Name
MELANOMA
DESCRIPTION
DETAIL
OTHER TESTS : * EXCISIONAL BIOPSY
TYPENOTES
RISK FACTORS: Heavy UVA and UVB exposure, Previous pigmented lesions (especially dysplastic nevi), Fair complexioned, freckling, blue eyes and blonde hair, Those with increased numbers of nevi, Family history of melanoma, Tanning bed use in ages < 30GENERAL MEASURES The key to the cure of melanoma is prevention: Avoidance of blistering solar radiation and the use of a sunscreen when exposure is unavoidable SURGICAL MEASURES β’ The appropriate health care for melanoma is surgical excision. Much debate exists as to the extent of the margins of excision once diagnosis has been made. The tendency now is toward margins of 1 cm if the lesion is less than 1 mm thick. If thicker, then margins can be extended to 2 cm. β’ Sentinel lymph node biopsy for lesions of 1-4 mm depth may benefi t. However, increased survival has not been clearly demonstrated. β’ Elective lymph node dissection (ELND) appears beneficial in patients age < 60 and thickness of lesion between 1.5-4 mm ACTIVITY Avoid sun exposure PATIENT EDUCATION β’ It is critical that a patient with a history of melanoma or dysplastic nevi syndrome has frequent total body examinations for any abnormal appearing or changing nevi DRUG(S) OF CHOICE β’ No one chemotherapeutic agent has shown unequivocal benefit β’ Adoptive immunotherapy with leukapheresis and IL-2 with LAKβs (under investigation) β’ Some benefit with vaccines containing melanoma associated antigens (MAAs) has occurred. No treatment has shown unequivocal benefit. β’ Interferon alfa-2b is considered of possible benefit PATIENT MONITORING . Current recommendations after diagnosis of malignant melanoma are skin exams every 3-6 months . Only chest x-rays on an annual basis have been shown to be of any benefi t at all in that 6% of recurrences were detected. These fi ndings did not appear to alter prognosis. . The patient should conduct his/her own skin examinations on a weekly basis. They must be thorough. PREVENTION/AVOIDANCE Avoidance of prolonged and high altitude solar exposures and the use of sunscreens is critical. Those at high risk should do all they can to avoid sunburn especially during the adolescent years. POSSIBLE COMPLICATIONS . Metastatic spread . Unsatisfactory cosmetic results following the primary surgery EXPECTED COURSE/PROGNOSIS . Prognosis is entirely based on staging of the initial lesion . Staging (falls into two categories) . Breslow: This shows a 70% fi ve-year survival of all patients who have no local or distant lymphatic spread. . Clarks staging depends on depth of invasion by skin layer. The best prognosis is for those lesions which are less than .85 mm (especially if restricted to the stratum granulosum or higher) which carry 95-100% five-year survival. Spread to lymphatics or regional lymph nodes carries less than a 5% five-year survival. . Women have a better prognosis than men . Truncal lesions have a poorer prognosis . With distant metastases, the disease is uniformly lethal PREGNANCY β’ Due to the facts that melanocyte-stimulating hormone (MSH) levels are markedly increased during pregnancy and that melanoma is one of the few carcinomas that can spread to the placenta, concern has been that pregnancy exacerbates melanoma. This has not been proven. β’ If a person has had recent melanoma, many authors suggest waiting 1-2 years if further pregnancy is desired β’ If invasion extends into the lymphatic structures, then further pregnancy is probably contraindicated
RELATED DISEASE
Not Available Disease
DISEASE
INVESTIGATION
COMPLETE BLOOD COUNT, BIOPSY