Lecture 8 Part 1

Podcast

Play an AI-generated podcast conversation about this lesson

Questions and Answers

What border characteristic is typically associated with melanoma?

Fuzzy and blurred border

Irregular and sharp border (correct)

Regular and smooth border

Rough and uneven border

Which color variations are particularly worrisome in melanoma identification?

Black, blue, or gray (correct)

Red and yellow

Green and orange

Pink and white

What is considered the most useful feature for identifying concerning lesions?

Presence of crusting

Color (correct)

Border sharpness

Size (diameter)

Which statement is true regarding the size of melanomas?

Most melanomas are over 5 mm in diameter Signup and view all the answers

What does the Ugly Duckling Rule imply in melanoma assessment?

Lesions that are significantly different should be biopsied Signup and view all the answers

Which feature is a concerning sign of a subungual melanoma?

Color extending beyond the nail onto surrounding skin Signup and view all the answers

What should be done when a melanoma is suspected?

Surgically remove the entire visible lesion Signup and view all the answers

What genetic alteration is most commonly associated with melanoma?

Mutation of the CDKN2A gene Signup and view all the answers

What is the prognosis for melanoma that extends 1 mm or less into the dermis?

90% 10-year survival Signup and view all the answers

What happens to survival rates if the melanoma surface is ulcerated?

Survival rates drop significantly Signup and view all the answers

Which procedure is recommended if there are no palpable lymph nodes in a melanoma patient?

Sentinel lymph node biopsy (SLNB) Signup and view all the answers

What is the incorrect treatment option for melanoma ≤1 mm deep?

Require extensive imaging studies Signup and view all the answers

What is the goal of the primary excision of melanoma?

To obtain a diagnosis and determine the depth Signup and view all the answers

At what depth of melanoma does the 10-year survival rate drop to 60%?

2-4 mm Signup and view all the answers

What is the initial removal of the melanoma called?

Primary excision Signup and view all the answers

What is done to ensure the melanoma is completely excised during re-excision?

A rim of normal skin is also removed Signup and view all the answers

What is the estimated lifetime risk of developing melanoma for individuals born today?

1 in 75 Signup and view all the answers

Which type of melanoma is the most common?

Superficial spreading melanoma Signup and view all the answers

In which groups is melanoma risk higher due to sun exposure?

Individuals living near the equator Signup and view all the answers

Which of the following types of melanoma typically presents as raised lesions?

Nodular melanoma Signup and view all the answers

What condition increases the melanoma risk for an individual?

Having a first-degree relative with melanoma Signup and view all the answers

Acral melanomas typically appear on which areas of the body?

Palms and soles Signup and view all the answers

Which feature is a key indication of a melanoma when comparing it to a mole?

Irregular pigmentation Signup and view all the answers

What type of melanoma is associated with extremely sun-damaged skin in elderly patients?

Lentigo maligna melanoma Signup and view all the answers

What is the lifetime risk of developing melanoma for individuals born today?

1 in 75 Signup and view all the answers

What characterizes nodular melanoma compared to superficial spreading melanoma?

It presents as a raised lesion. Signup and view all the answers

Which group is at higher risk of developing melanoma due to sun exposure?

Individuals with light pigmentation Signup and view all the answers

In which part of the body are men most likely to have melanomas?

Upper back Signup and view all the answers

What is a significant risk factor for melanoma related to family history?

Having a first degree relative with melanoma Signup and view all the answers

What feature distinguishes melanoma from a typical mole?

Pronounced irregularity Signup and view all the answers

Where do acral melanomas typically appear on the body?

On the palms and soles Signup and view all the answers

What is the ten-year survival rate for melanoma that extends between 1 to 2 mm into the dermis?

80% Signup and view all the answers

What is the recommendation for patients with melanoma greater than 1 mm deep who do not have palpable lymph nodes?

Perform a sentinel lymph node biopsy. Signup and view all the answers

What significantly affects the prognosis of melanoma in addition to its depth?

Surface ulceration. Signup and view all the answers

What is the ten-year survival rate for melanoma that penetrates 2 to 4 mm into the dermis?

60% Signup and view all the answers

What is the correct procedure when a melanoma is diagnosed and measures less than or equal to 1 mm deep?

Complete excision is the only treatment required. Signup and view all the answers

What is an important step following the primary excision of melanoma?

Close follow-up visits. Signup and view all the answers

What is the purpose of a re-excision after the initial melanoma diagnosis?

To ensure the melanoma is completely excised. Signup and view all the answers

What happens to the survival rate if a melanoma metastasizes?

Prognosis becomes extremely poor. Signup and view all the answers

What is the most distinguishing characteristic of the borders of a melanoma compared to a typical nevus?

Melanomas have irregular but sharp borders. Signup and view all the answers

Which color feature in melanoma is considered extremely concerning?

Areas that are black, blue, or gray. Signup and view all the answers

What should be done if a clinician notices a lesion that is significantly different from a patient's other moles?

Biopsy the lesion immediately. Signup and view all the answers

What is the most important feature to monitor for changes in a melanocytic lesion?

Color change. Signup and view all the answers

What is generally noted about the size of melanomas compared to nevi?

Most melanomas are over 5 mm, but not always. Signup and view all the answers

What is the role of the CDKN2A gene in melanoma?

It encodes proteins involved in cell cycle regulation. Signup and view all the answers

What is a critical aspect to consider when evaluating a changing lesion suspected of being a melanoma?

The rate of color and size change over time. Signup and view all the answers

Study Notes

Melanoma

Melanoma is uncommon but the lifetime risk for individuals born today is roughly 1 in 75.
Sun exposure is a risk factor. Individuals living closer to the equator are at higher risk.
Family history is also a significant risk factor, particularly in families with numerous atypical moles.
Dysplastic nevus syndrome is a condition where multiple family members have melanoma or numerous atypical moles, significantly increasing the risk.
Melanoma is divided into four types: superficial spreading, nodular, acral, and lentigo maligna.
Superficial spreading melanoma: the most common type, presenting as a flat, irregularly pigmented macule or plaque.
Nodular melanoma: the second most common type, characterized by raised, often ulcerated lesions.
Acral melanomas: usually flat, brown or black lesions on the palms and soles.
Lentigo maligna melanomas: develop on sun-damaged skin (often the face) in elderly individuals; appearing as large, irregular brown lesions.
Atypical moles share characteristics with melanoma, but melanoma features are typically more pronounced.
ABCDEs of Melanoma: a useful mnemonic device:
- Asymmetry: one half is different from the other
- Border: irregular, not smooth
- Color: varying shades of black, blue, brown or gray, with irregular coloration common.
- Diameter: usually greater than 5mm (although this can vary)
- Evolution: changes in size, shape, or color over time.

Melanoma Features

Size (Diameter): Melanomas are often over 5mm in diameter, though this is not always the case.
Change (Evolution): Changes in a mole are a primary concern. Quick changes to preexisting moles are far more problematic than stable moles.
Color: Pigmentation can vary, including black, blue, gray, with multiple different shades of brown (potentially worrisome).
Ugly Duckling Rule: When multiple moles are present, similar characteristics should be seen across most. Significant differences in characteristics (size, color, or border) should raise suspicion.
Subungual Melanomas: Look like subungual hematomas (under the nail) but not growing with the nail. Problems arise if color extends beyond the nail onto the surrounding skin.

Melanoma Prognosis

Melanoma in situ (confined to the epidermis): 100% curable with complete excision.
Depth of melanoma (mm): determines the likelihood of survival if melanoma is present (extending into the dermis),
1 mm or less: 90% 10-year survival
1-2 mm: 80% 10-year survival
2-4 mm: 60% 10-year survival
4 mm or more: 50% 10-year survival
Ulceration lowers survival rates, regardless of depth.
Micrometastases in lymph nodes are an extreme concern following metastasis.

Melanoma Diagnosis and Treatment

Primary and re-excision: removing and testing the lesion for precise diagnosis and determining depth.
Rim of normal tissue: around the primary excision site
Determining depth based on thickness (<1mm = small, 1-2mm=medium, >2mm=large)
Sentinel lymph node biopsy (SLNB): indicated for Stage 2 or greater melanomas that are >1mm, determined if lymph nodes are involved (palpable, to determine biopsy needed.)

Studying That Suits You

Use AI to generate personalized quizzes and flashcards to suit your learning preferences.

Description

Test your knowledge about melanoma, its types, and risk factors. This quiz covers essential information regarding the risk of melanoma related to factors such as sun exposure and family history. Understand the differences between the various types of melanoma, including superficial spreading and nodular melanoma.