Melanoma

Question 1

What is melanoma?

Answer 1

A malignancy originating from the melanocytes of the skin

Question 2

What are some risk factors for melanoma?

Answer 2

• Multiple atypical moles
• Female (2:1)
• Middle age
• UV exposure
• Genetics
• Skin prototype

Question 3

What are the 2 phases of melanoma growth?

Answer 3

Radial growth phase (Horizontal)
Vertical growth phase

Question 4

What is meant by radial growth phase?

Answer 4

This is the growth of a melanoma as a macule, either in situ or with dermal micro invasion, spreading out but not down

Question 5

What is meant by vertical growth phase?

Answer 5

The invasion of the melanoma into the dermis, forming an expansile mass with mitoses

Question 6

Which growth phase of melanoma can metastasise?

Answer 6

Vertical growth phase

Question 7

What are some genetic factors of melanoma?

Answer 7

BRAF mutation
MEK ans ERK up-regulation in the tumour driving proliferation

Question 8

What are some presentations of melanoma?

Answer 8

A - Asymmetry
B - Irregular border
C - Variable colour
D - Diameter >6mm
E - Elevation and evolution

Question 9

What are the major diagnostic criteria of melanoma?

Answer 9

Lesion that changes in shape, size and colour

Question 10

What are the minor diagnostic criteria of melanoma?

Answer 10

Diameter >6mm, bleeding, sensory changes, inflammation

Question 11

What are the 4 sub-types of melanoma?

Answer 11

Superficial
Nodular
Lentigo maligna melanoma
Acral metastatic melanoma

Question 12

What is meant by the ugly duckling sign in melanoma?

Answer 12

Look for the mole amongst the others that stands out and is different

Question 13

What is meant by lentigine (Lentigo)?

Answer 13

This is a slow, radially growing macule that remains for many years

Question 14

What is meant by lentigo maligna?

Answer 14

This is when a lentigine begins to grow vertically, forming a melanoma

Question 15

Name the condition

Answer 15

Melanoma

Question 16

Name the condition

Answer 16

Melanoma - Erratic pigment network (Abnormal projection of dermis into the epidermis)

Question 17

Name the condition

Answer 17

Superficial spreading melanoma - Asymmetry of shape and colour, irregular border, large, slightly elevated in the centre

Question 18

Name the condition

Answer 18

Nodular melanoma

Question 19

Name the condition

Answer 19

Nodular melanoma

Question 20

Name the condition

Answer 20

Nodular melanoma

Question 21

Name the condition

Answer 21

Lentigine formation (Lentigo)

Question 22

Name the condition

Answer 22

Lentigo maligna melanoma

Question 23

Name the condition

Answer 23

Melanoma

Question 24

What are some mole features that are suspicious of melanoma?

Answer 24

• Change in shape
• Irregular pigmentation
• Bleeding
• Development of satelite nodules
• Ulceration
• New pigmented lesion in adulthood

Question 25

How should a melanoma be managed?

Answer 25

Primary excision to give clear margins Diagnosis using histology Secondary excision based on Breslow thickness

Question 26

What is meant by Breslow thickness?

Answer 26

The depth from the granular layer of the epidermis to the deepest point of the tumour

Question 27

What are the stages of Breslow thickness and their prognosis?

Answer 27

- pTis-melanoma is in-situ-100% survival - pT1-tumour < 1mm-90% survival - pT2-tumour is 1-2mm-80% survival - pT3-tumour is 2-4mm-55% survival - pT4-tumour > 4mm thick-20% survival

Question 28

What are some indicators of adverse prognosis?

Answer 28

Ulceration High mitotic rate Lymphovascular invasion Satelite nodes Sentinel lymph node involvement

Question 29

How is ulceration denoted with breslin thickness?

Answer 29

By adding the suffix 'b' (E.g. pT3b is a tumour between 2-4mm with ulceration)

Question 30

Describe the features of superficial spreading melanoma?

Answer 30

- Large, flat, irregularly pigmented lesion - Commonest in trunk and limbs - Grows laterally before vertical invasion develops

Question 31

Describe the features of nodular melanoma?

Answer 31

- The most aggressive type - Occurs on varied sites but often trunk - Presents as a rapidly growing pigmented nodule, which bleeds or ulcerates

Question 32

Describe the features of lentigo maligna melanoma

Answer 32

- Invasive tumour that develops within pre-existing lentigo maligna - Occurs on sun damaged face/neck/scalp

Question 33

Describe the features of acral metastatic melanoma

Answer 33

Arise as pigmented lesions on the palm or sole or under the nail, and usually present late