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52 Cards in this Set
- Front
- Back
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What is melanoma? |
Neoplastic disorder produced by malignant transformation of the melanocyte; melanocytes are derived from neural crest cells |
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Which patients are at greatest risk for melanoma? |
- White patients with blonde/red hair - Fair skin, freckling - History of burning sunburns - Blue/green eyes - Actinic keratosis - Male > Female |
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What are the most common sites of melanoma? |
1. Skin 2. Eyes 3. Anus |
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What is the most common site for melanoma in African Americans? |
Palms of the hands, soles of the feet (acral lentiginous melanoma) |
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What characteristics are suggestive of melanoma? |
- Usually a pigmented lesion with an irregular border, irregular surface, or irregular coloration - Other clues: darkening of a pigmented lesion, development of pigmented satellite lesions, irregular margins or surface elevations, notching, recent or rapid enlargement, erosion or ulceration of surface, pruritus |
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What are the ABCDs of melanoma? |
- Asymmetry - Border irregularity - Color variation - Diameter (>6mm) and Dark lesion |
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What are the associated risk factors for melanoma? |
- Severe sunburn <18y - Giant congenital nevi - Family history - Race (white) - UV radiation (sun) - Multiple dysplastic nevi |
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How does location differ in men and women for melanoma? |
Men get more lesions on the trunk; women on the extremities |
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Which locations are unusual to find melanoma? |
Non-cutaneous regions, such as mucus membranes of the vulva/vagina, anorectum, esophagus, and choroidal layer of the eye |
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What is the most common site of melanoma in men? |
Back (33%) |
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What is the most common site of melanoma in women? |
Legs (33%) |
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What are the four major histologic types of melanoma? |
1. Superficial spreading 2. Lentigo maligna 3. Acral lentiginous 4. Nodular |
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What are the characteristics of the "superficial spreading" melanoma? |
- Occurs in both sun-exposed and non-exposed areas - Most common of all melanomas (75%) |
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What are the characteristics of the "lentigo maligna" melanoma? |
- Malignant cells that are superficial, found usually in elderly patients on the head or neck - Called "Hutchinson's freckle" if non-invasive - Least aggressive type; very good prognosis - Accounts for <10% of all melanomas |
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What are the characteristics of the "acral lentiginous" melanoma? |
- Occurs on the palms, soles, subungual areas, and mucus membranes - Accounts for ~5% of all melanomas (most common in African American patients; ~50%) |
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What are the characteristics of the "nodular" melanoma? |
- Vertical growth predominates - Lesions are usually dark - Most aggressive type / worst prognosis - Accounts for ~15% of all melanomas |
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What are the characteristics of the "amelanotic" melanoma? |
Melanoma from melanocytes but with obvious lack of pigment |
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What is the most common type of melanoma? |
Superficial spreading (~75%) |
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What type of melanoma arises in Hutchinson's freckle? |
Lentigo maligna melanoma |
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What is Hutchinson's freckle? |
Lentigo maligna melanoma in the radial growth phase without vertical extension (non-invasive); usually occurs on the faces of elderly women |
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What is the American Joint Committee on Cancer (AJCC) classification of Melanoma Stage IA? |
<1 mm without ulceration |
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What is the American Joint Committee on Cancer (AJCC) classification of Melanoma Stage IB? |
<1 mm with ulceration or 1-2 mm without ulceration |
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What is the American Joint Committee on Cancer (AJCC) classification of Melanoma Stage IIA? |
1-2 mm with ulceration or 2-4 mm without ulceration |
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What is the American Joint Committee on Cancer (AJCC) classification of Melanoma Stage IIB? |
2-4 mm with ulceration or >4 mm without ulceration |
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What is the American Joint Committee on Cancer (AJCC) classification of Melanoma Stage IIC? |
>4 mm with ulceration |
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What is the American Joint Committee on Cancer (AJCC) classification of Melanoma Stage III? |
Positive nodes |
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What is the American Joint Committee on Cancer (AJCC) classification of Melanoma Stage IV? |
Distant metastases |
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What are the common sites of metastasis? |
- Nodes (local) - Distant: lung, liver, bone, heart, and brain - Melanoma has a specific attraction for small bowel mucosa and distant cutaneous sites - Brain metastases are a common cause of death |
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What are the metastatic routes of spread for melanoma? |
Both lymphatic and hematogenous |
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How do you diagnose melanoma? |
Excisional biopsy (complete removal leaving only normal tissue) OR Incisional biopsy for very large lesions
Note: early diagnosis is crucial |
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What ist he role of shave biopsy for melanoma? |
No role |
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What is the "sentinel node" biopsy for melanoma? |
Inject Lymphazurin blue dye, colloid with a radiolabel, or both around the melanoma
The first LN in the draining chain is identified as the "sentinel lymph node" and reflects the metastatic status of the group of LNs |
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When is elective LN dissection recommended with melanoma? |
Controversial: possible advantage in melanomas 1-2 mm in depth but jury still out; sentinel node biopsy if >1 mm is becoming very common |
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What is the recommended size of the surgical margin for melanoma in situ? |
0.5 cm margin |
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What is the recommended size of the surgical margin for melanoma <1 mm thick? |
1 cm margin |
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What is the recommended size of the surgical margin for melanoma 1-4 mm thick? |
2 cm margin |
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What is the recommended size of the surgical margin for melanoma >4 mm thick? |
3 cm margin |
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What is the treatment for digital melanoma? |
Amputation |
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What is the treatment of palpable lymph node metastasis? |
Lymphadenectomy |
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What factors determine the prognosis of melanoma? |
Depth of invasion and metastasis are the most important factors: - Superficial Spreading and Lentigo Maligna have a better prognosis because they have a longer horizontal phase of growth and are thus diagnosed at an earlier stage - Nodular has the worst prognosis because it grows predominantly vertically and metastasizes earlier |
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What is the workup to survey for metastasis in the patient with melanoma? |
- Physical exam - LFTs - CXR - Bone scan / CT / MRI based on symptoms |
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What is the treatment of intestinal metastasis from melanoma? |
Surgical resection to prevent bleeding / obstruction |
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Which malignancy is most likely to metastasize to the bowel? |
Melanoma |
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What is the surgical treatment of nodal metastasis? |
Lymphadenectomy |
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What is FDA-approved adjuvant therapy? |
Interferon alpha-2b (for stages IIB/III) |
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What is the treatment of unresectable brain metastasis? |
Radiation |
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What is the treatment of isolated adrenal metastasis? |
Surgical resection |
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What is the treatment of isolated lung metastasis? |
Surgical resection |
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What is the most common symptom of anal melanoma? |
Bleeding |
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What is the treatment of anal melanoma? |
APR or wide excision (no survival benefit from APR, but better local control) |
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What other experimental therapy is available for metastatic disease? |
1. Monoclonal antibodies 2. Chemotherapy (eg, dacarbazine) 3. Vaccinations |
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What is the median survival with distant metastasis? |
~6 months |
