Melanoma

Question 1

Define Melanoma?

Answer 1

Malignancy arising from neoplastic transformation of melanocytes, the pigment-forming skin cells
The leading cause of death from skin disease

Question 2

What is the aetiology of Melanoma?

Answer 2

DNA damage caused by UV radiation leads to neoplastic transformation
50% arise in existing naevi
50% arise in previously normal skin

Question 3

What are the four histopathological types of Melanoma?

Answer 3

Superficial Spreading (70%)
Nodular (15%)
Lentigo Maligna (10%)
Acral Lentiginous (5%)

Question 4

What are the characteristics of Superficial Spreading Melanoma?

Answer 4

Arises in a pre-existing naevus, expands in a rapid fashion before a vertical growth phase

Question 5

What are the characteristics of Nodular Melanoma?

Answer 5

Arises de novo
Aggresive
No radial growth phase

Question 6

What are the characteristics of Lentigo Maligna Melanoma?

Answer 6

More common in ELDERLY with sun damage
Large flat lesions
Progresses slowly
Usually on the face

Question 7

What are the characteristics of Acral Lentiginous Melanoma?

Answer 7

Arise on palms, soles and subungual areas

Most common type in NON-WHITE populations

Question 8

What is the epidemiology of Melanoma?

Answer 8

Steadily increasing in incidence

White races have 20x increased risk compared to non-whites

Question 9

What are the presenting symptoms of Melanoma?

Answer 9

Change in size, shape or colour of a pigmented skin lesion
Redness
Bleeding
Crusting
Ulceration

Question 10

What is the ABCDE criteria for examining moles?

Answer 10

A - Asymmetry
B- Border irregularity 
C- colour variation
D - diameter > 6 mm 
E - elevation / evolution

Question 11

What investigations can you do for Melanoma?

Answer 11

Excisional Biopsy
Lymphoscintigraphy
Sentinel Lymph Node Biopsy
Staging
Bloods

Question 12

Why would you do an Excisional Biopsy for Melanoma?

Answer 12

Histological diagnosis and determination of Clark’s Levels and Breslow Thickness (two methods of determining the depth of penetration of a melanoma)

Question 13

What happens in a Lymphoscintigraphy for Melanoma?

Answer 13

A radioactive compound is injected into the lesion and images are taken over 30 mins to trace the lymph drainage and identify the sentinel nodes

Question 14

Why do we do Sentinel Lymph Node Biopsy for Melanoma?

Answer 14

Check for metastatic involvement

Question 15

What staging do we do for Melanoma?

Answer 15

US
CT or MRI
CXR