical growth phase is the formation of dermal
nodules and fascicles that are larger than the epidermal component
• Pleomorphic with variably hyperchromatic nuclei
dr.basit@live.com
20. ACRAL LENTIGINOUS MELANOMA
• The least common variant of radial growth phase melanomas
• Fewer than 5 percent of all melanomas
• Palmar, plantar, subungual, and occasionally, mucosal surfaces
• Most common type of malignant melanoma among asians
and dark-skinned individuals
• Not all melanomas arising in acral sites are acral lentiginous
melanomas
dr.basit@live.com
21. • Dark brown to black, unevenly pigmented patch
• Areas of regression manifest as foci of gray-white
discoloration
dr.basit@live.com
22. • Histologically
• Lentiginous array of atypical melanocytes along the dermal-
epidermal junction, with foci of confluent melanocytic growth
• Invasive lesions are characterized by the presence of neoplastic
single cells or nests in the dermis
• Large, hyperchromatic, angulated melanocytes with scant
cytoplasm
dr.basit@live.com
24. DIAGNOSIS
• The clinical recognition of melanoma may be challenging
even for the most experienced dermatologist
• Asymmetry
• Irregular borders
• Variegated color
• Diameter >6mm
• Recent change in a lesion
dr.basit@live.com
25. ABCDE RULE
• Asymmetry (if a lesion is bisected, one half is not identical to
the other half)
• Border irregularities
• Color variegation (brown, red, black or blue/gray, and white)
• Diameter ≥6 mm
• Evolving: a lesion that is changing in size, shape, or color, or a
new lesion
dr.basit@live.com
26. THE REVISED GLASGOW SEVEN-POINT
CHECKLIST
• Major:
• Change in size/new lesion
• Change in shape
• Change in color
• Minor:
• Diameter ≥7mm
• Inflammation
• Crusting or bleeding
• Sensory change
dr.basit@live.com
27. THE "UGLY DUCKLING" SIGN
• A pigmented lesion that looks different from other
surrounding lesions must be considered suspicious, even if
it does not fulfill the ABCD criteria.
dr.basit@live.com
30. MANAGEMENT OF PATIENTS WITH
SUSPICIOUS SKIN LESIONS
• Referral
• Biopsy
• Monitoring
dr.basit@live.com
31. • Referral
• A new mole appearing after the onset of puberty which is changing in shape, color, or
size
• A long-standing mole which is changing in shape, color, or size
• Any mole which has three or more colors or has lost its symmetry
• A mole which is itching or bleeding
• Any new persistent skin lesion especially if growing, if pigmented or vascular in
appearance, and if the diagnosis is not clear
• A new pigmented line in a nail especially where there is associated damage to the nail
• A lesion growing under a nail
dr.basit@live.com
32. • Biopsy
• Biopsy is necessary whenever melanoma is suspected.
• An excisional biopsy that includes the entire lesion with 1 to 3
mm margins of normal skin and part of the subcutaneous fat
should be performed whenever possible.
• Incisional biopsy may be occasionally acceptable for very large
lesions or for certain sites, including the face, palm or sole, ear,
distal digit, or subungual lesions
dr.basit@live.com
33. • Monitoring
• Patients at increased risk of melanoma should have regular
examinations once or twice a year
• Australian Cancer Network recommends monthly skin self-
examination and biannual full body skin examination by a
clinician for high risk individuals
dr.basit@live.com
37. INITIAL BIOPSY
• Excisional biopsy
• Incisional biopsy
• Shave biopsy
• Never appropriate for the following reasons
• The lesion is likely to be inadequately excised, with residual tumor remaining at both the radial and
deep margins.
• Because only the superficial portion of the tumor is removed, shave biopsies results underestimate
tumor thickness, a critical prognostic factor and determinant of treatment.
• Fibrosis and scarring at the base of the biopsy site may obscure residual melanoma, making it
impossible for a pathologist to identify tumor and accurately measure its thickness.
dr.basit@live.com
38. WIDE LOCAL EXCISION
• The definitive surgical treatment
• The recommended width of the normal tissue around the
lesion has progressively decreased as a result of multiple large
clinical trials that have examined the impact of the surgical
margin on the local recurrence rate
• The thickness of the melanoma is a key factor in determining
the stage of the lesion and the recommended margin of
normal tissue to be resected.
dr.basit@live.com
39. Study, author;
year
n
Median
follow-up
Melanoma
thickness
Margi
ns
Local recurrence,
(percent)
Overall survival,
percent
World Health
Organization
Cascinelli, N; 1998
612 12 yrs 0-1 mm 1 cm 3/186 (1.6) 87
1.1-2 mm 1 cm 5/119 (4.2)
0-1 mm 3 cm 1/173 (0.6) 85
1.1-2 mm 3 cm 2/134 (1.5)
Swedish
Cohn-Cedarmark, G;
2000
989 11 yrs 0.8-2 mm 2 cm 3/476 (0.6) 79
5 cm 5/513 (1) 76
French Cooperative
Group
Khayat, D; 2003
326 16 yrs <2.1 mm 2 cm 1/181 (0.05) 87
5 cm 4/185 (0.2) 86
Melanoma
Intergroup Trial
Karakoussis, CP;
1996
468 8 yrs 1-4 mm 2 cm (2.1) 80
4 cm (2.6) 84
British Trial
Thomas, JM; 2004
900 60 mos ≥2 mm 1 cm 15/453 (3.3) No significant
difference3 cm 13/457 (2.8)
dr.basit@live.com
40. WIDE LOCAL EXCISION
• Thin melanomas
• Resect melanomas <1 mm thick (T1) with a 1 cm margin of normal
tissue
• For melanomas 1 to 2 mm thick (T2 lesions), use a 2 cm margin of
normal tissue if this is feasible without the need for a skin graft
dr.basit@live.com
41. • Intermediate thickness melanomas
• Primary melanomas between 2 and 4 mm thick (T3), 2 cm excision
margin
dr.basit@live.com
43. • In situ melanomas
• There are no data from randomized trials to define the optimal extent
of surgical resection.
• Retrospective data support the routine use of 0.5 cm margins
dr.basit@live.com
44. LYMPH NODE METASTASIS
• 20 percent of clinically node-negative patients have
metastatic involvement
• 20 percent of those with clinically positive nodes are
pathologically negative
dr.basit@live.com
46. THERAPEUTIC LYMPHADENECTOMY
• Therapeutic lymphadenectomy is the preferred treatment
for cytologically or pathologically proven regional lymph
node involvement
• Complete regional lymphadenectomy is necessary rather
than partial dissection or sampling
dr.basit@live.com
47. ELECTIVE LYMPH NODE DISSECTION
• ELND for clinically node-negative patients is controversial
despite a number of trials evaluating this approach
• There may be subgroups of patients who benefit from
ELND, but consensus is lacking on this issue.
dr.basit@live.com
48. SENTINEL LYMPH NODE BIOPSY
• If the sentinel lymph nodes are not involved, the entire
basin should be free of tumor
• Completion lymph node dissection is used for patients
with tumor involvement of the sentinel lymph node
dr.basit@live.com
49. • Patient selection
• SLNB is indicated for tumors ≥1 mm thick.
• Tumors less than 1 mm in thickness have less than a 10 percent
likelihood of nodal metastases, and SLNB is not routinely indicated.
However, certain high-risk features (ulceration, a mitotic rate ≥1 per
mm2) are associated with a higher rate of lymph node metastasis,
thereby justifying the use of SLNB
• Tumors >4 mm thick have a 65 to 70 percent risk of distant metastasis.
However, SLNB may still provide important prognostic information.
dr.basit@live.com
50. SURVEILLANCE AFTER TREATMENT
• The primary objective of follow-up in patients with
melanoma is to identify potentially curable locoregional
recurrences and second primary cancers.
dr.basit@live.com
51. • A routine physical examination, including a full skin
assessment and palpation of the regional lymph nodes,
which should be repeated at least yearly
• The frequency of such evaluation should be increased in
patients at high risk of recurrence
• Imaging studies should be done if symptoms are present;
the value of routine imaging is uncertain
dr.basit@live.com