Melanoma

Question 1

Risk factors of melanoma

Answer 1

• sunbeds
• fair skin, freckled, burn easily
• FH
• large number of moles (>100 young people, >50 old people)
• atypical moles
• immunosuppression
• childhood sun burning episodes

Question 2

History in suspected melanoma

Answer 2

• duration of lesion
• change in colour, size, shape
• associated symptoms - itching, bleeding
• FH - psoriasis, skin cancer
• PMH - skin conditions, immunosuppressed?
• DH
• RF
• SH - smoking, alcohol, occupation

Question 3

Examination in melaoma

Answer 3

• full skin examination
• check for evidence of mets - lymp nodes around lesion, lymphadenopathy else where, hepato and splenomegaly

Question 4

ABCDE of malignant moles

Answer 4

A: asymmetry

B: border irregularity

C: colour - variable colours in one lesion, intensly black, some show no or little pigmentation

D: diameter - benign moles are usually <1cm, any lesions over 0.5cm should be carefully checked, melanomas can be smaller than this though

E: evolving

pain, crusting, ulceration or bleeding may also indicate malignant change

Question 5

Criteria for 2 week wait

Answer 5

7 point check list - score 3 or more

major features - score 2

• change in size
• irregular shape
• irregular colour

Minor feature - scores one

• larges diameter 7mm or more
• inflammation
• oozing
• change in sensation

Question 6

Prognosis of melanoma

Answer 6

• histological analysis needed
• Breslow thickness - deepest level of invasion

Question 7

Treatment for melanoma

Answer 7

excision with narrow margin

urgent procedure same day or week

radiotherapy sometimes useful

chemotherapy for metastatic