Moles

Question 1

When looking at moles or lesions, what system would you use to assess the area?

Answer 1

A-E approach
A - Asymmetry 
B - Border
C - Colour
D - Darkness
E - Evolution

Question 2

What is the clinical name for a mole?

Answer 2

Melanocytic Naevus

Question 3

What is the mole composed of?

Answer 3

Melanocytes that lie in the basal layer of the epidermis and within the dermis

Question 4

What should you do when assessing a patient’s moles?

Answer 4

Always look for the ugly duckling - the odd one out

Question 5

When assessing a suspicious looking mole, how do we examine the patient after conducting a full body skin assessment?

Answer 5

Look for any routes of metastases.

• localised: cutaneous/subcutaneous around the mole site
• Regional: lymphadenopathy
• Distant: hepato or spleno- megaly

Question 6

What is the first line of management when dealing with a mole that represents a high clinical suspicion for malignant melanoma?

Answer 6

Excision of the lesion with a narrow margin of normal skin - this is to be done URGENTLY within the same day or week of assessment

Question 7

What percentage of melanomas develop in pre-existing moles?

Answer 7

50%

Question 8

How many people are diagnosed with melanoma annually in the UK?

Answer 8

16,000

Question 9

At what age does melanoma become more prevalent?

Answer 9

Over 75

Question 10

What percentage of melanomas are caused by too much UV radiation?

Answer 10

85%

Question 11

What are the risk factors for developing melanoma?

Answer 11

1. Short periods of strong UV exposure (regular holidaying in hot countries)
2. People who have had sunburn - If you have sunburn several times in your life you are more likely to develop melanoma
3. Sunbed use - particularly before the age of 35

Question 12

What directly increases the risk of melanoma?

Answer 12

The more moles you have, the more likely you are to develop melanoma

Question 13

What chronic health condition increases the risk of developing melanoma?

Answer 13

Inflammatory bowel disease (IBD)

Question 14

Weakened immunity may be a risk factor for developing melanoma, what are some causes of a weakened immune system?

Answer 14

1. HIV infection
2. Immunosuppressant use
3. Post organ-transplant
4. Chemotherapy use

Question 15

What is the Breslow Thickness?

Answer 15

The distance in mm from the granular layer in the epidermis to the deepest level on invasion in the dermis.

Question 16

What is the pathophysiology of melanoma?

Answer 16

Melanin gives skin its colour. It is within the epidermis. When exposed to UV radiation, DNA damage can occur within the melanin cells that mutates and results in uncontrolled cellular growth.

Question 17

What are the 2 types of melanin?

Answer 17

1. Eumelanin - protective and gives skin a tan to protect against UV
2. Pheomelanin

Question 18

Why are people with darker skin less likely to develop melanoma?

Answer 18

They have more eumelanin than pheomelanin. This is a protective factor

Question 19

There are many types of melanoma, describe the following; Superficial Spreading Melanoma

Answer 19

This melanoma tends to spread outwards rather than downwards into the deep skin layers

Question 20

Where is the most common site of melanoma in a woman?

Answer 20

The lower limb

Question 21

Where is superficial spreading melanoma more common on a male?

Answer 21

On the chest and abdomen (trunk)

Question 22

Superficial spreading melanoma is the most common type of skin cancer, what percentage of melanomas are of this type?

Answer 22

60-70%

Question 23

There are many types of melanoma, describe the following; Nodular melanoma

Answer 23

This type of melanoma grows downwards into the deeper layer of the skin. It can grow rapidly

Question 24

What is the 2nd most common type of melanoma?

Answer 24

Nodular melanoma

Question 25

There are many types of melanoma, describe the following; Lentigo maligna melanoma

Answer 25

This type of melanoma is very slow growing a develops from patches of skin called lentigo maligna or Hutchinson’s melanotic freckle.
Lentigo maligna is a flat and outward growing freckle that may get bigger and change colour over time. When it becomes a melanoma it may start to grow deeper and become nodular.

Question 26

Where is the most common site for lentigo maligna melanoma?

Answer 26

The face or anywhere that gets the most sun exposure

Question 27

There are many types of melanoma, describe the following; Amelanotic melanoma

Answer 27

These are red or skin coloured melanomas as they lack melanin

Question 28

There are many types of melanoma, describe the following; Acral lentiginous melanoma

Answer 28

It can grow under nails but it only found on the hands or feet.

Question 29

In regards to melanoma, describe the following T stage; Tis

Answer 29

Melanoma in situ

Question 30

In regards to melanoma, describe the following T stage; T0

Answer 30

No melanoma cells can be seen where the melanoma started

Question 31

In regards to melanoma, describe the following T stage; T1a

Answer 31

The melanoma is <0.8mm thick and the skin appears to not be ulcerated under the microscope

Question 32

In regards to melanoma, describe the following T stage; T1b

Answer 32

• The skin is ulcerated and the melanoma is <0.8mm thick

- The skin may or may not be ulcerated but is between 0.8-1.0mm thick

Question 33

In regards to melanoma, describe the following T stage; T2

Answer 33

The melanoma is between 1mm and 2mm thick

Question 34

In regards to melanoma, describe the following T stage; T3

Answer 34

The melanoma is between 2mm and 4mm thick

Question 35

In regards to melanoma, describe the following T stage; T4

Answer 35

The melanoma is >4mm thick

Question 36

What does a and b mean for stage T2, T3 and T4?

Answer 36

a - not ulcerated

b - ulcerated