Malignant Melanoma

MALIGNANT MELANOMA


MALIGNANT MELANOMA (MELANOCARCINOMA)

  • Malignant melanoma is a malignant tumour arising from epidermal melanocyte derived from neural crest.
  • Most aggressive cutaneous malignant tumour.
  • DOPA REACTION-

SITES FOR MALIGNANT MELANOMA-

  • Head & neck
  • Lower extremity
  • Trunk
  • Upper limb
  • Choroid of the eye
  • Genetalia
  • MC site for men- front or back of the trunk
  • MC site for female- leg
  • More common in whites than black

 ETIOLOGY-

  • UV rays
  • Albinism
  • Xeroderma pigmentosa- AR (Chromosome 9q)
  • Genetic factors-

i) Tumour suppressor gene mutation 9q 21

ii) Deletion or rearrangement of chromosome 10 & 8p

iii) Dysplastic naevus syndrome

  • Pre- existing mole
  • Immunocompromised- HIV, Hodgkin’s disease

CLASSIFICATION-

I) Breslow classification-

  • According to maximum thickness at the centre of the lesion-

a) Stage I- thickness less than 0. 75 mm

b) Stage II- 0.75 mm to 1.5 mm

c) Stage III- 1.5 mm to 3.0 mm

d) Stage IV- more than 3 mm

II) Clark’s Classification-

  • According to the basis of the depth of the invasion

a) Stage I- Melanoma restricting to epidermis and appendages

b) Stage II- invading papillary dermis without filling it

c) Stage III- reach interface of papillary and reticular dermis

d) Stage IV- invading reticular dermis

e) Stage V- invading subcutaneous tissue

III) According to clinical types-

a) Lentigo malignant melanoma-

  • Benign
  • MC- face

b) Superficial spreading-

  • MC type
  • MC site- torso

c) Nodular-

  • Most malignant
  • MC site- head, neck, trunk

d) Acral lentiginous-

  • Least common with worst prognosis
  • MC site- sole, mucosa

CLINICAL FEATURES-

  • Can spread from mother to foetus
  • Asymmetry, border irregularity, color variation and diameter >6mm (ABCD)
  • Microsatellites (0.05mm)- separated from main body tumour by normal dermal collagen or subcutaneous fat
  • Macrosatellites associated with increase risk of regional LN
  • MC site of systemic metastasis- liver
  • Choroidal melanoma is the most common primary malignant intraocular tumor and the second most common type of primary malignant melanoma in the body and may produce  exudative retinal detachment.
  • In melanoma cells, numbers of mutations and/or dysregulated expression of B-Rof N-Ras, CDK2A, MDM2, PTEN, p53 have been recognized”

SPREAD-

  • Through lymphatics (MC)
  • In- transit or satellite nodules
  • Through blood 

INVESTIGATIONS-

  • Chest X-ray- cannonball secondaries
  • USG abdomen- secondary in liver
  • FNAC- detects spreading & stages of the disease
  • Serum LDH levels- indicate metastatic disease
  • HHB- 4S- premelanosomal protein is specific immunohistochemical marker for melanoma
  • Full thickness excisional biopsy- confirms MM

TREATMENT-

  • Surgical excision with sentinel LN biopsy
  • Block dissection to be done when sentinel node is involved

Exam Important

According to clinical types-

a) Lentigo malignant melanoma-

  • Benign
  • MC- face

b) Superficial spreading-

  • MC type
  • MC site- torso

c) Nodular-

  • Most malignant
  • MC site- head, neck, trunk

d) Acral lentiginous-

  • Least common with worst prognosis
  • MC site- sole

CLINICAL FEATURES-

  • Can spread from mother to foetus
  • Asymmetry, border irregularity, color variation and diameter >6mm (ABCD)
  • Microsatellites (0.05mm)- separated from main body tumour by normal dermal collagen or subcutaneous fat
  • Macrosatellites associated with increase risk of regional LN
  • MC site of systemic metastasis- liver
  • Choroidal melanoma is the most common primary malignant intraocular tumor and the second most common type of primary malignant melanoma in the body and may produce  exudative retinal detachment.
  • In melanoma cells, numbers of mutations and/or dysregulated expression of B-Rof N-Ras, CDK2A, MDM2, PTEN, p53 have been recognized”

SPREAD-

  • Through lymphatics (MC)
  • In- transit or satellite nodules
  • Through blood

INVESTIGATIONS-

  • Chest X-ray- cannonball secondaries
  • USG abdomen- secondary in liver
  • FNAC- detects spreading & stages of the disease
  • Serum LDH levels- indicate metastatic disease
  • HHB- 4S- premelanosomal protein is specific immunohistochemical marker for melanoma
  • Full thickness excisional biopsy- confirms MM

TREATMENT-

  • Surgical excision with sentinel LN biopsy
  • Block dissection to be done when sentinel node is involved
Don’t Forget to Solve all the previous Year Question asked on MALIGNANT MELANOMA

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