Describe the four common subtypes of malignant melanoma
- Superficial spread: Commonest (70%); radial growth; invades late
- Nodular: Raised; aggressive vertical growth; ulcerates and bleeds
- Lentigo maligna: In situ; slow growth and nodular
- Affects face, neck, arms.
- Acral lentiginous: Affects nail beds, palms and soles
- Commonest in darker skin, least common overall
Acral = distal portion of limbs
Lentiginous = small pigmented sport with a defined edge.
Provide four risk factors for melanoma
- Personal or FHx of skin cancer; strong FHx
- Increasing age
- Fitzpatick skin type I and II: burns easily
- Red, blonde or light hair; blue/green eyes; freckles
- History of sunburn; indoor tanning or sun beds
- 50+ moles; atypical moles; 100+ moles
- Giant (>20cm) congenital melanocytic naevus
- Immunosuppressed
Bold = higher risk
Outline the ABCDE method of describing a suspicious melanoma
Bold = major suspicious feature
- Asymmetrical shape
- Border irregularity
- Colour irregularity
- Diameter >6mm
- Evolution of lesion: eg. change in size and/or shape
Symptoms - bleeding, itching etc
Outline the weighted 7-point checklist for identification of melanoma
Urgent (2ww) referral if score 3+ or strong concerns
- Major features: Two points each
- Change in size
- Irregular colour
- Irregular shape or border
- Minor features: One point each
- Largest diameter 7+mm
- Inflammation
- Oozing or crusting of the lesion
- Change in sensation, including itch
How does melanoma present differently in men and women?
- Women: occurs more commonly in legs
- Men: occurs more commonly in trunk
What is the management of skin lesions with low suspicion (score of 1 or 2) of melanoma?
Monitor skin lesion, return if any changes
Review in 8 weeks
Outline the management of a skin lesion with high suspicion (score 3+) of melanoma
Urgent 2 week wait referral to dermatologist, plastic surgeon, or specialist with experience of melanoma
How is psoriasis and malignant melanoma linked?
UVB phototherapy is used to treat psoriasis by slowing the growth of cells. UV light can cause mutations of keratinocytes and melanocytes which predispose to skin cancer.
Outline treatment options for melanoma
- Curative surgical excision
- Palliative options: surgery; chemotherapy; radiotherapy
How is risk of recurrence for melanoma assessed?
Breslow thickness
- <0.75mm: low risk
- 0.75 - 1.5mm: medium risk
- >1.5mm: high risk
