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Monday, December 26, 2011

Melanoma

Mimics

  • Compound nevus (with irregular border)
  • Seborrheic keratosis
  • Hemangioma
  • Dermatofibroma (pigmented)


Prognosis
  • Two most important determinants
    • Tumor thickness
    • Ulceration: present or not
  • Recurrence/survival
    • Sample sentinel lymph node
      • 1st node in lymphatic basin that drains lesion
      • Bx if depth of lesion >=1mm


Risk Factors

  • Complexion (fair skin; red or blond hair)
  • PHx
    • Atypical nevus
      • 1 lesion         --> 2* risk
      • >=10 lesions --> 12* risk
    • Melanoma
    • Non-melanoma skin cancer
    • Congenital nevus >20cm diameter




70% are superficial-spreading melanomas and slow-growing


15% are nodular melanoma and fast-growing




Any changing skin lesion (pigmented or non-pigmented)
--> must consider melanoma




Stage
  • Sample sentinel group of lymph nodes
      • # affected
      • Tumor burden within node
  • FBC; LFTs; serum LDH
  • CXR; ?CT chest?
  • ?CT or MRI brain?

Rx
  • Surgical
    • Excision margin
      • <1mm thick   --> 1cm
      • >=1mm thick --> 2cm
  • Medical
    • Interferon-alfa
      • Improves outcomes in Stage IIB - IIIC


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