Skin Cancer and Malignant Melanoma

Skin melanoma: statistical data in Ukraine

19,3 % - death within a year,

M. – 26,2 %; F. – 14,9 %

49,7 % - 5-year survival

67,7 % - І-ІІ stages

Comparative Statistics: UA – USA

Ukraine USA

5-year survival

49,7 % 88,0 %

Melanoma in situ

0 37,5 %

Year: 2000 2000

Biologic progression of melanoma

Melanocyte → nevus → dysplastic nevus → меlanoма “ in situ” → superficial spreading melanoma →

nodular melanoma → metastatic melanoma

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Medical Lecture Notes – All Subjects

USMLE Exam (America) – Practice

Malignant Melanoma: Risk Factors

Age > 40 yr. Race: whiteSun exposure: UVA, UVB Hereditary factors: “melanoma families“, atypical mole syndrome or dysplastic nevus syndrome Trauma of moles, Giant congenital neviOncogene mutations

Screening:

Self-Examination for Melanoma:

examine your body front and back in the mirror, arms and palms, legs and feet, neck and scalp – If you have any doubt about a mole, see a dermatologist-oncologist

(American Academy of Dermatology)

Professional education:

students family doctors dermatologists surgeons cosmetologists morphologists oncologists ! nurses

ABCD-test

ABCD rules for diagnosis of melanoma:

Epiluminescence microscopy (dermatoscopy)

Epiluminescence microscopy (ABCD)

ЕЛМ

Diagnostics system MoleMax:

Growth patterns of melanoma:

superficial spreading melanoma – 70% nodular melanoma – 15-20% lentigo maligna melanoma – 4 -10% acral lentigo-melanoma – 2-8% amelanotic melanoma – 5%

Thickness of melanoma

TNM:

T1 < 1 mmT2 1-2 mmT3 2-4 mmT4 > 4 mm

Radial growth phase

Vertical growth phase

Evaluation for Metastasis: N0-3, M0-1

Regional Lymph Nodes: N0 – no metastasis,N1 – one lymph node with metastasis,N2 – 2-3 lymph nodes with Mts.,

N3 – 4 and > metastatic lymph nodes. Distant Metastasis: M0 – no metastasis,M1a: Mts in subcutaneous tissue, M1b: Mts in lung,M1c: Mts in other visceral organs (brain, liver, etc)

Nodular Melanoma Т4bNхM0

Biopsy techniques

For cytologic diagnosis:- fine-needle aspiration,- superficial scraping.

For histologic diagnosis:- complete excision

(Clark’ levels,Breslow’s thickness)

melanoma

operation

Sentinel node biopsy,or regional lymph node

dissection

Regional lymphangiectomy

Surgical approach to lymphogenous metastases of melanoma

Complex treatment of primary melanoma Т3bN1аМ0(X-ray + Chemo. → Surgery + Chemo. + INF)

Operative wound closed by flaps’ transposition

Lentigo maligna melanoma (arise from Hutchinson’s freckle)

1 year after Radiation Therapy

Melanoma: scars, recurrence, in transit Mts

1

3

2

4

Superficial melanoma with skin lymphangeitis and in-transit metastasis

Wound xenoplasty after wide local excision of melanoma

Skin autografting of granulated wound

Spleen metastasis of melanoma (2001);CT scan in 3 years after splenectomy (2004)

04. 2001 06. 2004

Меланома: метастази в селезінку і лімфовузли

Хворий К., 34 роки03.2000 – меланома шкіри на

спині, T3bN0M0Лікування: - БФ-РТ, СВД 80 Гр,- Операція - ПХТ + лаферон (2 курси)04.2001 – метастази в л/вузли

і селезінку04.2001

Melanoma metastases into spleen (surgical specimen) and lymph node

“In transit” metastases

Metastatic melanoma

Palliative γ - therapyHormonotherapySupportive care

Skin cancer

Basal Cell Carcinoma, T1N0M0

(growth pattern)

Precancerous diseases:

Факультативні:

- гіперкератози,- шкірний ріг,- папіломи, - фіброми,- гемангіоми,- бородавки

Облігатні:

пігментна ксеродерма, хвороба Боуена, еритроплазія Кейра

Skin cancer

Basal Cell Carcinoma, T1N0M0

(ulcer pattern)

Skin cancer

Squamous Cell Carcinoma,

T4N0M0

TNM-Classification of Skin Cancer:

Тis – carcinoma in situ Т1 – ≤ 2 cm Т2 – 2 - 5 cm Т3 – > 5 см Т4 – t-r invades cartilage, muscle, or bone. N0, N1 M0, M1

Skin Cancer

Squamous Cell Carcinoma of lower eyelid with invasion in bulbar conjunctiva,

T4N0M0

Skin Cancer

Squamous Cell Carcinoma of Cheek,

T4N0M0

results of local phytotherapy for a year!!!

Skin Cancer

Results after half course of gamma-therapy, 45 Gy

Skin Squamous Cell Cancer of Neck:

Postoperative wound is temporary covered with Pig skin xenografts

Skin Cancer:granulation wound (1), skin autografting (2)

Wound after removing of xenografts

Skin Cancer: complete recovery12 months later

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