Cutaneous Melanoma Maligna.ppt

download Cutaneous Melanoma Maligna.ppt

of 51

Transcript of Cutaneous Melanoma Maligna.ppt

  • 8/9/2019 Cutaneous Melanoma Maligna.ppt

    1/51

     

    CUTANEOUSMELANOMA MALIGNA

     Yono Hadi Agusni

    Dept of DermatovenereologyPadjadjaran University

  • 8/9/2019 Cutaneous Melanoma Maligna.ppt

    2/51

     

    Melanoma maligna 

    • Melanoma results from themalignant transformation ofmelanocytes

    • Richard G.B. Langley 

  • 8/9/2019 Cutaneous Melanoma Maligna.ppt

    3/51

     

    Epidemiology  

    • USA : !"# : in "##

    •   !!$ : in #%

    •   $### : in &%

    • '(utaneous melanoma currentlyrepresent ) percent of all types ofne*ly diagnosed cancer '

  • 8/9/2019 Cutaneous Melanoma Maligna.ppt

    4/51

     

    Mortality  

    • !!+ %,year survival rate --.$ /

  • 8/9/2019 Cutaneous Melanoma Maligna.ppt

    5/51

     

    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

  • 8/9/2019 Cutaneous Melanoma Maligna.ppt

    6/51

     

    Type of Melanoma

    maligna

    • 7 8entigo maligna

    • $7 8entigo maligna melanoma

    • )7 Super9cial spreading melanoma

    • +7 odular melanoma• %7 Acral lentiginous melanoma

  • 8/9/2019 Cutaneous Melanoma Maligna.ppt

    7/51 

    Lentigo maligna LM!

    • 8M a ;at

  • 8/9/2019 Cutaneous Melanoma Maligna.ppt

    8/51 

    •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

  • 8/9/2019 Cutaneous Melanoma Maligna.ppt

    9/51 

    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

  • 8/9/2019 Cutaneous Melanoma Maligna.ppt

    10/51

     

    "#ysical e$amination (2)

    • General medical examination :

    • Search for regional lymphadenopathy

    • LM/4

  • 8/9/2019 Cutaneous Melanoma Maligna.ppt

    11/51

     

    La%oratory  

    • o n e

  • 8/9/2019 Cutaneous Melanoma Maligna.ppt

    12/51

     

    &ermatopat#ology 

    • ncreased num@ers ofmelanocytes. usually atypical and

    @iCCare and distri@uted along the@asal layerE

  • 8/9/2019 Cutaneous Melanoma Maligna.ppt

    13/51

     

    Diferential diagnosis 

    • Solar lentigo

  • 8/9/2019 Cutaneous Melanoma Maligna.ppt

    14/51

     

    Treatment 

    • Surgery

  • 8/9/2019 Cutaneous Melanoma Maligna.ppt

    15/51

     

    Lentigo maligna

    melanoma LMM!

    • 8M develops focal papular andnodular areas that signal invasioninto dermis.

  • 8/9/2019 Cutaneous Melanoma Maligna.ppt

    16/51

     

    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

  • 8/9/2019 Cutaneous Melanoma Maligna.ppt

    17/51

     

    "#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

  • 8/9/2019 Cutaneous Melanoma Maligna.ppt

    18/51

     

    • General medical e$amination '

    • search for regional lymphadenopathy

    •   LMM3

  • 8/9/2019 Cutaneous Melanoma Maligna.ppt

    19/51

     

    La%oratori(m 

    •   n o n e

    •   LMM4

  • 8/9/2019 Cutaneous Melanoma Maligna.ppt

    20/51

     

    &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

  • 8/9/2019 Cutaneous Melanoma Maligna.ppt

    21/51

     

    &i)erential diagnosis 

    • Se@orrheic 3eratosis

    • Solar lentigo

    • 8MM"

  • 8/9/2019 Cutaneous Melanoma Maligna.ppt

    22/51

     

    Treatment '

    •   surgery

    • 8MM&

  • 8/9/2019 Cutaneous Melanoma Maligna.ppt

    23/51

     

    Prognosis

    • Depend on stage of tumor at the time ofdiagnosis made7

    •   LMM8

  • 8/9/2019 Cutaneous Melanoma Maligna.ppt

    24/51

     

    S(per*cial spreading

    melanomaSSM!

    • SSM has a distinctive morphology :a uniformly elevated. ;attenedlesion

  • 8/9/2019 Cutaneous Melanoma Maligna.ppt

    25/51

     

    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 

  • 8/9/2019 Cutaneous Melanoma Maligna.ppt

    26/51

     

    Epidemiology  (2)

    • ncidence : / of all melanomasarising in *hite persons

    • History : evolves over a period of,% years

    •   SSM4

  • 8/9/2019 Cutaneous Melanoma Maligna.ppt

    27/51

     

    "#ysical e$amination 

    • Skin lesions :

    • Distribution : isolatedsingle lesion

    •   multiple are rare• Bype : ;attened papule. @ecoming plaFue

    •   then developing one more

    •   nodules•   SSM5

  • 8/9/2019 Cutaneous Melanoma Maligna.ppt

    28/51

     

    "#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

  • 8/9/2019 Cutaneous Melanoma Maligna.ppt

    29/51

     

    "#ysical e$amination (3)

    • 6eneral medical e1amination :

    •   search for lymph nodes

    •   SSM7

  • 8/9/2019 Cutaneous Melanoma Maligna.ppt

    30/51

     

    La%oratori(m '

    •   n o n e

    • SSM8 

  • 8/9/2019 Cutaneous Melanoma Maligna.ppt

    31/51

     

    &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

  • 8/9/2019 Cutaneous Melanoma Maligna.ppt

    32/51

     

    Treatment

    •   Surgery

    •   (hemotherapy

    •   SSM10

  • 8/9/2019 Cutaneous Melanoma Maligna.ppt

    33/51

     

    "rognosis

    • Melanoma is responsi@le for a@out"%## deaths per year in USA

    • Thomas B. Fitzpatrick 

    •   SSM 11

  • 8/9/2019 Cutaneous Melanoma Maligna.ppt

    34/51

     

    Nod(lar melanoma

    NM!

    • M is one type of melanoma thatarises Fuite rapidly

  • 8/9/2019 Cutaneous Melanoma Maligna.ppt

    35/51

     

    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!

  • 8/9/2019 Cutaneous Melanoma Maligna.ppt

    36/51

     

    "#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

  • 8/9/2019 Cutaneous Melanoma Maligna.ppt

    37/51

     

    General medical

    e$amination

    •   Al*ays search for node

    •  M4

  • 8/9/2019 Cutaneous Melanoma Maligna.ppt

    38/51

  • 8/9/2019 Cutaneous Melanoma Maligna.ppt

    39/51

     

    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"

  • 8/9/2019 Cutaneous Melanoma Maligna.ppt

    40/51

     

    &i)erential diagnosis

    • Hemangioma

    • Pyogenic hemangioma

    • Pigmented @asal cell carcinoma

    •  M#

  • 8/9/2019 Cutaneous Melanoma Maligna.ppt

    41/51

     

    Treatment 

    • Surgery

    • (hemotherapy

    •  M$

  • 8/9/2019 Cutaneous Melanoma Maligna.ppt

    42/51

     

    "rognosis 

    • Gorse than other melanoma

    • Prognosis related to the thic3ness

    at the time of diagnosis7

    •   %illiam &. 'aro

    •  M(

  • 8/9/2019 Cutaneous Melanoma Maligna.ppt

    43/51

     

     Acral Lentigino(s

    melanoma ALM! 

    • 4ccurs as a ;at pigmented lesionon the sole. palm and su@ungualregion7

  • 8/9/2019 Cutaneous Melanoma Maligna.ppt

    44/51

     

    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

  • 8/9/2019 Cutaneous Melanoma Maligna.ppt

    45/51

     

    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

  • 8/9/2019 Cutaneous Melanoma Maligna.ppt

    46/51

     

    "#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)

  • 8/9/2019 Cutaneous Melanoma Maligna.ppt

    47/51

     

    "#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 "

  • 8/9/2019 Cutaneous Melanoma Maligna.ppt

    48/51

     

    &i)erential diagnosis

    • A#$ +pantar type=:

    •   plantar *arts

    •   nevus

    • A#$ +subungua type,:

    •   post traumatic lesion•   fungal infection

    • &LM$

  • 8/9/2019 Cutaneous Melanoma Maligna.ppt

    49/51

     

    La%oratory e$amination

    '

    • n o n e

  • 8/9/2019 Cutaneous Melanoma Maligna.ppt

    50/51

     

    &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(

  • 8/9/2019 Cutaneous Melanoma Maligna.ppt

    51/51

    Treatment  

    • Surgery

    • Perfusion *ith chemotherapeuticagents7

    • &LM*+