melanoma

0
1094
  • Risk factors (MCQ)
    • Giant melanocytic naevus
    • Total number of naevi
    • Dysplastic naevus syndrome
    • History of recurrent sunburn
    • 10% autosomal dominant with reduced penetrance
  • Clinical features
    • Major Sign (MCQ)
      • Change in size
      • Change in shape
      • Change in colour
      • Diameter >7 mm
    • Minor signs (MCQ)
      • Inflammation
      • Bleeding
      • Sensory changes
    • Early detection
      • Lesion unlikely to be a melanoma without at least one major sign
      • Need to assess (MCQ)
        • A=Asymmetry
        • B=Border irregularity
        • C=Colour variegation
        • D=Diameter
  • Pathology
    • 60% arise in pre-existing naevi
    • Have initial radial and then vertical growth phase
    • Determines growth characteristics of the tumour
    • Superficial spreading melanoma (65%)
      • Occurs in middle age
      • Female : male ratio 2:1
      • Commonest sites – lower leg in women and trunk in man(MCQ)
      • Usually slightly elevated lesion with variable colour
    • Nodular melanoma (27%)
      • Aggressive tumour
      • Occurs in younger age group
      • Female : male ratio 1:2
      • Early vertical growth phase
      • Usually uniform colour, early ulceration and bleeding
    • Lentigo maligna melanoma (7%)
      • Least malignant (MCQ)
      • Usually found on face of elderly(MCQ)
      • Long radial growth phase
      • Presents as flat light brown macule(MCQ)
    • Acral lentiginous melanoma (1%)
      • Aggressive tumour (MCQ)
      • Occurs on soles of feet and palms of hand
      • Subungual melanomas included in this group(MCQ)
    • Intransit metastases
      • Uncommon. Seen in less than 2% tumours
      • Appear as intracutaneous metastases or ‘satellites’(MCQ)
      • Those within 2 cm of primary classified as part of it (MCQ)
      • Usually associated with regional lymphadenopathy (MCQ)
  • Lymph node metastases
    • Commonest metastatic presentation(MCQ)
    • Reduces survival by 50%
    • 70 – 80% patients with regional lymphadenopathy have distant disease
  • Tumour thickness
    • Tumour thickness most important prognostic factor for local, distant recurrence and survival
    • With regional lymphadenopathy 10-year survival is less than 10%

Five-year survival related to Breslow thickness (mm)

39

    • Melanoma surgery
      • Resection margins
      • Generally accepted resection margins based on clinical appearance are: (MCQ)
        • Impalpable lesions1 cm margin
        • Palpable lesion2 cm margin
        • Nodular lesion3 cm margin
    • Regional lymphadenectomy
      • 20% clinically palpable nodes are histologically negative
      • 20% palpably normal nodes have occult metastases
      • Therapeutic lymph node dissection provides regional control and prognostic information
      • No improvement in survival
        • For tumours less than 0.75 mm thick – 90% cured by local excision alone (MCQ)
        • For tumours more than 4.0 mm thick – 70% have distant metastases at presentation(MCQ)
      • For these two groups lymphadenectomy provides no added survival benefit
      • Lymphadenectomy for ‘intermediate’ thickness tumours controversial
    • Morbidity of lymphadenectomy (in descending order) (MCQ)
      • Lymphoedema
      • Seroma
      • ‘Functional deficit’
      • Wound Infection
      • Persistent pain
    • Adjuvant Therapy
      • Patients at high risk of recurrence should be considered for systemic adjuvant therapy
      • Patients include those with: (MCQ)
        • Primary tumour > 4mmthick
        • Resectable positive locoregional lymph nodes
      • No standard adjuvant therapy exists
        • Interferon α2b has shown promising results
      • Shown to increase disease-free and overall survival
    • Isolated limb perfusion
      • Intra-arterial chemotherapy
      • Commonly used agents – Melphalan +/- TNF-alpha(MCQ)
      • Used with hyperoxygenation
      • Hyperthermia at temperature of 41-42 °C
      • Perfusion generally last about 1 hour
      • Usually combined with lymphadenectomy
      • Indications (MCQ)
        • In transit metastases
        • Irresectable local recurrence
        • Adjuvant therapy for poor prognosis tumours
        • Palliation to maintain limb function
      • Morbidity of Isolated limb perfusion (MCQ)
        • Mortality (2%)
        • Limb oedema (most common)
        • Persistent pain
        • Neuropathy
        • Venous thrombosis
        • Septicaemia & thrombocytopenia


Melanoma Removal – GRAPHIC
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The number of skin cancers is rising at an alarming rate. In the U.S., the risk for melanoma is now 1 in 58. This is up from 1 in 1500 in 1930. If melanoma is diagnosed early, the chance for cure approaches 100%; however, for widespread metastatic melanoma, survival is only 6 to 9 months. What you don’t know can harm you or prove fatal. Avoid being a statistic and learn the warning signs and causes of this potentially curable form of skin cancer.Key points
Signs and Symptoms of Melanoma and Skin Cancer
Each year, more than two million Americans are diagnosed with skin cancer, 9,000 them with melanoma, the most dangerous form of skin cancer. Surgical oncologist Dr. Mark Gimbel, of Banner MD Anderson Cancer Center, explains who is most at risk and what you can do to decrease your risk. Dr. Gimbel goes on to discuss what happens after a skin cancer diagnosis including treatment options.
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Erin Huiras Amerson, MD reviews the causes of melanoma and nonmelanoma skin cancer and reveals how dermatologists diagnose and treat these diseases. Dr. Amerson discusses new advances in melanoma treatment as well as the current controversies over the use of sunscreen.
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Mole vs Melanoma
1) Melanoma is the most dangerous of all skin cancers killing 8,790 people per year
2) The A,B,C,D,E rules help distinguish innocent moles vs melanomas
3) Tanning beds, sunburns, excessive sun exposure and fair skin are associated with higher rates of melanomas
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