Risk factors for malignant melanoma - ANSrace and gender: caucasion, men
sun exposure: sunburns in childhood and adult
compared to dark hair - blondes 1.8, red hair 2.4
tanning beds 1.25 risk
benign nevi-greater number & size increase risk
dysplastic nevi - found in 25-40% of people with melanoma. increased further if family
members have lesions
histologic subtypes of mm - ANSsuperficial spreading melanoma
nodular melanoma
lentigo maligna
acral lentiginous melanoma
ABCD - ANSSuspicious lesions identified by:
A = asymmetry of the lesion
B = Border irregularity
C = color variation
D = diameter greater than or equal to 6mm
superficial spreading melanoma - ANSmost common subtype (60-70%) and can occur in sun
and non sun exposed areas.
nodular melanoma - ANS2nd most common subtype (15-30%). dark blue-black or bluish red
uniformly colored lesion. more rapid onset and spreading than superficial spreading
melanoma.
lentigo maligna - ANS5% of cases and generally found in older individuals. frequently arises
from pre-existing benign pigmented lesion know as a Hutchinson freckle. generally thin and
indolent, slow.
acral lentiginous melanoma - ANSleast common subtype. frequently on palm, sole, under
nail. more common in black and dark skin. difficult to diagnose, poorer prognosis.
Breslow level - ANSdepth of invasion
ulceration - ANSmalignant cells extend through the skin surface layer, metastatic potential
mitoses or dividing cells - ANSone or more detectable mitoses have significantly reduced
survival
, MM prognostic factors - ANS1. age of onset - younger/higher mortality
2. lesion location - trunk, head, neck higher mortality
3. presence of lymph node mets - most important prognostic factors in order of importance:
a. number of positive lymph nodes
b. extent of involvement within lymph node
c. presence of ulceration in the primary lesion
4. Clark level -indicator of level of skin
a. I epidermis only
b. II upper portion of papillary dermis
c. III fills papillary dermis
d. IV reticular dermis
e. V subcutaneous fat
Clark Level - ANSrecent data confirmed that Clark level of invasion is of no significant
prognostic importance when the presence of ulceration and mitosis count are taken into
account.
Staging of melanoma - ANSTNM system
Stage 0 TisN0M0
Stage IA T1aN0M0
Stage IB T1bN0M0 / T2aN0M0
Stage IIA T2bN0M0 / T3aN0M0
Stage IIB T3bN0M0 / T4aN0M0
Stage IIC T4bN0M0
TNM system - ANSevaluates tumors based on:
T - local extent or depth of lesion
N - presence of lymph node mets
M - existence of metastasis
Treatment of MM - ANScomplete surgical resection. generally resistant to radiation therapy
and response rates to chemo are poor
Prostate Specific Antigen (PSA) velocity greater than .75 ng/ml/per year - ANSis highly
suggestive of malignancy
risk factors of prostate ca - ANSage
family history
digital rectal exam - ANSfinger palpation through the anal canal and rectum to examine the
prostate gland
prostate ca - ANSmost commonly dx malignancy in males in the u.s. and second leading
cause of death behind lung ca
PSA testing - ANSintroduced 1987 and revolutionized dx of prostate CA
prostate CA produces more psa per volume that benign tissue.
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