| What is malignant melanoma? | • Malignant melanoma is a neoplasm of melanocytes
• The annual incidence has increased dramatically over the past few decades
• Surgery is the definitive treatment for early-stage melanoma, with medical management generally reserved for adjuvant treatment of advanced melanoma |
| What are S&S of malignant melanoma? | The history should address the following:
• Family history of melanoma or skin cancer
• Family history of irregular, prominent moles
• Family history of pancreatic cancer or astrocytoma
• Previous melanoma (sometimes multiple; patients have reported as many as 8 or more primary melanomas)
• Previous sun exposure
• Changes noted in moles (eg, size, color, symmetry, bleeding, or ulceration)
• History or family history of multiple nevus syndrome |
| How is physical exam of malignant melanoma? | • Total-body skin examination, to be performed on initial evaluation and during all subsequent visits
• Serial photography, epiluminescence microscopy, and computerized image analysis, to be considered as adjuncts
The ABCD’s
Early melanomas may be differentiated from benign nevi by the ABCD’s:
• A - Asymmetry
• B - Border irregularity
• C - Color that tends to be very dark black or blue and variable
• D - Diameter ≥ 6 mm
Dermoscopy
If a patient is diagnosed with a melanoma examine all lymph node groups |
| What are some types of malignant melanoma? | Hemangioma
Melanoma
Superficial Spreading Melanoma (SSM)
Nodular Melanoma
Dubreuilh Melanosis (Lentigo Maligna)
Melanoma of Dubreuilh (MM developed on Lentigo maligna)
Transient metastasis
Lymph nodes |
| How are labs of melanoma? | Laboratory studies indicated:
• Complete blood count
• Complete chemistry panel (including alkaline phosphatase, hepatic transaminases, total protein, and albumin)
• Lactate dehydrogenase |
| How is imaging of melanoma? | The imaging modalities may be considered:
• Chest radiography
• Magnetic resonance imaging of the brain
• Ultrasonography (possibly the best imaging study for diagnosing lymph node involvement)
• Computed tomography of the chest, abdomen, or pelvis
• Positron emission tomography (PET; PET-CT may be the best imaging study for identifying other sites of metastasis) |
| What are procedures done for melanoma? | • Complete excisional biopsy of a suggestive lesion
• Surgical excision or reexcision after biopsy
• Elective lymph node dissection (ELND) for patients with clinically enlarged nodes and no evidence of distant disease
• Sentinel lymph node biopsy (SLNB; see Sentinel Lymph Node Biopsy in Patients With Melanoma) |
| How is histology of melanoma? | • Cytologic atypia, with enlarged cells containing large, pleomorphic, hyperchromic nuclei with prominent nucleoli
• Numerous mitotic figures
• Pagetoid growth pattern with upward growth of the melanocyte |
| What is Breslow and Clark levels of melanoma? | . |
| How is tx of melanoma? | • Surgery (eg, wide local excision with SLNB, ELND, or both) is the definitive treatment for early-stage melanoma
• Medical management is reserved for adjuvant therapy of patients with advanced melanoma
Adjuvant therapy:
• Interferon alfa
• Granulocyte-macrophage colony-stimulating factor (GM-CSF)
• BRAF inhibitors (vemafurenib and dabrafenib)
Advanced Stage (CVD, IL2, ....)
• The following procedures may be used to treat brain metastases:
• Stereotactic radiosurgery (for patients with a limited number of metastases)
• External-beam radiation |
