Malignant melanoma, MM

Notes
  • MM arises from melanocytes of skin, mucous membranes of the eyes, oral, genital, and rectal regions and CNS (pigmented areas)
  • MM is strongly associated with ultraviolet (UV) exposure.
  • Statistics: although MM causes <5% of the skin cancers in US it has the highest mortality rate; global prevalence – 1.6%
Symptoms
  • Pigmented lesions

##ABCD classical symptoms of MM include:

  • Asymmetry for mole that has an irregular shape, or two different looking halves
  • Border of a moles that are irregular, blurred, rough or notched edges.
  • Colors of majority of moles are even color (brown, black, tan or even pink)
  • Diameter of moles > 6 mm across may be suspect (although some moles may be <6 mm)
  • Enlarging and darkening lesion
  • Bleeding and pigmented lesion
  • Ulceration that do not heal
  • Itchiness, tenderness or pain
Diagnosis
  • Excisional biopsy and histology
  • Polarized light and immersion contact dermoscopy
  • Molecular biology testing of mutations
Differential
  • Atypical moles
  • Basal cell carcinomas
  • Blue nevi
  • Dermatofibromas
  • Foot ulcer
  • Hematomas
  • Hyperkeratosis-corns/callus
  • Ingrowing toe nail
  • Lentigo Maligna Melanoma
  • Mycosis Fungoides
  • Poroma
  • Pyogenic granulomas
  • Seborrheic keratoses
  • Squamous cell carcinomas
  • Subungual haematoma
  • Warts with focal thromboses
Prevention

##Avoid UV exposure by:

  • Use of sunscreens such as Sun Protection Factor (SPF) 30
  • Protective clothing such as long sleeve shirts and wearing of trousers
  • Deliberate efforts to prevent over exposure to sunshine
Management
  • Surgical excision

##Adjuvant therapy for localized MM:

  • Radiation therapy
  • Imiquimod therapy
  • Cryotherapy

##Adjuvant therapy for metastatic or unresectableMM

  • Immunotherapy such as nivolumab and dabrafenib
  • Radiation therapy
  • Cytotoxic chemotherapy is not useful
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