Dermatology Book

http://www.fpnotebook.com/

Melanoma

Advertisement

  1. See Also
    1. Ocular Melanoma
    2. Subungual Melanoma
  2. Epidemiology
    1. Deaths: 7700 per year in United States predicted 2005
      1. Sixth leading cause of death in United States
    2. Incidence: 59,580 new U.S. cases estimated for 2005
    3. Increasing Incidence
      1. Has doubled every 10 years (related to ozone deplete)
      2. One in 74 Americans develop melanoma yearly
    4. Median age of diagnosis: 57
  3. Risks
    1. See Melanoma Risk Factors
  4. Precursor Lesions
    1. Lentigo maligna
    2. Congenital neoplastic nevi
    3. Clark's (dysplastic) melanocytic nevi
  5. Classification (melanoma is melanoma)
    1. Superficial spreading melanoma (SSM): 70% of melanoma
    2. Nodular Melanoma (NM): 15% of melanoma
    3. Acral lentiginous melanoma (ALM): 8% of melanoma
    4. Lentigo maligna melanoma (LMM): 5% of melanoma
  6. Differential Diagnosis
    1. Seborrheic Keratosis
    2. Irritated nevus
    3. Pigmented Basal Cell Carcinoma
    4. Lentigo
    5. Blue nevus
    6. Angiokeratoma
    7. Traumatic hematoma
    8. Venous lake
    9. Hemangioma
    10. Dermatofibroma
    11. Pigmented Actinic Keratosis
  7. Lab: Histology
    1. Clark's Level
      1. Level 1: Epidermis
      2. Level 2: Reaches papillary Dermis
      3. Level 3: Fills papillary Dermis
      4. Level 4: Enters reticular Dermis
      5. Level 5: Penetrates subcutaneous fat
    2. Five-year survival related to tumor depth
      1. Survival 99%: Depth < 0.85mm
      2. Survival 80%: Depth 0.85 to 1.69mm
      3. Survival 70%: Depth 1.70 to 3.64mm
      4. Survival 40%: Depth > 3.65mm
  8. Staging (AJCC)
    1. Localized
      1. Stage IA
        1. Thickness <0.75 mm (96% overall survival)
      2. Stage IB
        1. Thickness 0.76 to 1.5 mm (87% overall survival)
      3. Stage IIA
        1. Thickness 1.5 to 2.49 mm (75% overall survival)
        2. Thickness 2.5 to 3.99 mm (66% overall survival)
      4. Stage IIB
        1. Thickness >3.99 mm (47% overall survival)
    2. Metastatic
      1. Stage III: Regional node metastases
        1. One node involved (45% overall survival)
        2. Two nodes involved (<20% overall survival)
      2. Stage IV: Distant metastases
        1. One year survival: 8 to 10%
  9. Systemic evaluation for melanoma metastases
    1. Lymph Node exam
    2. Full skin exam
    3. Chest XRay
    4. Complete Blood Count (CBC)
    5. Chemistry Panel (Chem7, SMA7)
    6. May require CT Head, chest and abdomen
  10. Management
    1. Surgical excision
      1. Local excision with clear margins
        1. Melanoma in situ: Margin 0.5 cm
        2. Breslow thickness <1 mm: Margin 1 cm
        3. Breslow thickness >1 mm: Margin 2 cm
        4. Wide margins (>3 cm) no longer recommended
      2. Lymph node biopsy indicated if Breslow thickness >1mm
        1. Sentinel Node biopsy for Breslow thickness 1-4 mm
    2. Interferon alfa-2b (Intron A)
      1. Effective in increasing relapse-free survival
      2. Wheatley (2003) Cancer Treat Rev 29:241
  11. Defusing Myths
    1. Hairy moles do NOT differentiate benign from malignant
    2. Do not prophylacticly biopsy benign appearing moles
    3. Incisional Biopsy into melanoma does NOT spread tumor
  12. Prevention
    1. Follow-up Immediately for:
      1. Pruritic nevus
      2. Atypical Nevus Signs
    2. Frequent skin exams for high risk or melanoma history
      1. Thickness <1 mm and no Atypical Nevus syndrome or FHx
        1. Follow-up every six months for 2 years, then
        2. Follow-up yearly
      2. Thickness >1 mm or Clark's Level IV
        1. Chest XRay and Liver Function Tests q6-12 months
        2. Follow up every 3-6 months for 3 years, then
        3. Follow up every 6-12 months for 2 years, then
        4. Follow-up annually
      3. Clark's Level III or IV
        1. Chest XRay, CBC, Liver Function Tests q3-12 months
        2. Follow up every 3-6 months for 3 years, then
        3. Follow up every 4-12 months for 2 years, then
        4. Follow-up annually
  13. Prognosis
    1. See Histology and Staging above
    2. Survival rates are better in women
    3. Relative Risk of developing a second primary tumor: 10
  14. References
    1. Fauci (1998) Harrison's Medicine, 14th ed., McGraw-Hill
    2. Goldstein (2001) Am Fam Physician 63(7):1359
    3. Houghton (1998) Oncology 12:153
    4. Landis (1999) CA Cancer J Clin 49:8
    5. Rager (2005) Am Fam Physician 72:269

melanoma (C0025202)

Definition (MSH)A malignant neoplasm derived from cells that are capable of forming melanin, which may occur in the skin of any part of the body, in the eye, or, rarely, in the mucous membranes of the genitalia, anus, oral cavity, or other sites. It occurs mostly in adults and may originate de novo or from a pigmented nevus or malignant lentigo. Melanomas frequently metastasize widely, and the regional lymph nodes, liver, lungs, and brain are likely to be involved. The incidence of malignant skin melanomas is rising rapidly in all parts of the world. (Stedman, 25th ed; from Rook et al., Textbook of Dermatology, 4th ed, p2445)
Definition (CSP)malignant neoplasm derived from cells that are capable of forming melanin, which may occur in the skin of any part of the body, in the eye, or, rarely, in the mucous membranes of the genitalia, anus, oral cavity, or other sites; occurring mostly in adults and may originate de novo or from a pigmented nevus or malignant lentigo; frequently metastasize widely, and the regional lymph nodes, liver, lungs, and brain are likely to be involved.
Definition (NCI)A form of skin cancer that arises in melanocytes, the cells that produce pigment. Melanoma usually begins in a mole.
Definition (NCI)A malignant, usually aggressive tumor composed of atypical, neoplastic melanocytes. Most often, melanomas arise in the skin (cutaneous melanomas) and include the following histologic subtypes: superficial spreading melanoma, nodular melanoma, acral lentiginous melanoma, and lentigo maligna melanoma. Cutaneous melanomas may arise from acquired or congenital melanocytic or dysplastic nevi. Melanomas may also arise in other anatomic sites including the gastrointestinal system, eye, urinary tract, and reproductive system. Melanomas frequently metastasize to lymph nodes, liver, lungs, and brain.
ConceptsNeoplastic Process (T191)
EnglishMalignant Melanoma, Malignant Melanomas, melanoma, Melanoma - malignant, MELANOMA MALIGNANT, Melanomas, Melanosarcoma, MM - Malignant melanoma
Spanishmelanoma, melanoma maligno
Parent ConceptsMalignant neoplasm of skin (C0007114), Skin Neoplasms (C0037286), Neuroendocrine Tumors (C0206754), Nevi and Melanomas (C0206769), Melanocytic neoplasm (C1302746), Common Neoplasm (C1333132), adult solid tumor (C0280099), Malignant Neoplasms (C0006826), Malignant melanoma - category (C0431097), Primary malignant neoplasm (C1306459), Ambiguous concept (C1274012)
SourcesAOD, COSTAR, CSP, CST, DXP, LCH, MEDLINEPLUS, MSH, MTH, NCI, NDFRT, OMIM, PDQ, SCTSPA, SNOMEDCT
Derived from the NIH UMLS (Unified Medical Language System)



Navigation Tree