M EL ANO M A

Noverissa V. Torralba
 OUTLINE
01 02 03
INTRODUCTION CLINICAL SUBTYPES ETIOLOGY &
Definition Cutaneous and PATHOGENESIS
Epidemiology Noncutaneous findings
Complications

04 05 06
DIAGNOSIS CLASSIFICATION & MANAGEMENT
STAGING
MELANOMA

● Malignant tumor
● Cutaneous melanoma - most frequent type

“ tumor of people with fair skin”

MELANOMA

Source: https://www.cancerresearchuk.org/health-professional/cancer-statistics/statistics-by-cancer-type/melanoma-skin-cancer/incidence
 Superficial spreading
melanoma
Nodular melanoma

02 Lentigo maligna
melanoma
Acral lentiginous
melanoma

CLINICAL SUBTYPES
Cutaneous Findings
SUPERFICIAL SPREADING MELANOMA
Most common Sun-exposed areas:

Associated with
pre-existing nevi
70%
Slowly changing over
months to years
Upper back Lower
extremities
SUPERFICIAL SPREADING MELANOMA

Source: Kang et. al. Fitzpatrick’s Dermatology 9th edition.2019

 NODULAR MELANOMA
Second most common Trunk

Begins de novo

15-30% Rapid evolution

Lacks an apparent
radial growth phase
NODULAR MELANOMA

Source: Kang et. al. Fitzpatrick’s Dermatology 9th edition.2019

LENTIGO MELANOMA & LENTIGO MALIGNA
MELANOMA
Occurrence Chronically
sun-exposed face Cumulative sun
exposure
Melanoma in situ (LM)
10-15%
→ LMM
c-KIT aberrations
LENTIGO MALIGNA MELANOMA

Source: Kang et. al. Fitzpatrick’s Dermatology 9th edition.2019

ACRAL LENTIGINOUS MELANOMA

Occurrence Median age of onset: 65

y.o Sites: sole, palm,
subungual
Not thought to be
associated with sun
60-72% exposure
BRAF, c-KIT
ACRAL LENTIGINOUS MELANOMA

Source: Kang et. al. Fitzpatrick’s Dermatology 9th edition.2019

 ACRAL LENTIGINOUS MELANOMA

Image courtesy of Carl Washington, MD, and Mona Saraiya, MD, MPH, via the Public Health Image Library of the Centers for Disease Control and Prevention. Source: Kang et. al. Fitzpatrick’s Dermatology 9th edition.2019
 DESMOPLASTIC MELANOMA

Sun-exposed areas ● 50% arise in assoc.

with LM
>90%: mutations in NF1
● Higher local recur-
rence but lower nodal
Induced by UV
metastatic rates
radiation
DESMOPLASTIC MELANOMA

Source: Kang et. al. Fitzpatrick’s Dermatology 9th edition.2019

 MUCOSAL MELANOMA

often
ir re g u la r lesion
,
pigmented
● Deeply ig n s of bleeding tion
tumorous w
it h s
: m a c u la r pigmenta
hase
l growth p hould be bio
psied
● Radia u s a r ea s s
→ suspicio l tract melanomas
n: g ita
en
al melanom
as
● Wome : in tr a n a s
genders
● Both
lterations -KIT mutati
ons
● RAS a R A F a n d c
vaginal: B
● Vulvo

Source: Kang et. al. Fitzpatrick’s Dermatology 9th edition.2019

NEVOID MELANOMA

Source: @ProfRScolyerMIA
NEVOID MELANOMA

https://propath.com/clinicopathologic-quiz-case-nevoid-melanoma/
 SPITZOID MELANOMA

Features:
)
➔ Large size (>1 cm
component (>2 Breslow
➔ Thick invasive
thickness)
s
➔ Numerous mitose
th in size or satellitosis
➔ Very rapid grow

Source: https://www.sciencedirect.com/science/article/pii/S1578219019303713#fig0005
SPITZOID MELANOMA

Source: https://www.path.org.uk/wp-content/uploads/Belfast_2017_Speakers_Presentations/Dermatopathology/Derm-3-de-la-Fouchardiere.pdf
 02
● Mucosal
melanomas

● NODAL NEVUS: nevus

cells that have
escaped from
melanocytic nevi of
the skin
CLINICAL SUBTYPES ● UVEAL MELANOMAS
Noncutaneous Findings
 UVEAL MELANOMA
OCCURRENCE

5%

RISK FACTORS
RISK FACTORS:
● Choroidal nevus
MOST COMMON PRIMARY
● A nevus of Ota
● Dysplastic nevus syndrome INTRAOCULAR MALIGNANCY
 RISK FACTORS

Choroidal nevus

Nevus of Ota

Dysplastic nevus
syndrome
 UVEAL MELANOMA
Chief complaint: painless loss
or distortion of vision

RISK FACTORS
RISK OF METASTASES:
● Monosomy 3: poorer clinical
outcome, 75.1% disease-specific
mortality
LIVER METASTASES: most
● Disomy 3 after 5 years: 13.2%
common cause of death
 COMPLICATIONS
PAIN CONVULSION INSTABILITY CUTANEOUS CASO E
Brain Bone
Any metastases metastases Y P O
PER-
-/HY ION
VITILIGO
tases
H T
ENTA
m e t a s PIGM

DIFFUSE AUTOIMMUNE
CUTANEOUS MELANURIA
DERMATOMYO- RETINOPATHIES
SITIS
MELANOSIS
MELANOCY
TIC NEVI
SKIN PHENOTYP
E
03
SUN EXPOSURE
RY
ETIOLOGY &
FAMILY HISTO
PATHOGENESIS
 SUN EXPOS
UV exposure
URE
Susceptibility
to UV light Not all melanomas
are sun related

INTERMITTENT Psoralen
EXPOSURE
HYPOTHESIS UVA and UVB light
Tanning booths
Exposed skin areas have the
highest rates of developing
melanoma The more sunburns in a
lifetime, the higher the
melanoma risk
 SKIN PHENOTYPE
Light skin
pigmentation

Blond or red
hair
Blue or green
eyes
Prominent frec
kling
tendency
Tendency to su
nburn
 MELANOCY
Quantitative &
Qualitative:
TIC NEVI
>50 or >100 typ
ical, any atypic
al
Solitary dyspla
stic nevus

Large congenit
al nevi

Increased risk:
melanoma in the CNS
At risk for
neurocutaneous melanoma
 FAMILY HISTORY
5-12%: Familial melanoma

1 first-degree relative: 2x risk Shared risk factors

MECHANISMS OF INC
RISK WITH GENETIC 3 or more first-degree
ALTERATIONS: relatives: 35-70x risk
● Activation of
oncogenes EARLY-ONSET MELANOMA
● Loss of tumor MULTIPLE PRIMARIES
suppressor
genes ATYPICAL NEVI INCREASED RISK OF
● Increased INTERNAL CANCERS
chromosomal
instability
 04 ● EARLY DETECTION

EARLY CHARACTERISTICS:
★ Change in color
★ Increase in size
★ Presence of new
DIAGNOSIS lesion
 IC A L
PHYS ATION
M I N
EXA
Under optimal
lighting
ss
Encompa
e
the entir
skin
nt
integume

ABCDE acronym
ABCDE acronym
 The “UGLY DUCKLING“ SIGN
Different from the other pigmented
lesions = HIGH INDEX OF SUSPICION A

Within an individual: nevi should

globally share a common
appearance

Multiple atypical nevi: the nevi

should be morphologically similar
DERMOSCOPY
DERMOSCOPY
HISTOLOGY
HISTOLOGY
HISTOLOGY
DIAGNOSTIC ALGORITHM
DIAGNOSTIC ALGORITHM
CLASSIFICATION
CLASSIFICATION
STAGING
STAGING
MANAGEMENT
MANAGEMENT
MANAGEMENT
 Kang et. al. Fitzpatrick’s Dermatology 9th
edition. 2019

https://www.nccn.org/professionals/physician_gls
/pdf/cutaneous_melanoma.pdf

https://www.sciencedirect.com/science/article/pii/
S1578219019303713#fig0005

REFERENCES https://www.cancerresearchuk.org/health-professional/cancer-statistics/statistics-by-cancer-type/melanoma-skin-cancer
/incidence
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