Melanoma

• Epidemiology
  • This cancer is usually solar induced, and is extremely deadly. It is curable if caught early. The lifetime risk for Americans is 1 in 71, and this risk is rising.
     
• Prognosis
  • Tumor thickness is related to melanoma prognosis. Thickness is measured on a vertical scale from to top of the granular layer to the deepest tumor. Microscopic ulceration is the second most important factor. Staging of the tumor (categorizing the stage of growth) is based on these two factors. One must always worry about metastasis as these are generally very invasive tumors.
     

• ABCD Criteria
  • Look for these things in a lesion to characterize it as melanotic.
    • Asymmetry
    • Border Notching
    • Color Variegation (red, white and blue hues)
    • Diameter more than 6mm

• Types
  • Lentigo Maligna melanoma
    • This type of cancer makes up 5-15% of all melanomas.
    • Derived from an in situ lentigo maligna, this is a slow growing neoplasia that typically appears on the face and arms of the elderly.
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  • Superficial Spreading melanoma
    • This type is the most common of all melanomas (70%).
    • Due to sun exposure, it often appears on the trunk in men and women, as well as on the legs in women. It presents with a play of colors (blue, brown, white, black, etc.) and is characterized by irregular asymmetric borders.
      
      
       
  • Nodular melanoma
    • 15-30% of all skin melanomas (one of the lesser common ones)
    • A rapid growing lesion, most commonly appears on the legs and trunk. Presents as a dark colored nodule that may be friable (bleeds easily).

    
     

  • Acrolentiginous melanoma
    • This melanoma is not as common as the others, but makes up a large percentage of the melanomas found in dark-complexioned persons.
    • It is often seen on the palms, soles and subungal (beneath the nail). There is diffuse nail discoloration with longitudinal bands and pigment spread to and beyond the proximal and lateral nail folds.

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