Skin cancers are best divided into melanoma and nonmelanoma.

Melanoma
• Melanoma is a cancerous growth of melanocytes.
• 1 out of 39 men and 1 out of 58 women will be
diagnosed with melanoma during their lifetime.
• Rising incidence is thought to be increasing sun
exposure, especially early in life
• Leading cause of death 1 to 2% of all cancer death
• Largely a disease of whites, low incidence in asian
• 5-10 % of melanoma are familiar. (p16/CDKN2A )
 Melanoma arises from the melanocyte, a neural crest–
derived cell that migrates during embryogenesis predominantly
to the basal layer of the epidermal skin and less commonly to
the other tissues in the body such as mucosa of the upper
aerodigestive and the lower genitourinary tract, the meninges,
and the ocular choroid, where melanoma is rarely encountered.
 Typical tumour progression
• Benign naevus (typical mole) • Vertical growth phase 
– controlled proliferation of – malignant cells invade
melanocytes the basement membrane and
• Dysplastic naevus (atypical mole) proliferate vertically downwards
– abnormal proliferation of into the dermis.
melanocytes resulting in a pre- • Metastasis 
malignant lesion with atypical – malignant cells may spread to
cellular structure. other areas of body. Typically
• Radial growth phase  they travel to regional lymph
– melanomas tend to extend nodes first; but they may
superficially and outwards spead to other areas of the skin /
initially. Melanocytes acquire the soft tissue, or to solid organs
ability to proliferate horizontally (such as the lungs, liver, bone
in the epidermis, but few cells or brain).
invade the papillary dermis.
Clinical Features of Cutaneous Melanoma
(ABCDE)
• Maybe painless or itching and discomfort
• Rarely (<1 %) lack pigment
• In melanoma in situ, the transformed
melanocyte is restricted to the epidermal
layer of skin.
• Invasive melanoma is defined by its invasion
of the dermis quantified by Clark and Breslow.
 Cutaneous melanoma subtypes
SUPERFICIAL SPREADING MELANOMA
• Incidence: Accounts for 70% of all
melanomas, tends to occur in younger
patients (median age, 50)
• Anatomic site: Any; predominantly
trunk and extremities, anatomic sites
associated with intermittent sun
exposure
• Clinical appearance: Change in the
appearance of a large mole, asymmetry,
irregular border, variegated color
(brown, black, pink, white, gray, and
blue), often arising in a precursor mole
• Can be associated with mutation in
BRAF
 Cutaneous melanoma subtypes
NODULAR MELANOMA

• Incidence: Accounts for 15% of

melanomas
• Anatomic site: Any
• Clinical appearance: Rapidly
enlarging, elevated, or polypoid
lesion; often arising in normal skin;
often blue, black, or pink and can be
amelanotic
 Cutaneous melanoma subtypes

LENTIGO MALIGNA MELANOMA

• Incidence: Accounts for 4% to 10% of all
melanoma; tends to occur more
commonly in older patients
• Anatomic site: Areas with chronic
exposure to the sun, head and neck
regions, and distal extremities
• Clinical appearance: Macular (flat)
lesion; arising in a lentigo maligna,
which often appears as a flat, light
brown skin lesion
• Can be associated with mutation in KIT
 Cutaneous melanoma subtypes
ACRAL LENTIGINOUS MELANOMA
• Incidence: 5%–10%
• Anatomic site: Most commonly
on the palms or soles or
subungual (under the nail bed)
• Clinical appearance: Darkly
pigmented, flat to nodular
lesion, highly irregular borders
• Can be associated with
mutation in KIT
 BIOPSI
• A biopsy should be performed on any skin lesion suspected to
be melanoma.
• Adequate biopsy specimens are essential for the diagnosis of
the primary melanoma in order to assess key microscopic
features: Breslow depth or thickness, mitotic rate, and
presence or absence of ulceration.
• Excision of the entire lesion is preferred; partial biopsies
increase the risks of both misdiagnosis (false negative or false
positive) and microstaging inaccuracy (either the biopsy
transects the base of the melanoma or fails to sample the
deepest portion of the melanoma).
Biopsi
 Breslow Thickness
• Breslow used an ocular micrometer to measure the vertical
depth of penetration of tumor from the granular layer of the
epidermis or from the base of the ulcerated melanoma to the
deepest identifiable contiguous melanoma cell.
 Increasing thickness is associated with a higher risk
of recurrence of melanoma and therefore death. In
addition, the thicker the primary melanoma, the more
likely that there is microscopic involvement of regional
lymph nodes.
AJCC STAGING (2018)
 Wide local excision (WLE)
WLE represents the standard treatment for primary
melanoma. Involves removal of the biopsy scar with a
surrounding margin of ‘healthy’ skin, with fat, down to muscular
fascia. This margin is determined by the Breslow thickness.
 BCC (Basal Cell Carcinoma)
• Accounts for apporcimately 80% of all skin cancer.
• Etiologi
– UVR expossure
– Severe sunburn during childhood and adolescence
• Risk factor
– Fitzpatrick skin types 1 and 2
– Red hair
– Freckling in childhood
– Family history of skin cancer
– Male sex
– Celtic ancestry