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Malignant Melanoma

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May simply be blurred or indistinct. ... eccentrically located, the classic 'fried egg' may appear fairly symmetric but requires biopsy. ... – PowerPoint PPT presentation

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Title: Malignant Melanoma


1
Malignant Melanoma
  • By
  • Bill V. Way, DO
  • Dan Ladd Jr., DO

2
A-B-C-D-Es of Melanoma
  • A - Asymmetry - several types
  • B - Border Irregularity
  • C - Colors - multiple
  • D - Diameter - bigger than a pencil eraser
  • E - Elevation, Erythema

3
ASYMMETRY - WHAT DOES IT MEAN?
  • One side differs from the other side
  • Shape
  • Color
  • Elevation
  • Borders
  • Does the lesion mirror itself in every way?
  • May be subtle.

4
BORDERS
  • May be notched or jagged
  • May simply be blurred or indistinct.
  • Can be indicative of the irregular growth of
    malignant melanocytes.
  • Requires close inspection of lesion, preferably
    with a magnifying glass, may be subtle - take it
    seriously.

5
COLOR
  • Many benign lesions have 2 colors, tan and brown,
    but the color is symmetrically placed, ie., brown
    central with round peripheral tan ring.
  • Look for multiple or asymmetrically positioned
    colors - may see red, white, tan brown or black.
  • Again requires magnification, can be subtle.

6
DIAMETER
  • Always measure the greatest diameter.
  • Include lighter or indistinct areas in your
    measurement, not just the darker pigment.
  • Remember PENCIL ERASER 6 mm.
  • Document size carefully if you are going to watch
    a lesion over time - consider the compliance
    level of your patient.

7
ELEVATION
  • Remember that if the lesion is melanoma,
    elevation above the surface means depth below,
    and is the single worst prognostic factor.
  • Elevation need not be eccentrically located, the
    classic fried egg may appear fairly symmetric
    but requires biopsy.
  • PALPATE !

8
LETS TRY A FEW
9
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10
Path Junctional Nevus with Dysplastic Features,
11
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12
Path Compound Nevus with Features of
Dysplastic (Clark) Nevus
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14
Path Compound Nevus
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16
Path Pigmented Seborrheic Keratosis
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18
Path Compound Nevus
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20
Path Melanocytic Nevus, Compound Type
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Path Compound Dysplastic Melanocytic Nevus
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Path Compound Dysplastic Melanocytic Nevus
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Path Possible Early Evolving Melanoma In Situ
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Path Malignant Melanoma,Clarks Level IV,
Breslows Thickness 1.9 mm
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30
Path Melanoma In-Situ
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Path Evolving Melanoma In Situ
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Path Evolving Melanoma In-Situ
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36
Path Malignant Melanoma, Breslows Thickness 0.9
mm
37
THE END
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