Malignant Melanoma Quiz

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Questions and Answers

What characteristic is NOT typically associated with malignant melanoma?

Absence of mitotic activity

Lack of necrosis

Circumscription and symmetry

Irregular cellular density (correct)

Which feature distinguishes dysplastic nevus from other nevi?

Uniform cellular density

Bridging rete ridges with atypical melanocytes (correct)

Small melanocyte nuclei

Lack of mitotic activity

What is the significance of congenital melanocytic nevi in relation to malignant melanoma risk?

They are completely benign with no risk

They indicate a higher risk if present at birth (correct)

They have a low propensity for melanoma development

They are always dysplastic

What is the lifetime risk for developing malignant melanoma in individuals with Familial atypical multiple mole and melanoma syndrome?

100% Signup and view all the answers

In which type of nevus is there a notable decrease in melanocyte size towards the base of the lesion?

Malignant melanoma Signup and view all the answers

What is the most significant factor influencing the prognosis of melanoma?

Depth of invasion Signup and view all the answers

What is the optimal surgical margin for a pT1 melanoma measuring 4.0 mm in thickness?

2 cm Signup and view all the answers

Which characteristic is NOT associated with the radial growth phase of melanoma?

Increased melanocyte proliferation Signup and view all the answers

What percentage of skin tumor deaths are attributed to melanoma?

75% Signup and view all the answers

How thick must melanoma be to be classified as pTis (in situ)?

It has no thickness restriction Signup and view all the answers

Which type of skin neoplasm is characterized by abnormal melanocytes in the upper layer of the dermis?

Melanoma Signup and view all the answers

At what median age is melanoma most commonly diagnosed?

59 years Signup and view all the answers

What is a feature of superficial spreading malignant melanoma?

Cytologic atypia and nuclear pleomorphism Signup and view all the answers

What is the most common type of skin cancer?

Basal cell carcinoma Signup and view all the answers

Which histological feature is most commonly associated with basal cell carcinoma?

Peripheral palisading of nuclei Signup and view all the answers

Which subtype of basal cell carcinoma is characterized by a tendency to infiltrate deeply?

Micronodular BCC Signup and view all the answers

What is a major risk factor for developing basal cell carcinoma?

Chronic sun exposure Signup and view all the answers

Which type of basal cell carcinoma is described as having pink or red scaly irregular plaques?

Superficial BCC Signup and view all the answers

Which description is correct regarding the nodular basal cell carcinoma?

Typically appears as a shiny, skin-colored or pinkish lump Signup and view all the answers

What histological features are almost always present in basal cell carcinoma?

Cleft-like retraction spaces Signup and view all the answers

In which location is basal cell carcinoma most commonly found?

Head and neck Signup and view all the answers

What is the Breslow depth used to measure in melanoma?

Thickness from the granular cell layer to the deepest dermal extension Signup and view all the answers

Which melanoma type is most commonly found in the white-skinned population?

Superficial spreading melanoma Signup and view all the answers

What histologic feature is associated with melanoma?

Increased apoptosis Signup and view all the answers

Which of the following characteristics is associated with nodular melanoma?

Commonly ulcerates and bleeds Signup and view all the answers

In which demographic is acral lentiginous melanoma most frequently observed?

Black and Asian populations Signup and view all the answers

What is the significance of microsatellitosis in melanoma?

Suggests potential for metastasis Signup and view all the answers

What is a common misdiagnosis for subungal melanoma?

Infections or trauma Signup and view all the answers

Why is diagnosis of amelanocytic melanoma often missed?

Due to the rapid growth of the tumor causing lack of pigmentation Signup and view all the answers

What is the prognosis for a squamous cell carcinoma that is less than 1.5 cm deep?

Excellent with uncommon metastasis Signup and view all the answers

Which treatment is typically recommended for squamous cell carcinoma?

Surgical excision with adequate margins Signup and view all the answers

What is a distinguishing feature of seborrheic keratosis on the skin?

Thickened epidermis and granular surface Signup and view all the answers

Which type of skin lesion is very rare in black individuals?

Squamous cell carcinoma Signup and view all the answers

What indicates a potential malignant transformation in numerous seborrheic keratosis lesions?

Leser-Trélat sign Signup and view all the answers

What is the most common site for metastasis in squamous cell carcinoma that is 2 cm or more in depth?

Lung Signup and view all the answers

What characteristic is NOT typical of actinic keratosis?

Surface texture is greasy Signup and view all the answers

What feature is typically seen in melanoma in situ?

Atypical melanocytes in the epidermis Signup and view all the answers

Study Notes

Dermatopathology - Benign and Malignant Tumors

The lecture covered the diagnostic features of pigmented skin neoplasms (e.g., melanocytic nevus, melanoma, other pigmented lesions) and epidermal and dermal neoplasms (e.g., squamous cell carcinoma (SCC), basal cell carcinoma (BCC)).

Objectives

Students should be able to identify and discuss the diagnostic features of pigmented skin neoplasms and epidermal/dermal neoplasms by the end of the lecture.

Skin Layers

The epidermis is comprised of multiple strata (layers):
- Stratum corneum
- Stratum granulosum
- Stratum lucidum
- Stratum spinosum
- Stratum basale
The dermis lies beneath the epidermis and contains connective tissue.
- Papillary dermis
- Reticular dermis

Melanoma Case Study

A 52-year-old woman presented with a 5 mm pigmented papule on her right hand.
Six months later, the size of the lesion changed to 1.5 cm.
Histological examination of the lesion revealed abnormal melanocytes in the upper layer of the dermis.
The presence of an in-situ component and superficial spreading malignant melanoma were also noted.
The diagnosis of superficial spreading malignant melanoma was made.

Melanoma - Statistics

Approximately 122,000 new cases of melanoma are diagnosed annually.
Melanoma accounts for roughly 75% of skin cancer deaths.
About 8,700 people die from melanoma each year.
The median age of melanoma diagnosis is 59 years.
Melanoma is a leading malignancy in young adults (25-29 years old).

Melanoma - Characteristics

Atypical characteristics include asymmetry, irregular borders, varied colors, and a diameter exceeding 6 mm.

Melanoma - Growth Phases

Radial growth phase: Characterized by the lack of maturation, cytological atypia and nuclear pleomorphism, with mitoses commonly occurring in the dermis.
Vertical growth phase: Continued growth with apparent descent, cytological atypia and nuclear pleomorphism with mitoses and atypicality.

Melanoma - Prognostic Indicators

Thickness (Breslow depth) : The distance from the granular cell layer to the deepest dermal extension, in millimeters.
Ulceration
Mitotic rate (mitoses/mm²)
Microsatellitosis
Neurotropism
Angiolymphatic invasion

Melanoma - Stage and Margins

pTis (in situ): 5 mm margin
pT1 (<1.0 mm): 1 cm margin
pT2 (1.0-2.0 mm): 1-2 cm margin
pT3 (2.0-4.0 mm): 1-2 cm margin
pT4 melanoma (>4.0 mm): 2 cm margin
A wider margin (2 cm) is generally preferred, whenever feasible, considering the tumor site and patient/surgeon preference.

Melanoma - Histologic Features

Lack of maturation with descent
Cytologic atypia and nuclear pleomorphism
Large and irregular nucleoli
Deep dermal, often atypical mitosis
Increased apoptosis

Melanoma - Types

Superficial spread: Most common in white-skinned individuals (approximately 70% of cases); often occurs on the lower legs of female patients and the back of male patients. Usually initially small then grows irregularly.
Nodular: Typically common in male patients, frequently found on the trunk. Often displays a poor prognosis. Characterized by a black/brown nodule. Ulceration and bleeding are frequently observed.
Lentigo maligna: Primarily affecting elderly patients, this melanoma originates on the face. An invasive nodule may take years to develop.
Acral lentiginous: Common in Black and Asian populations. Makes up 10% of melanoma in white-skinned people. Generally presents as a flat lesion.
Subungal: Rare, often diagnosed late due to misdiagnosis with benign subungual nevi or infections.
Conjunctival: Found in the conjunctiva (lining of the eyelids).
Amelanocytic: Diagnosis is frequently missed because it lacks pigmentation; this is due to the rapid growth and differentiation of malignant melanocytes.
Metastatic: Often characterized by satellitosis near the primary melanoma and distant metastases which may present as non-pigmented papules or plaques.

Case Study - Non-melanocytic Neoplasm

A 67-year-old male presented with a 12 mm round nodular pearly lesion on his cheek for 6 months.
The lesion displayed dilated subepidermal blood vessels (telangiectasias)
Repeated washing caused the crust of the lesion to peel off; causing the lesion to bleed

Basal Cell Carcinoma (BCC)

Highly common skin cancer, originating from basal cells of the epidermis.
Chronic sun exposure is the key risk factor.
Commonly appears as a translucent or pearly nodule or plaque on the head and neck of the elderly.
BCC grows slowly; usually locally destructive and recurs, but rarely metastasizes.

BCC - Types

Superficial: Predominantly occurs in younger patients as multiple multicentric patches; appearing as a pink/red scaly area which bleeds or ulcerates easily; Often multiple.
Micronodular: Infiltrates deeply often as multiple nodular areas.
Nodular: Usually affects the face. Characterized by a small, shiny and pinkish/skin-coloured lump. Often blood vessels are seen crossing the surface.
Pigmented: Displays a brown/greyish discoloration, histology may mimic malignant melanoma (differentiation via immunohistochemistry is crucial)
Pleomorphic: Shows variable cell types and sizes.
Sclerosing: prone to recurrence post-treatment and may infiltrate the cutaneous nerves (perineural spread).
Infiltrative growth: Shows a spreading pattern of growth; this type can infiltrate cutaneous nerve tissue.

BCC - Histological Features

Most frequently displays an epidermal attachment; with clusters (nests or lobules) of uniform hyperchromic basaloid cells, exhibiting peripheral palisading; surrounded by loose stroma
Cleft-like retraction spaces.
Potentially discoloured by dermal melanophages

Actinic Keratosis

Sun-damaged skin on the scalp of elderly men.
Highlighted as a precursor to squamous cell carcinoma (SCC), characterized by atypical and crowded keratinocytes in the lower epidermis.
Presence of parakeratosis (nucleated keratin layer)
Presence of orthokeratosis(non-nucleated keratin layer).
Hair follicles exhibit atypical epidermal keratinocytes..
Elastosis in the dermis.
Can lead to a non-healing ulcer in the center.

Squamous Cell Carcinoma (SCC)

Typically affects men and is less frequent in Black people.
Slow-growing; locally invasive and generally does not spread beyond local lymph nodes.
Approximately 5% of patients show evidence of node positivity at the time of diagnosis.
Exceptional prognosis; metastases is uncommon if tumor is under 1.5 cm of depth.
5% chance for metastasis when lesion is over 2cm and dermal invasion is evident.
Lung is the typical metastasis site.
Treatment is generally surgical excision with adequate margins.

Other Pigmented Lesions

A 55-year-old patient presented with firm brown papules on his back, 14 mm in diameter, raised 3 mm above the normal skin level.
No bleeding, itching or pain is noted.
The lesions are characterized by being dark-brown, and greasy- appearing.

Seborrheic Keratoses

Thickened epidermis (acanthosis) with inter-connections, basaloid cells and pseudocysts; surrounded by squamous cells
Commonly found in middle-aged and elderly individuals

Leser-Trélat Sign

Explosively emerging numerous skin lesions, requiring further investigation

Summary of Neoplastic Skin Diseases

Pigmented skin neoplasms (melanocytic nevus, melanoma, other pigmented lesions)
Epidermal and dermal neoplasms (BCC, SCC)

Additional Information

Skin with sun damage (solar elastosis)
Images of various skin conditions, including different types of BCC, melanoma, and actinic keratosis, were presented.

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Description

Test your knowledge on malignant melanoma and its characteristics. This quiz covers essential topics such as melanoma types, risk factors, and prognosis. Perfect for students and professionals in dermatology and oncology.