Malignant Melanoma
Transcript of Malignant Melanoma
![Page 1: Malignant Melanoma](https://reader036.fdocuments.us/reader036/viewer/2022070313/554b395cb4c905ff268b4671/html5/thumbnails/1.jpg)
MALIGNANT MELANOMA
![Page 2: Malignant Melanoma](https://reader036.fdocuments.us/reader036/viewer/2022070313/554b395cb4c905ff268b4671/html5/thumbnails/2.jpg)
Outline
• Introduction• Aetiology• Types• Invasion and Metastasis• Risk Factors• Diagnosis and Staging• Treatment and Prevention
![Page 3: Malignant Melanoma](https://reader036.fdocuments.us/reader036/viewer/2022070313/554b395cb4c905ff268b4671/html5/thumbnails/3.jpg)
Skin:Epidermis - Melanocytes
• Melanocytes:– In stratum basale– Pale “halo” of cytoplasm– Neural crest– Produce melanin and pass it on to
nearby keratinocytes– Melanin covers nuclei of nearby
keratinocytes– Skin colour depends on melanocytes
activity, rather than the number present
![Page 4: Malignant Melanoma](https://reader036.fdocuments.us/reader036/viewer/2022070313/554b395cb4c905ff268b4671/html5/thumbnails/4.jpg)
MALIGNANT MELANOMA
• A tumour arising from melanocytes of the basal layer of the epidermis
• Less commonly – uveal tract (eye) and meningeal membranes
![Page 5: Malignant Melanoma](https://reader036.fdocuments.us/reader036/viewer/2022070313/554b395cb4c905ff268b4671/html5/thumbnails/5.jpg)
AETIOLOGY
• The cause is unknown.
• Excessive exposure to sunlight
• Genetic predisposition
![Page 6: Malignant Melanoma](https://reader036.fdocuments.us/reader036/viewer/2022070313/554b395cb4c905ff268b4671/html5/thumbnails/6.jpg)
RISK FACTORS FOR MELANOMA
• Large numbers of benign naevi
• Clinically atypical naevi
• Severe sunburn
• Early years in a tropical climate
• Family history of MM
![Page 7: Malignant Melanoma](https://reader036.fdocuments.us/reader036/viewer/2022070313/554b395cb4c905ff268b4671/html5/thumbnails/7.jpg)
Clinical features
• Occur anywhere on the skin– Females (commonest is lower leg)– Males ( back).
• Early melanoma is pain free. The only symptom if present is mild irritation or itch.
![Page 8: Malignant Melanoma](https://reader036.fdocuments.us/reader036/viewer/2022070313/554b395cb4c905ff268b4671/html5/thumbnails/8.jpg)
AIDS IN CLINICAL DIAGNOSIS
GLASGOW SYSTEM
Major:• Change in size• Irregular pigment• Irregular outline
Minor:• Diameter >6mm• Inflammation• Oozing/bleeding• Itch/altered sensation
AMERICAN ‘ABCDE’ SYSTEM
• Asymmetry
• Border
• Colour
• Diameter
• Examination
![Page 9: Malignant Melanoma](https://reader036.fdocuments.us/reader036/viewer/2022070313/554b395cb4c905ff268b4671/html5/thumbnails/9.jpg)
Evolving; a mole or skin lesion that looks different from the rest or is changing in size, shape, or color
![Page 10: Malignant Melanoma](https://reader036.fdocuments.us/reader036/viewer/2022070313/554b395cb4c905ff268b4671/html5/thumbnails/10.jpg)
TYPES OF MELANOMA
• Superficial spreading Malignant melanoma
• Nodular melanoma
• Letingo maligna melanoma
• Acral malanoma
![Page 11: Malignant Melanoma](https://reader036.fdocuments.us/reader036/viewer/2022070313/554b395cb4c905ff268b4671/html5/thumbnails/11.jpg)
SUPERFICIAL SPREADING
• The most common type of MM in the white-skinned population – 70% of cases
• Commonest sites – lower leg in females and back in males
• In early stages may be small, then growth becomes irregular
![Page 12: Malignant Melanoma](https://reader036.fdocuments.us/reader036/viewer/2022070313/554b395cb4c905ff268b4671/html5/thumbnails/12.jpg)
NODULAR• Commoner in males
• Trunk is a common site
• Rapidly growing
• Usually thick with a poor prognosis
• Black/brown nodule
• Ulceration and bleeding are common
![Page 13: Malignant Melanoma](https://reader036.fdocuments.us/reader036/viewer/2022070313/554b395cb4c905ff268b4671/html5/thumbnails/13.jpg)
ACRAL LENTIGINOUS MELANOMA
• In white-skinned population this accounts for 10% of MMs, but is the commonest MM in nonwhite-skinned nations
• Found on palms and soles
• Usually comprises a flat lentiginous area with an invasive nodular component
![Page 14: Malignant Melanoma](https://reader036.fdocuments.us/reader036/viewer/2022070313/554b395cb4c905ff268b4671/html5/thumbnails/14.jpg)
SUBUNGAL MELANOMA
• Rare
• Often diagnosed late – confusion with benign subungal naevus, paronychial infections, trauma
• Hutchinson’s sign – spillage of pigment onto the surrounding nailfold
![Page 15: Malignant Melanoma](https://reader036.fdocuments.us/reader036/viewer/2022070313/554b395cb4c905ff268b4671/html5/thumbnails/15.jpg)
LENTIGO MALIGNA MELANOMA
• Occurs as a late development in a lentigo maligna
• Mainly on the face in elderly patients
• May be many years before an invasive nodule develops
![Page 16: Malignant Melanoma](https://reader036.fdocuments.us/reader036/viewer/2022070313/554b395cb4c905ff268b4671/html5/thumbnails/16.jpg)
DDx
• Superficial spreading melanomas
Benign melanocytic naevi.
• Nodular melanomas
Vascular tumor
Histiocytoma
• Latingo maligna melanoma
Seborrhic keratoses
![Page 17: Malignant Melanoma](https://reader036.fdocuments.us/reader036/viewer/2022070313/554b395cb4c905ff268b4671/html5/thumbnails/17.jpg)
![Page 18: Malignant Melanoma](https://reader036.fdocuments.us/reader036/viewer/2022070313/554b395cb4c905ff268b4671/html5/thumbnails/18.jpg)
PROGNOSTIC VARIABLES• The Breslow thickness is
the single most important prognostic variable (distance in mm of the furthest tumour cell from the basal layer of the epidermis)
Breslow depth
5 year survival
In situ 95-100%
<1mm 95-100%
1-2mm 80-96%
2.1-4mm 60-75%
>4mm 50%
![Page 19: Malignant Melanoma](https://reader036.fdocuments.us/reader036/viewer/2022070313/554b395cb4c905ff268b4671/html5/thumbnails/19.jpg)
• Scalp lesions worse prognosis, then palms and soles, then trunk, then extremeties
• Younger women appear to do better than either men at any stage or women over 50
• Ulceration of the tumour surface is a high risk factor
![Page 20: Malignant Melanoma](https://reader036.fdocuments.us/reader036/viewer/2022070313/554b395cb4c905ff268b4671/html5/thumbnails/20.jpg)
MANAGEMENT
Surgical resection of tumourMOHS techniqueLymph node dissectionChemotherapyRadiotherapyImmunotherapy
![Page 21: Malignant Melanoma](https://reader036.fdocuments.us/reader036/viewer/2022070313/554b395cb4c905ff268b4671/html5/thumbnails/21.jpg)
Prevention
• Reduce risk factor exposure:
• Awareness (TV, leaflets, billboards)
• Covering up (sunscreen, sunglasses, clothes)
• Avoidance (less time in sun)
• Screening (possibly feasible)
![Page 22: Malignant Melanoma](https://reader036.fdocuments.us/reader036/viewer/2022070313/554b395cb4c905ff268b4671/html5/thumbnails/22.jpg)
REFERENCES :
• Clinical Dermatology, Rona M. Mackie
• Dermatology an Illustrated Colour Text, David J. Gawkrodger
• Dermatology, Emedicine