Malignant Melanoma
By
Bill V. Way, DO
Dan Ladd Jr., DO
A-B-C-D-E’s of Melanoma
• A - Asymmetry - several types
• B - Border Irregularity
• C - Colors - multiple
• D - Diameter - bigger than a pencil eraser
• E - Elevation, Erythema
ASYMMETRY - WHAT DOES IT MEAN?
• One side differs from the other side
• Shape
• Color
• Elevation
• Borders
• Does the lesion mirror itself in every way?
• May be subtle.
BORDERS
• May be “notched” or “jagged”
• May simply be blurred or indistinct.
• Can be indicative of the irregular growth of malignant melanocytes.
• Requires close inspection of lesion, preferably with a magnifying glass, may be subtle - take it seriously.
COLOR
• Many benign lesions have 2 colors, tan and brown, but the color is symmetrically placed, ie., brown central with round peripheral tan ring.
• Look for multiple or asymmetrically positioned colors - may see red, white, tan brown or black.
• Again requires magnification, can be subtle.
DIAMETER
• Always measure the greatest diameter.
• Include lighter or indistinct areas in your measurement, not just the darker pigment.
• Remember: PENCIL ERASER = 6 mm.
• Document size carefully if you are going to watch a lesion over time - consider the compliance level of your patient.
ELEVATION
• Remember that if the lesion is melanoma, elevation above the surface means depth below, and is the single worst prognostic factor.
• Elevation need not be eccentrically located, the classic “fried egg” may appear fairly symmetric but requires biopsy.
• PALPATE !
LET’S TRY A FEW…
Path: Junctional Nevus with Dysplastic Features,
Path: Compound Nevus with Features of “Dysplastic” (Clark)
Nevus
Path: Compound Nevus
Path: Pigmented Seborrheic Keratosis
Path: Compound Nevus
Path: Melanocytic Nevus, Compound Type
Path: Compound “Dysplastic” Melanocytic Nevus
Path: Compound “Dysplastic” Melanocytic Nevus
Path: Possible Early Evolving Melanoma In Situ
Path: Malignant Melanoma,Clarks Level IV,
Breslow’s Thickness 1.9 mm
Path: Melanoma In-Situ
Path: Evolving Melanoma In Situ
Path: Evolving Melanoma In-Situ
Path: Malignant Melanoma, Breslow’s Thickness 0.9 mm
THE END
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