Melanoma - Clinicals, Diagnosis, and Management

Dermatology

Clinicals - History

Fact Explanation
Recent changes of preexisting naevi Melanoma is a malignant epidermal tumor which arises from melanocytes. History of rapidly increasing diameter, variation of color, symmetry are important symptoms to suspect melanoma. Itching, bleeding and ulceration are other possible changes that can occur with malignant transformation. Melanoma has superficial and radial growth phase. The malignant cells are at first confined to the epidermis and uppermost dermis, but eventually invade more deeply and may metastasize. ,,,,,, Recent changes of preexisting naevi
Melanoma is a malignant epidermal tumor which arises from melanocytes. History of rapidly increasing diameter, variation of color, symmetry are important symptoms to suspect melanoma. Itching, bleeding and ulceration are other possible changes that can occur with malignant transformation. Melanoma has superficial and radial growth phase. The malignant cells are at first confined to the epidermis and uppermost dermis, but eventually invade more deeply and may metastasize. ,,,,,,
Onset of satellite lesions near preexisting naevi Due to superficial spread satellite lesions can appear near the preexisting naevi. ,,,,,, Onset of satellite lesions near preexisting naevi
Due to superficial spread satellite lesions can appear near the preexisting naevi. ,,,,,,
New onset of pigmented nodule Melanoma can also arise denovo. There for new onset of pigmented nodule is a important symptom. Usually occurs most of the skin. But also can occur in oral cavity, nasal mucosa, choroid layer in eye, vagina etc. ,,,,,, New onset of pigmented nodule
Melanoma can also arise denovo. There for new onset of pigmented nodule is a important symptom. Usually occurs most of the skin. But also can occur in oral cavity, nasal mucosa, choroid layer in eye, vagina etc. ,,,,,,
History of having very large or numerous naevi The risk of developing a malignant melanoma is highest in those with atypical naevi, congenital melanocytic naevi or many banal melanocytic naevi. ,,,,,, History of having very large or numerous naevi
The risk of developing a malignant melanoma is highest in those with atypical naevi, congenital melanocytic naevi or many banal melanocytic naevi. ,,,,,,
History of sun exposure The incidence and mortality increase with decrease latitude. For melanomas , the number of sunburns seems more relevant than cumulative ultraviolet radiation dose. Therefore who are expose to sun for short intensive period are more vulnerable. ,,,,,,, History of sun exposure
The incidence and mortality increase with decrease latitude. For melanomas , the number of sunburns seems more relevant than cumulative ultraviolet radiation dose. Therefore who are expose to sun for short intensive period are more vulnerable. ,,,,,,,
Fair skinned Episodic exposure of fair skinned ( skin type 1& 11) individuals to intense sun light is a identified risk factor. Specially fair skin which is not get tan with sun exposure has a higher risk. ,,,,,,, Fair skinned
Episodic exposure of fair skinned ( skin type 1& 11) individuals to intense sun light is a identified risk factor. Specially fair skin which is not get tan with sun exposure has a higher risk. ,,,,,,,
Past history of melanoma Patients who had melanoma has a higher risk of developing second melanoma. ,,,,,, Past history of melanoma
Patients who had melanoma has a higher risk of developing second melanoma. ,,,,,,
Immunodefficiency History of immuno defficiency such as organ transplant, immuno suppressive drug therapy is a important risk factor for melanoma. ,,,,,, Immunodefficiency
History of immuno defficiency such as organ transplant, immuno suppressive drug therapy is a important risk factor for melanoma. ,,,,,,
Family history of melanoma or skin cancer 10% of patients with melanoma have a positive family history of melanoma. ,,,,,, Family history of melanoma or skin cancer
10% of patients with melanoma have a positive family history of melanoma. ,,,,,,
Family history of moles Family history of irregular atypical moles or numerous moles is important due to multiple nevus syndrome
,,,,,
Family history of moles
Family history of irregular atypical moles or numerous moles is important due to multiple nevus syndrome
,,,,,
Family history of pancreatic cancer and astrocytoma : Familial melanoma syndrome is associated with pancreatic cancer and astrocytoma .,,,,, Family history of pancreatic cancer and astrocytoma :
Familial melanoma syndrome is associated with pancreatic cancer and astrocytoma .,,,,,

Clinicals - Examination

Fact Explanation
Irregularly pigmented asymmetrical macule or plaque. Their margins are irregular with reniform projections and notches. Their may be bleeding and ulceration over the surface. The total body skin examination in a well lit room is very important to identify skin lesions. Must assess the number, size, color, border and surface carefully. Their are four main types of malignant melanoma. ,,,,,,, Irregularly pigmented asymmetrical macule or plaque. Their margins are irregular with reniform projections and notches. Their may be bleeding and ulceration over the surface.
The total body skin examination in a well lit room is very important to identify skin lesions. Must assess the number, size, color, border and surface carefully. Their are four main types of malignant melanoma. ,,,,,,,
Irregularly pigmented, irregularly shaped macule on exposed skin. Lentigo malignant melanoma commonly affects the elderly population. The macule may have been enlarging slowly for many years. ,,,,,,, Irregularly pigmented, irregularly shaped macule on exposed skin.
Lentigo malignant melanoma commonly affects the elderly population. The macule may have been enlarging slowly for many years. ,,,,,,,
A nodule coming up within varied colored plaque. Superficial spreading melanoma is the most common type in Caucasoid. ,,,,,,, A nodule coming up within varied colored plaque.
Superficial spreading melanoma is the most common type in Caucasoid. ,,,,,,,
Irregularly pigmented macule or plaque on palms or soles. Acral lentigious melanoma is the most common type in Chinese and Japanese people. This is rare among Caucasoid. ,,,,,,, Irregularly pigmented macule or plaque on palms or soles.
Acral lentigious melanoma is the most common type in Chinese and Japanese people. This is rare among Caucasoid. ,,,,,,,
Pigmented nodule without preceding insitu stage. Nodular melanoma is the most rapidly growing and aggressive type. ,,,,,,, Pigmented nodule without preceding insitu stage.
Nodular melanoma is the most rapidly growing and aggressive type. ,,,,,,,
lymph node enlargement The regional lymph node groups must assess to identify their Involvement. ,,,,,,, lymph node enlargement
The regional lymph node groups must assess to identify their Involvement. ,,,,,,,

Investigations - Diagnosis

Fact Explanation
Biopsy of lesion A complete excisional biopsy is preferred. Incisional or punch biopsy suitable in large lesions and in lesions in cosmetically sensitive areas. ,,, Biopsy of lesion
A complete excisional biopsy is preferred. Incisional or punch biopsy suitable in large lesions and in lesions in cosmetically sensitive areas. ,,,
Fine needle aspiration If lymph node involvement is suspected clinically then the initial investigation should be with fine needle aspiration. ,,,, Fine needle aspiration
If lymph node involvement is suspected clinically then the initial investigation should be with fine needle aspiration. ,,,,
Sentinal lymph node biopsy Sentinal lymph node is the first node to be involved in lymphatic spread. Sentinal biopsy is important to diagnostic, prognostic and therapeutic decision making. ,,, Sentinal lymph node biopsy
Sentinal lymph node is the first node to be involved in lymphatic spread. Sentinal biopsy is important to diagnostic, prognostic and therapeutic decision making. ,,,
Dermoscopy This is a non invasive technique for didtinguishing pigmented lesions in vivo. This is the first test to distinguish non melnocytic lesions, including sebrrhoic warts, haemangioma from melanocytic lesion. Dermoscopy
This is a non invasive technique for didtinguishing pigmented lesions in vivo. This is the first test to distinguish non melnocytic lesions, including sebrrhoic warts, haemangioma from melanocytic lesion.
Full blood count and blood picture Full blood count and blood picture may show malignant changes. ,,, Full blood count and blood picture
Full blood count and blood picture may show malignant changes. ,,,
Erythrocyte Sedimentation Ratio (ESR) Increased ESR value can be seen in malignant conditions. ,,, Erythrocyte Sedimentation Ratio (ESR)
Increased ESR value can be seen in malignant conditions. ,,,

Investigations - Management

Fact Explanation
Follow up clinic visits Patients who have had melanoma should be screened for recurrence and metastasis. Recurrence usually appear as a growth or pigmentation at the site. In transit melanomas are satellite nodules nearby but not connected to original tumor. The regional lymph nodes should be palpated., Follow up clinic visits
Patients who have had melanoma should be screened for recurrence and metastasis. Recurrence usually appear as a growth or pigmentation at the site. In transit melanomas are satellite nodules nearby but not connected to original tumor. The regional lymph nodes should be palpated.,
Lactate dehydrogenase level (LDH) LDH levels monitoring helps to identify recurrence and secondaries., Lactate dehydrogenase level (LDH)
LDH levels monitoring helps to identify recurrence and secondaries.,
Total protein and albumin Total protein and albumin provide an idea about nutritional level . It affects prognosis.,, Total protein and albumin
Total protein and albumin provide an idea about nutritional level . It affects prognosis.,,
Serum creatinine level Many chemotherapy drugs are renal toxic. Therefore baseline serum creatinine level must be chekced. ,, Serum creatinine level
Many chemotherapy drugs are renal toxic. Therefore baseline serum creatinine level must be chekced. ,,
Biopsy of lesion The most popular staging systems for melanoma are TNM classification (tumor, node, metastasis). The histology can be used to assess prognosis. Breslow's and Clark's methods are used to micro staging. Breslow's method is to measure, with an ocular micrometer, the vertical distance from granular cell layer to deepest part of the tumor. Clark's method used less frequently nowadays, is to assess the depth of penetration of melanoma in relation to layers of dermis. ,,, Biopsy of lesion
The most popular staging systems for melanoma are TNM classification (tumor, node, metastasis). The histology can be used to assess prognosis. Breslow's and Clark's methods are used to micro staging. Breslow's method is to measure, with an ocular micrometer, the vertical distance from granular cell layer to deepest part of the tumor. Clark's method used less frequently nowadays, is to assess the depth of penetration of melanoma in relation to layers of dermis. ,,,
Sentinal lymph node biopsy Sentinal lymph node biopsy provides information regarding lymph node involvement.,, Sentinal lymph node biopsy
Sentinal lymph node biopsy provides information regarding lymph node involvement.,,
Chest X-ray Chest X-ray is performed to identify lung metastasis. , Chest X-ray
Chest X-ray is performed to identify lung metastasis. ,
Ultra sound scan Ultra sound scan is the best imaging study to identify lymph node metastasis. , Ultra sound scan
Ultra sound scan is the best imaging study to identify lymph node metastasis. ,
PET/CT scanning PET/CT scanning is the best imaging study to identify other sites of metastasis. , PET/CT scanning
PET/CT scanning is the best imaging study to identify other sites of metastasis. ,
Liver function tests Elevated levels of liver function tests [AST], [ALT] may indicates metastasis to the liver. , Liver function tests
Elevated levels of liver function tests [AST], [ALT] may indicates metastasis to the liver. ,
Lactate dehydrogenase level (LDH) An elevated alkaline phosphatase level may suggests metastasis to bone or liver. , Lactate dehydrogenase level (LDH)
An elevated alkaline phosphatase level may suggests metastasis to bone or liver. ,

Management - Supportive

Fact Explanation
Educate the patient and family The breaking bad should be done in a sensitive and effective way. Explain to patient that melanoma is a skin cancer which can be treated successfully in many cases. Discuss about available treatment options, possible side effects. ,, Educate the patient and family
The breaking bad should be done in a sensitive and effective way. Explain to patient that melanoma is a skin cancer which can be treated successfully in many cases. Discuss about available treatment options, possible side effects. ,,

Management - Specific

Fact Explanation
Surgical excision Surgical excision, with minimal delay, is required. A minimal of 0.5cm clearance for melanomas insitu and 1cm clearance is required in invasive melanomas. Nowadays many surgeons excise 1cm of normal skin around the tumor for every millimeter of tumor thickness, up to 3mm. ,,,, Surgical excision
Surgical excision, with minimal delay, is required. A minimal of 0.5cm clearance for melanomas insitu and 1cm clearance is required in invasive melanomas. Nowadays many surgeons excise 1cm of normal skin around the tumor for every millimeter of tumor thickness, up to 3mm. ,,,,
Lymph node dissection Patients with lymphadenopathy with no evidence of distant metastasis must undergo complete regional lymph node dissection. ,,,, Lymph node dissection
Patients with lymphadenopathy with no evidence of distant metastasis must undergo complete regional lymph node dissection. ,,,,
Chemotherapy In treatment of advanced stage melanoma combination regimens are used. Cisplatine, Vinblastine, DTIC , Carmustine & Tamoxiten are included in commonly used regimens. ,,,, Chemotherapy
In treatment of advanced stage melanoma combination regimens are used. Cisplatine, Vinblastine, DTIC , Carmustine & Tamoxiten are included in commonly used regimens. ,,,,
Radiotherapy External beam radiation is effective in brain metastasis. ,,,, Radiotherapy
External beam radiation is effective in brain metastasis. ,,,,
Immunotherapy Interferon alpha is used for adjunctive therapy after excision who have high risk of recurrence. Granulocyte - macrophage colony stimulating factor used to adjunctive therapy to treat melanoma of stage III and IV . ,,,, Immunotherapy
Interferon alpha is used for adjunctive therapy after excision who have high risk of recurrence. Granulocyte - macrophage colony stimulating factor used to adjunctive therapy to treat melanoma of stage III and IV . ,,,,
Vaccines Treatment with melanoma specific antigen vaccines has a role as adjunct to surgery in patients at TNM stage 11 and 111. ,,,, Vaccines
Treatment with melanoma specific antigen vaccines has a role as adjunct to surgery in patients at TNM stage 11 and 111. ,,,,

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