This document discusses skin cancer and malignant melanoma. It provides statistics on melanoma survival rates in Ukraine versus the US. It describes the biological progression of melanoma from melanocytes to metastatic melanoma. Risk factors for melanoma are described including age, race, sun exposure, and hereditary or genetic factors. Screening, diagnosis, staging, treatment options including surgery, chemotherapy, and radiation therapy are outlined. Growth patterns, recurrence, and palliative care are also mentioned. Precancerous skin conditions and TNM classification of skin cancers like basal cell carcinoma and squamous cell carcinoma are defined.

1. Skin Cancer and Malignant Melanoma

2. Skin melanoma: statistical data in Ukraine
19,3 % - death within
a year,
M. – 26,2 %; F. – 14,9
%
49,7 % - 5-year
survival
67,7 % - І-ІІ stages

3. Comparative Statistics: UA – USA
Ukraine USA
5-year
survival
49,7 % 88,0 %
Melanoma
in situ
0 37,5 %
Year: 2000 2000

4. Biologic progression of melanoma
Melanocyte → nevus →
dysplastic nevus → меlanoма “in situ”
→ superficial spreading melanoma →
nodular melanoma → metastatic
melanoma

5. Sponsored
Medical Lecture Notes – All Subjects
USMLE Exam (America) – Practice

6. Malignant Melanoma: Risk Factors
Age > 40 yr.
Race: white
Sun exposure: UVA,
UVB
Hereditary factors:
“melanoma families“,
atypical mole syndrome or
dysplastic nevus syndrome
Trauma of moles,
Giant congenital nevi

7. Screening:
Self-Examination for
Melanoma:
examine your body front and back in
the mirror, arms and palms, legs and
feet, neck and scalp –
If you have any doubt about a mole,
see a dermatologist-oncologist
(American Academy of Dermatology)

8. Professional education:
students
family doctors
dermatologists
surgeons
cosmetologists
morphologists
oncologists !
nurses
ABCD-test

9. ABCD rules for diagnosis of melanoma:

10. Epiluminescence microscopy (dermatoscopy)

11. Epiluminescence microscopy (ABCD)
ЕЛМ

12. Diagnostics system MoleMax:

13. Growth patterns of melanoma:
superficial spreading melanoma – 70%
nodular melanoma – 15-20%
lentigo maligna melanoma – 4 -10%
acral lentigo-melanoma – 2-8%
amelanotic melanoma – 5%

14. Thickness of melanoma
TNM:
T1 < 1 mm
T2 1-2 mm
T3 2-4 mm
T4 > 4 mm
Radial growth phase
Vertical growth phase

15. Evaluation for Metastasis: N0-3, M0-1
Regional Lymph Nodes:
N0 – no metastasis,
N1 – one lymph node with metastasis,
N2 – 2-3 lymph nodes with Mts.,
N3 – 4 and > metastatic lymph nodes.
Distant Metastasis: M0 – no metastasis,
M1a: Mts in subcutaneous tissue,
M1b: Mts in lung,
M1c: Mts in other visceral organs (brain, liver, etc)

16. Nodular Melanoma Т4bNхM0
Biopsy techniques
For cytologic diagnosis:
- fine-needle aspiration,
- superficial scraping.
For histologic diagnosis:
- complete excision
(Clark’ levels,
Breslow’s thickness)

17. melanoma operation
Sentinel node biopsy,
or regional lymph node
dissection
Regional
lymphangiectomy
Surgical approach to lymphogenous metastases of melanoma

18. Complex treatment of primary melanoma Т3bN1аМ0
(X-ray + Chemo. → Surgery + Chemo. + INF)

19. Operative wound closed by flaps’ transposition

20. Lentigo maligna melanoma
(arise from Hutchinson’s freckle)
1 year after Radiation Therapy

21. Melanoma: scars, recurrence, in transit Mts
1
3
2
4

22. Superficial melanoma with skin
lymphangeitis and in-transit metastasis

23. Wound xenoplasty after wide local
excision of melanoma

24. Skin autografting of granulated wound

25. Spleen metastasis of melanoma (2001);
CT scan in 3 years after splenectomy (2004)
04. 2001 06. 2004

26. Меланома: метастази в селезінку і
лімфовузли
Хворий К., 34 роки
03.2000 – меланома шкіри на
спині, T3bN0M0
Лікування:
- БФ-РТ, СВД 80 Гр,
- Операція
- ПХТ + лаферон (2 курси)
04.2001 – метастази в л/вузли
і селезінку
04.2001
Melanoma metastases into spleen (surgical specimen)
and lymph node

27. “In transit” metastases

28. Metastatic melanoma
Palliative γ - therapy
Hormonotherapy
Supportive care

29. Skin cancer
Basal Cell Carcinoma,
T1N0M0
(growth pattern)

30. Precancerous diseases:
Факультативні:
- гіперкератози,
- шкірний ріг,
- папіломи,
- фіброми,
- гемангіоми,
- бородавки
Облігатні:
пігментна ксеродерма,
хвороба Боуена,
еритроплазія Кейра

31. Skin cancer
Basal Cell Carcinoma,
T1N0M0
(ulcer pattern)

32. Skin cancer
Squamous Cell
Carcinoma,
T4N0M0

33. TNM-Classification of Skin Cancer:
Тis – carcinoma in situ
Т1 – ≤ 2 cm
Т2 – 2 - 5 cm
Т3 – > 5 см
Т4 – t-r invades cartilage, muscle, or
bone.
N0, N1
M0, M1

34. Skin Cancer
Squamous Cell
Carcinoma of lower
eyelid with invasion
in bulbar
conjunctiva,
T4N0M0

35. Skin Cancer
Squamous Cell
Carcinoma of Cheek,
T4N0M0
results of local
phytotherapy for a
year!!!

36. Skin Cancer
Results after
half course of
gamma-
therapy, 45 Gy

37. Skin Squamous Cell Cancer of Neck:
Postoperative wound is temporary
covered with Pig skin xenografts

38. Skin Cancer:
granulation wound (1), skin autografting (2)
Wound after removing of xenografts

39. Skin Cancer: complete recovery
12 months later

40. Тернопільське озеро
Дякую за увагу!