Cutaneous Melanoma

Posted by e-Medical PPT Thursday, August 8, 2013
A xx year old male presents to your office with a complaint of a right upper extremity skin lesion that has changed in size, shape and color. He is afraid that it might be melanoma. How would you approach and evaluate this patient?

Melanocytes - originate from neural crest cells - found along basement membrane at the dermoepidermal junction - exposure to carcinogenic stimuli result in malignant transformation and melanoma
•Accounts for 4 – 5% of all skin cancers, but causes majority of deaths
•Eighth most common cancer in the United States
•68,130 new cases; 8700 deaths in US (2010)

Epidemiology - 20x more common in white individuals, especially those of Celtic ancestry; less in Asian and black population - anatomic distribution varies among gender - men: trunk, head and neck - women: lower extremities - median age at presentation: 45-55yrs

Etiology - exposure to sunlight - UV radiation (UVA and UVB) - UVA: deeper level of penetration leading to dermal connective tissue damage - UVB: induces effects of sunburn, increases melanin production

Risk Factors - fair complexion, severe sunburns, intermittent doses of radiation (sun bathing, tanning beds) - xeroderma pigmentosum, family history of melanoma, history of non-melanoma skin cancer, dysplastic nevi syndrome - Aging: related to either exposure to carcinogens (UV radiation) or the decreasing ability of individual cells to repair DNA damage - Precursor Lesions: congenital nevi, dysplastic nevi, spitz nevi

Xeroderma Pigmentosum - autosomal recessive - inability to repair DNA damage caused by UV radiation - incidence 1 in 250,000 - increased risk for skin cancers; melanoma and SCC most common cause of death - symptoms: severe sun burn to minimal sun exposure, freckles, solar keratoses, painfully sensitive eyes to sun exposure - poor prognosis, less than 40% survive beyond 20 yrs of age

Giant Congenital Nevi - rare, occurs in 1 in 20,000 newborns - increased risk of melanoma within nevi - lifetime risk 5-8% - require regular examination throughout life

Dysplastic Nevi (DN) - large (6-15mm), flat pigmented lesion - indistinct margins, variable color - may occur sporadically or in a familial pattern

Dysplastic Nevi (DN) - DN syndrome ( BK mole syndrome, FAMMM syndrome): multiple nevi >100, mutation CDKN2A gene, chromosome 9, leads to unstable p53; penetrance for melanoma ranges 52-98% - unclear consensus in management; can excise all lesions - surveillance mandatory; complete skin examination every 3-6 months, monthly self-examination
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