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8/9/2019 Cutaneous Melanoma Maligna.ppt
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CUTANEOUSMELANOMA MALIGNA
Yono Hadi Agusni
Dept of DermatovenereologyPadjadjaran University
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Melanoma maligna
• Melanoma results from themalignant transformation ofmelanocytes
• Richard G.B. Langley
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Epidemiology
• USA : !"# : in "##
• !!$ : in #%
• $### : in &%
• '(utaneous melanoma currentlyrepresent ) percent of all types ofne*ly diagnosed cancer '
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Mortality
• !!+ %,year survival rate --.$ /
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Risk factors
• 0 Sun e1posure
• 0 2eaction of s3in to sunlight
• 0 Phenotype
• 0 4ccupation and Social status
• 0 5amilial melanoma• 0 Melanocytic nevi
• 0 6ender and Hormonal factors
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Type of Melanoma
maligna
• 7 8entigo maligna
• $7 8entigo maligna melanoma
• )7 Super9cial spreading melanoma
• +7 odular melanoma• %7 Acral lentiginous melanoma
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Lentigo maligna LM!
• 8M a ;at
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•Epidemiology
(2)
• Age : 45 - 65 year
• Sex : man ? *oman
• Race : very rare in @lac3 or @ro*n s3in• Incidence : %,#/ of cutaneous melanoma
• Predisposing factors :
• sun,induced nonmelanoma s3in cancer
• older population
• outdoor *or3ers• LM/2
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Physical examination
• Skin lesions :
• Distri@ution : 'sun,e1posed area
• Bype : uniformly ;at. macule
• (olor : @ro*n to @lac3
• SiCe : )7# , $#7# cm < or larger=
• Shape : irregular @order. often *ith anotch. geographic shape
• LM/3
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"#ysical e$amination (2)
• General medical examination :
• Search for regional lymphadenopathy
• LM/4
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La%oratory
• o n e
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&ermatopat#ology
• ncreased num@ers ofmelanocytes. usually atypical and
@iCCare and distri@uted along the@asal layerE
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Diferential diagnosis
• Solar lentigo
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Treatment
• Surgery
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Lentigo maligna
melanoma LMM!
• 8M develops focal papular andnodular areas that signal invasioninto dermis.
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Epidemiology
• Age : median age is "% years
• Se1 : male ? female
• 2ace : very rare in @ro*n or @lac3 s3inned• ncidence : %,# / cutaneous melanoma
• Predisposing factors :
• sun,induced non melanoma s3in cancer• older population
• outdoor occupations LMM1
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"#ysical e$amination
• Skin lesions '
• Distribution : 'sun,e1posed area
• Type : 5lat *ith focal area ofpapules or nodules
• Coor : same *ith 8M plus grayarea and @lue area7 Papule may@e@lac3. @lue or pin3
• LMM2
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• General medical e$amination '
• search for regional lymphadenopathy
• LMM3
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La%oratori(m
• n o n e
• LMM4
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&ermatopat#ology
• ncrease the num@er of melanocytes. usuallyatypical and @iCCare and distri@uted along the @asal
layer. at certain places in the dermis. malignant
melanocytes have invaded and formed huge nest7• Thomas B. Fitzpatrick
• LMM5
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&i)erential diagnosis
• Se@orrheic 3eratosis
• Solar lentigo
• 8MM"
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Treatment '
• surgery
• 8MM&
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Prognosis
• Depend on stage of tumor at the time ofdiagnosis made7
• LMM8
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S(per*cial spreading
melanomaSSM!
• SSM has a distinctive morphology :a uniformly elevated. ;attenedlesion
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Epdemiology
• Age : )# , %# years
• Sex : Slightly higher incidence in females
• Race :• Ghite,s3inned predominantly
• only $/ @ro*n@lac3 s3inned
• @ro*n @lac3 usually occuring on the
e1tremities7 Half arising on sole of the
foot7
• SSM2
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Epidemiology (2)
• ncidence : / of all melanomasarising in *hite persons
• History : evolves over a period of,% years
• SSM4
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"#ysical e$amination
• Skin lesions :
• Distribution : isolatedsingle lesion
• multiple are rare• Bype : ;attened papule. @ecoming plaFue
• then developing one more
• nodules• SSM5
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"#ysical e$amination (2)
• Coor : dar3 @ro*n. @lac3 *ithadmi1ture of pin3. gray and@lue,gray
hues7 Ghite areas indicate regressedportions7
• S!ape : asymmetrical. oval *ithirregurelarly irregular @orders and often*ith one or more notches
• SSM6
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"#ysical e$amination (3)
• 6eneral medical e1amination :
• search for lymph nodes
• SSM7
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La%oratori(m '
• n o n e
• SSM8
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&ermatopat#ology
• Pagetoid distri@ution of large melanocytes throughtthe epidermis. occuring singly or in the nests
• Bhe melanocytes often have regularly dispersed
9ne particles of melanin7
• SSM9
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Treatment
• Surgery
• (hemotherapy
• SSM10
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"rognosis
• Melanoma is responsi@le for a@out"%## deaths per year in USA
• Thomas B. Fitzpatrick
• SSM 11
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Nod(lar melanoma
NM!
• M is one type of melanoma thatarises Fuite rapidly
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Epidemiology
• Age : Median age is %# years
• Se1 : male ? female
• 2ace : occurs in all races
• I Japanese : - time more thanSSM
• ncidence : %,)#/ of the melanomain US
• M!
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"#ysical e$amination
• Skin lesions :
• Distribution : same as SSM
• Type : Uniformly elevated '@lue@erryli3e nodule ulcerated
• Coor : dar3 @lue , @lac3 or pin3
• Si"e : ,) cm. larger• S!ape : ovalround usually *ith smooth7
• M3
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General medical
e$amination
• Al*ays search for node
• M4
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Dermatopathology
• Arises at the dermoepidermal junction and e1tendvertically in the dermis7
• Bumor may sho* large epitheloid cells. spindle
cells. small malignant melanocytes or mi1ture of allthree
• M"
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&i)erential diagnosis
• Hemangioma
• Pyogenic hemangioma
• Pigmented @asal cell carcinoma
• M#
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Treatment
• Surgery
• (hemotherapy
• M$
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"rognosis
• Gorse than other melanoma
• Prognosis related to the thic3ness
at the time of diagnosis7
• %illiam &. 'aro
• M(
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Acral Lentigino(s
melanoma ALM!
• 4ccurs as a ;at pigmented lesionon the sole. palm and su@ungualregion7
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Epidemiology
• Age : median age is "%
• Sex : male ? female
• Race : A8M is the principal melanomain Japanese. Africans and @lac3Americans7
• I A#$ accounts for 5% to &% ' of(eano(a in )apanese*
• ALM 2
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Epidemiology +!
• Incidence : & , !/ of all melanoma
• Predisposing factors :
• Su@ungual melanoma is mostfreFuent type of A8M in *hite
persons. @ut trauma has not @eenproved to @e a factor
• &LM3
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"#ysical e$amination (1)
• Skin lesions :
• Distribution : Soles. palm. 9ngers and toes• Type : Macular lesion in the radial gro*th
phase *ith focal papules and nodulesdeveloping during the vertical gro*th phase
• Coor : @ro*n. @lac3. @lue and depigmentedpale areas7
• &LM)
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"#ysical e$amination (2)
• Si"e : up to $ cm
• S!ape : irregularly @orders li3e
lenitigo maligna melanoma
• General medical e$amination '
• search for regionallymphadenopathy
• &LM "
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&i)erential diagnosis
• A#$ +pantar type=:
• plantar *arts
• nevus
• A#$ +subungua type,:
• post traumatic lesion• fungal infection
• &LM$
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La%oratory e$amination
'
• n o n e
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&ermatopat#ology
• (haracteristic large melanocyte *ithprominent dendrites along @asal cell
layer may e1tend as large nest intothe dermis. as long eccrine ducts7
• Thomas B. Fitzpatrick
• &LM(
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Treatment
• Surgery
• Perfusion *ith chemotherapeuticagents7
• &LM*+