Question
A 65-year-old man comes to the physician because he is worried about a mole on his right forearm. He has had the mole for several years, but it has grown in size in the past 3 months. Physical examination shows a hyperpigmented plaque with irregular borders and small area of ulceration. Histopathologic analysis of a full-thickness excisional biopsy confirms the diagnosis of malignant melanoma. Invasion of which of the following layers of skin carries the highest risk of mortality for this patient?
| A. |
Stratum corneum
|
| B. |
Papillary dermis
|
| C. |
Hypodermis
|
| D. |
Stratum basale
|
Show Answer
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Correct Answer � C
Explanation
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Answer C) Hypodermis
Tumor thickness is one of the most important prognostic factors for malignant melanoma.
Hypodermis
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The hypodermis (subcutis) is the deepest layer of the skin, and melanoma mortality is directly correlated with tumor thickness.
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Due to variability in the thickness of skin compartments among different individuals, tumor thickness does not always correspond with skin layer invasion.
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However, in this patient it is likely that a tumor extending into the hypodermis is thicker than a tumor in a more superficial layer.
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Breslow depth is the most important prognostic factor used for melanoma staging and to determine the safety margin of a full-thickness incision.
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