1 / 29

A Tan to Die For?

A Tan to Die For?. Dan Magrill Taz Singh Laura Tincknell. Mr. RB History and Examination. Background - 53 yrs, male, unemployed PC - RIF pain

everly
Télécharger la présentation

A Tan to Die For?

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. A Tan to Die For? Dan Magrill Taz Singh Laura Tincknell

  2. Mr. RB History and Examination • Background - 53 yrs, male, unemployed • PC - RIF pain • HPC - RIF pain for 1/12, radiating to the back. Loss of appetite, weight loss, tiredness, indigestion. Loose bowels 1/52, no blood or mucus. No N+V. • PMH - No THREAD. L Testicular lump 18/12 - under observation.

  3. History and Examination cont... • FH - Paternal Grandfather - Bowel Ca. Father - Diverticulitis. • SH - Unmarried, living alone and unemployed. Smoking 20+/day. Social drinker. • SE: • CVS - No chest pain, palpitations, breathlessness, orthopnoea, collapse, nocturnal dyspnoea...

  4. History and Examination cont... • Respiratory - No cough, wheeze, S.O.B, haemoptysis... • GI - No N+V, rectal bleeding. But had indigestion, abdo pain, loose bowels, loss of appetite and weight loss... • GU - No dysuria, frequency, haematuria, loin pain... • Neurological - No headaches, dizziness, fits, collapse, weakness...

  5. History and Examination cont • O/E - Anxious, thin. T-37.5C, Pulse-regular, 75 bpm, BP 120/60 mmHg. O2 Sats- 97% • CVS : Unremarkable • Resp: Unremarkable • Neuro: Unremarkable • GI: Abdomen distended. Large firm mass in whole of abdomen apart from LIF which was tender on palpation. Liver percussed out to 35cm. BS present. PR-NAD

  6. Plan • USS: showing multiple liver metastases. Biopsy - melanoma. • Ix to find primary: colonoscopy, CXR, ENT and opthalmology. • Opthalmology report: R eye, smooth melanotic mass in anterior chamber. • Management: Palliative Chemotherapy.

  7. Presentation of a disease • In Incidence • A Age • Surgeon’s Sex • Gown Geography • Physicians Predisposing factors • Might Macro/Micro Pathology • Make Management • Progress Prognosis

  8. Incidence • UK incidence of 10 / 100 000 (per year) • Rising by 7% every Year • Least common of the “Big Three”, but highest mortality. • Over last 20 years, incidence risen by over 80%

  9. Age • Superficial Spreading and Nodular Malignant Melanoma - 20-60 year olds • Lentigo Malignant Melanoma - >60y.

  10. Sex • In the UK, women are affected twice as often as men • In Men, the commonest site is the back • In Women it is the Lower Leg (50%)

  11. Geography • The worldwide incidence is proportional to the Geographic Latitude • Caucasians living closest to equator at highest risk • This suggests an effect of UV radiation • People living outside their indigenous climate are at risk

  12. Predisposing Factors • Fair Skin • Red Hair • Living close to Equator • Freckles • Exposure to the Sun • Melanocytic Naevus (found in 30%) • Genetics - 5% of Pt have Family History

  13. Macro/Micro Pathology 1 • Superficial Spreading Malignant Melanoma • 50% of UK cases, especially female • Commonest in Lower Leg • Macular Tumour with Variable Pigmentation

  14. Macro/Micro Pathology 2 • Nodular Malignant Melanoma • Seen in 25% of UK cases, especially Male • Commonest site is the Trunk • Pigmented Nodule • Grows rapidly and can Ulcerate

  15. Macro/Micro Pathology 3 • Lentigo Malignant Melanoma • 15% of UK cases • Malignant melanoma growing in long standing Lentigo Maligna • These arise form sun damaged skin • Often in elderly, especially who have worked outside for many years

  16. Macro/Micro Pathology 4 • Acral Lentiginous Malignant Melanoma • 10% of UK cases • Commonest form in Mongoloids • Tumour affects Palms, Soles and Nail Beds • Often diagnosed late - poor prognosis

  17. Staging • Local Staging assessed using the BRESLOW method • Measured mm between granular cell layer and deepest identifiable melanoma cell • Metastasis are uncommon if confined to epidermis

  18. Diagnosis • The following changes in a Naevus or Pigmented lesion • Size, usually a recent increase • Shape, irregular in outline • Colour, variation - darker or lighter • Inflammation, especially at edge • Crusting, may ooze or bleed • Itch

  19. Differential Diagnosis • Benign melanocytic naevus • Seborrhoeic wart • Haemangioma • Dermatofibroma • Pigmented Basal Cell Carcinoma • Benign Lentigo

  20. Management 1 • Surgical Excision • If <1mm, use a 1cm clearance margin • If >1mm, need a 1-2cm clearance • As this is quite a large area a skin graft may be indicated • Regular follow up to detect recurrence • Local • Lymphatic, regional or distant • Blood Bourne - to distant sites (eg Liver)

  21. Management 2 • Elective Lymph node dissection and Sentinel node biopsy not recommended as routine. • Radiotherapy of limited use • Interferon-alfa may increase survival if tumour >1.5mm thick

  22. Prognosis • Related to tumour depth • 5 year survival: • <1mm 95-100% • 1-2mm 80-96% • 2.1-4mm 60-75% • >4mm 50%

  23. Prevention and Public Education • If caught early have good prognosis • Public should be encouraged to visit doctor early if changing pigmented lesion • Sun exposure should be discouraged • Especially if fair skinned or with multiple melanocytic naevi

More Related