Malignant Melanoma

	Skin Cancer
		Malignant Melanoma General Points Freckles Nevi Atypical Nevi Melanoma ABCDs of melanoma superficial spreading melanoma nodular melanoma lentigo maligna melanoma Treatment General Points malignant melanoma arises from the melanocyte, whereas basal cell carcinoma and squamous cell carcinoma arise from the keratinocyte damaged melanocytes can die or manifest that damage as freckles, nevi, atypical nevi, or melanoma
	Freckles	Freckles all are from sun damage indicate a profound degree of damage to the skin, but in themselves are not known to become malignant
	Life cycle of a nevus	Nevi result of cell division, leading to an increased number of melanocytes nests of melanocytes can be located entirely at dermal-epidermal junction (junctional nevus), both the epidermis and dermis (compound nevus), or entirely within the dermis (dermal nevus) in childhood, nevi are typically junctional, and evolve through life to become dermal melanocytes migrate into the dermis, and many of them disappear through apoptosis number of common nevi is the most significant predictor of melanoma risk > 100 nevi suggests a melanoma risk of at least 1 in 10 (vs 1:90)
	Atypical Nevus Atypical Nevus Atypical Nevus Atypical Nevus Atypical Nevus	Atypical Nevi a subset of nevi that show considerable variation in edge and color variation in color implies variable melanin production tend to remain very flat and youthful, extending sideways to a size typically > 6 mm, implying an inability to mature through the evolutionary sequence of junctional to compound to dermal nevi are at significant risk for developing melanoma tendency towards many atypical nevi can be inherited as an autosomal dominant trait, the dysplastic nevus syndrome highly atypical nevi should be excised to prevent melanoma developing
	Superficial Spreading Melanoma Superficial Spreading Melanoma Superficial Spreading Melanoma Nodular Melanoma Nodular Melanoma Lentigo Maligna Lentigo Maligna	Melanoma ABCD’s of melanoma: Asymmetry Border Color Diameter superficial spreading melanoma nevi, when they become melanomas, usually become superficial spreading melanomas superficial spreading melanomas show a morphology of considerable variation in edge and color, like a very severely atypical nevus nodular melanoma seems to arise without an obvious precursor lesion in other words, the atypical melanocyte may evolve directly into a melanoma, rather than through the process of increasingly abnormal nevi approximately 10% of melanomas are nodular melanomas lentigo maligna melanoma arises in an expanding brown patch called a lentigo maligna lentigo maligna is not a nevus there are no nests of melanocytes instead, abnormal melanocytes progressively extend along the dermal-epidermal junction, often for many years this expanding brown patch is most common on areas of maximal sun exposure such as the face etiology is different from that of other types of melanoma, and is similar to that of squamous carcinoma approximately 10% of melanomas arise in lentigo maligna clinically, is a nodule appearing within the longstanding brown patch Treatment for malignant melanoma surgical management is primary therapy primary cancer excised with 1 to 3 cm surgical margin risk of systemic spread correlates with the thickness of the tumor