I Think My Mole Has Changed

Question 1

Questions to ask a patient presenting with a mole

Answer 1

Duration 
Change in:
-size
-colour
-shape
Associated symptoms (itching, bleeding)

Question 2

Medical term for mole (how are they formed)

Answer 2

(Melanocytic) Naevus - by a proliferation of melanocytes

Question 3

Acronym for assessing potential malignancy of a mole

Answer 3

A - asymmetry
B - border (scalloped edges)
C - colour  (variation may be sign of dysplasia, melanoma may be intensely black
D - diameter or darkeness   - >6mm
E - evolution (change over time)

Question 4

4 different types of mole

Answer 4

Junctional naevus (epidermal junction, brown, flat)
Intradermal naevus (dermis, skin coloured, raised)
Intermediate naevus (centrally within dermis,skin coloured, raised; peripherally at junction, brown, flat)
Compound naevus (epidermal junction and dermis, brown, raised)

Question 5

Reasons for a 2ww referral (6)

Answer 5

Mole that’s growing quickly
Long standing mole that’s changing in shape and colour
3 or more colours/lost its symmetry
New nodule, growing and pigmented/vascular in appearance
New pigmented line in nail
Something growing under nail (esp. if vascular tissue or pigment)

Question 6

Evidence of mole metastasis

Answer 6

Localised: cutaneous/subcutaneous nodules around the lesion
Regional: lymphadenopathy
Distant: heoatomegaly +/- splenomegaly

Question 7

Treatment for suspected melanoma

Answer 7

Excise the legion with narrow margin of normal skin

Question 8

Most at risk patients of developing melanoma

Answer 8

Fair or freckled ski, tans easily, burns poorly
Large number of moles (>100 in young, >50 old)
Atypical moles (>6mm in diameter, irregular outline, colour variation)
History of severe sunburn, esp. in childhood
Personal or FH of melanoma

Question 9

Epidemiology of melanoma

Answer 9

5th most common cancer
2nd most common in 25-49 year olds 
Incidence has increased 4fold since 70s
15400 diagnosed each year
42 new cases each day
Second

Question 10

Scale used for staging and is a major determinant of progression

Answer 10

Breslow Thickness (+evidence of mitoses, ulceration, lymph node involvement and evidence of distant metastases)

Question 11

Stage, Breslow thickness, Prognosis (5 year survival)

Answer 11

0 - in situ, 100%
I - <1mm, 95-100%
IIA - 1-2mm, 80-96%
IIB- - 2.1-4mm, 60-75%
IIC - >4mm, 37-50%
III - lymph node mets, 24-29%
IV - distant mets, 7-19%

Question 12

Most common sites of melanoma in men and women

Answer 12

Women - lower limb

Men - back