Malignant melanoma
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Transcript of Malignant melanoma
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MALIGNANT MELANOMA
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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.
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CONJUNCTIVA Risk factors: - White race - Older age - H/o repeated intense sunlight
exposure Pathology : Anaplastic ,malignant appearing
melanocytic cells involve substantia propria.
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CLASSIFICATION 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.
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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.
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TREATMENT Simple observation Incisional biopsy – Complete excision &
cryotherapy Contact radiation Topical chemotherapy Exenteration – frank orbital invasion/
massive unresectable
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IRIS Symptom: Visible spot /discolouration on iris/no
symptom
Risk Factors: - H/o intense sustained sunlight exposure - Conditions like Ocular melanocytosis , Dysplatic nevus syndrome. -
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Ocular manifestations: - Localized dark brown to tan - well circumscribed, cohesive ,intrinsic
vascularity /shaggy ,dispersive. - Pupillary peaking - Ectropion iridis - Iris splinting
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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.
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TREATMENT Observation Excision [iridectomy /iridocyclectomy] Plaque radiotherapy Enucleation.
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CHOROIDAL & CILIARY BODY Symptoms : - Blurred vision - Visual field defect - Flashes - Floaters - no symptom
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SIGN:
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.
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CILIARY BODY Elevated ,nodular dark brown –peripheral
fundus.
Pathology :Anaplastic melanocytic cells – high N/C ratio prominent
nucleoli mitotic figuresSpindle cells, mixed cells, Epitheloid cells, Vascular loops & networks.
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DIAGNOSIS: 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
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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.
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MRI : Hyperintense relative to dark vitreous
on T1 Hypointense relative to bright vitreous
on T2
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TREATMENT: Enucleation Radiation therapy Observation Photocoagulation Non coagulative laser therapy Microsurgical resection Exenteration Hyperthermia therapy PDT Cryotherapy Chemotherapy
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EYELIDS Lentigo maligna Melanoma
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LENTIGO MALIGNA
(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.
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MELANOMA
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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THANK YOU