Malignant Melanoma
Malignancy of melanocytes and naevus cells. Potentially fatal skin tumour. Increasing prevalence due to the more socially acceptable ‘tanned’ appearance public health campaigns aimed at reducing incidence.
Risk Factors for Melanoma (MMRISK):
Moles – atypical (more than 10)
Moles – common moles (numerous)
Red hair and freckles
Inability to tan – skin phototypes 1 & 2
Sunburn – severe sunburn before age 13
Kindred – family history
Clinical features:
Six Keys Signs:
Asymmetry of shape
Border is irregular
Colour is mottled
Diametre is usually large
Elevation is almost always present
Enlargement – history of increase in Size
Clinical Types:
Superficial spreading melanoma (SSMM):
• most common melanoma (70%) in whites
• appears as slowly enlarging brown (usually) or black raised plaque with indurated margin and irregular border
• more common on legs of females and backs of males – especially ‘fair’ skinned individuals
• often have history of many ‘sunburns’ in childhood and have a predisposing naevus
Nodular melanoma:
• up to 20%
• history of a suddenly appearing ‘lump’ that recently started growing
• appears as an elevated pigmented dark blue/brown/black nodule
• tends to be invasive and ulcerates ‘nonhealing skin ulcer’
• metastasis to lymph nodes and local organs
• can occur anywhere on body
Lentigo malignant melanoma:
• about 5%
• more common on face and other sun exposed areas
• irregularly shaped, flat pigmented lesions
Acral lentiginous melanoma:
• uncommon type occurring in dark skinned individuals
• appears as a flat hyperpigmented black/brown lesion (macule)
• usually palms, soles and subungual
• slower growing than other forms
• differential diagnosis – blood blister
Clark’s Levels:
System used to describe depth and level of invasion – used to determine probability of the progression of the disease. Correlates to 5 year survival rates.
Level 1 – cells in epidermis only
Level 2 – cells extend from epidermis into (but on completely) papillary dermis
Level 3 – cells extend from epidermis into and fill papillary dermis
Level 4 – cells extend into reticular dermis
Level 5 – cells extend through the dermis into underlying subcutaneous fat
Breslow’s depth:
Assessment of depth of invasion.
Treatment:
Outcome:
For lower extremity primary melanoma’s, the more distal the lesion (ie in the foot), the worse the prognosis and poorer the survival
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