1 / 18

The Skin lesion

The Skin lesion. University of Florida Oral Exam Review. Introduction. Main goal is to differentiate benign vs. malignant lesions DDx benign: nevi, keratosis, hemangioma , granuloma, dermatofibroma , angiokeratoma DDx malignant: basal cell carcinoma, squamous cell carcinoma, melanoma.

megara
Télécharger la présentation

The Skin lesion

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. The Skin lesion University of Florida Oral Exam Review

  2. Introduction Main goal is to differentiate benign vs. malignant lesions DDx benign: nevi, keratosis, hemangioma, granuloma, dermatofibroma, angiokeratoma DDx malignant: basal cell carcinoma, squamous cell carcinoma, melanoma

  3. BCC SCC

  4. History • Assess melanoma risk factors • Family history – familial atypical mole, melanoma syndrome • Previous history of melanoma • Sunburn hx • History of the lesion • Change in size, shape, color, itching, bleeding • Signs of transformation • Race – white race 20x increased risk compared to black race

  5. Physical examination • Multiple benign nevi  higher risk of melanoma • ABCDE • Asymmetry • Irregular Borders • Variegated (mixed) Color • Large Diameter (>6mm) • Elevated surface • In-transit metastases • Palpate lymph nodes Skinipedia.org

  6. Labs and Imaging • Skin biopsy • Not shave bx • Staging and metastases • Serum lactose dehydrogenase (LDH) level • Liver function tests (Liver #2 metastasis) • Chest X-ray (Lung #1 most common metastasis) • CT, MRI, PET-CT

  7. Types of Melanomas • Superficial spreading – most common (70%) • Arises from pre-existing nevi • Nodular – aggressive (15-30%) • Mostly vertical growth (no radial growth) • Can rarely lack pigment • High metastatic rate • Lentigomaligna – older patients (4-10%) • Typical over face, typically large (>3cm) • Arises from macular brown nevus • Less aggressive, best prognosis • Acrallentiginous – palms or soles in patients with dark skin (2-8%) • Most aggressive • Highest metastatic rate • Ocular melanoma – most common non-cutaneous melanoma

  8. Superficial spreading Sabiston 18th edition

  9. Nodular Sabiston 18th edition

  10. Lentigomaligna Sabiston 18th edition

  11. Acrallentiginous Sabiston 18th edition

  12. Staging • Level of invasion (Clark staging) • Limited use, low predictive value • Depth of invasion (Breslow staging) • Used in American Joint Committee of Cancer (AJCC) TNM classification

  13. TNM Classification • Tumor – a (no ulceration), b (ulceration) • T1 ≤ 1 mm • T2 1.01-2 mm • T3 2.01-4 mm • T4 >4 mm • Node • N1 – 1 node • N2 – 2-3 nodes • N3 – 4+ nodes • Metastasis • M1a – distant skin, subq, or lymph node and normal LDH (lactate dehydrogenase) • M1b – lung metastases with normal LDH • M1c – Visceral metastases with normal LDH • OR any distant metastases with elevated LDH

  14. Surgical Treatment • Wide local excision (WLE) is the cornerstone of treatment • Margin of excision depends on depth • <1mm: 1cm margin • >1mm: 2cm margin • Primary closure or skin graft • Sentinel lymph node biopsy • Not needed if <1mm (WLE  95% cure • Unless Clark’s IV or V • Perform in >1mm and no clinically evident nodes

  15. Surgical Treatment • Positive regional lymph nodes – consider radiation therapy • Ajuvant therapy – chemo/radio/immunotherapy Unboundmedicine.com

  16. Melanoma Pearls • Prognosis • Tumor thickness is most important • Ulceration also important • Distant metastases • Lung > liver > brain > bone • Survival is 11mo for lung, 2-6 mo for others • Solitary brain metastasis should be resected • Can bleed, some can live 5+ years with resection and radiation therapy • The most common type of metastasis to small bowel is melanoma

  17. Other Pearls SCC and BCC can generally be resected with 4-6mm margins SCC and BCC can be resected with MOHS

More Related