Malignant Melanoma

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Slide 1 : Malignant Melanoma By Bill V. Way, DO Dan Ladd Jr., DO
Slide 2 : A-B-C-D-E’s of Melanoma A - Asymmetry - several types B - Border Irregularity C - Colors - multiple D - Diameter - bigger than a pencil eraser E - Elevation, Erythema
Slide 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.
Slide 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.
Slide 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.
Slide 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.
Slide 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 !
Slide 8 : LET’S TRY A FEW…
Slide 9 :
Slide 10 : Path: Junctional Nevus with Dysplastic Features,
Slide 11 :
Slide 12 : Path: Compound Nevus with Features of “Dysplastic” (Clark) Nevus
Slide 13 :
Slide 14 : Path: Compound Nevus
Slide 15 :
Slide 16 : Path: Pigmented Seborrheic Keratosis
Slide 17 :
Slide 18 : Path: Compound Nevus
Slide 19 :
Slide 20 : Path: Melanocytic Nevus, Compound Type
Slide 21 :
Slide 22 : Path: Compound “Dysplastic” Melanocytic Nevus
Slide 23 :
Slide 24 : Path: Compound “Dysplastic” Melanocytic Nevus
Slide 25 :
Slide 26 : Path: Possible Early Evolving Melanoma In Situ
Slide 27 :
Slide 28 : Path: Malignant Melanoma, Clarks Level IV, Breslow’s Thickness 1.9 mm
Slide 29 :
Slide 30 : Path: Melanoma In-Situ
Slide 31 :
Slide 32 : Path: Evolving Melanoma In Situ
Slide 33 :
Slide 34 : Path: Evolving Melanoma In-Situ
Slide 35 :
Slide 36 : Path: Malignant Melanoma, Breslow’s Thickness 0.9 mm
Slide 37 : THE END

 


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ASYMMETRYWHAT DOES IT MEAN? One side differs from the other side; Shape; ColorPath: Melanocytic Nev    more





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