Melanoma
F>M
Prognosis: average of 90% survival rate, prognosis improves if less invasion
worse prognosis if: increasing depth, age, ulceration, mitosis, lesions on head or neck
Risk factors: UV exposure, sunburn, fair complexion, many other common and 6 or more dysplastic moles, FHx, increasing age
Signs: can arise in normal skin or within a dysplastic naevi, size, shape, colour - heterochromia, diameter, inflammation, oozing/ bleeding, itch/ odd sensation, beware of new or changing lesions or rapidly growing raised lesion
Prognosis: average of 90% survival rate, prognosis improves if less invasion
worse prognosis if: increasing depth, age, ulceration, mitosis, lesions on head or neck
Risk factors: UV exposure, sunburn, fair complexion, many other common and 6 or more dysplastic moles, FHx, increasing age
Signs: can arise in normal skin or within a dysplastic naevi, size, shape, colour - heterochromia, diameter, inflammation, oozing/ bleeding, itch/ odd sensation, beware of new or changing lesions or rapidly growing raised lesion
Management
Excise lesion with a 2mm margin, can go back later and have a wider excision if required, do not freeze/ perform punch or shave biopsies on suspicious pigmented lesions
- Vemurafenib (BRAF enzyme inhibitor - shuts down MAP-kinase pathway that allows melanoma to grow uncontrollably)
- rapid tumour regression, but resistance develops quickly
- SE: photosensitivity, development of other skin cancers
- Ipilimumab (monoclonal antibody against CTLA-4 - works by enhancing T cell activation and cytokine production)
- 5-10% of patients have a good response but tolerance rarely develops
- SE: fatigue, diarrhoea, nausea, rash, pruitus
- refer to a dermatologist, regular follow up every 6-12 mo for monitoring, check for mets or other primary skin cancers
Source
OHCS 8th edn 2009
Dr Clark 2014
Excise lesion with a 2mm margin, can go back later and have a wider excision if required, do not freeze/ perform punch or shave biopsies on suspicious pigmented lesions
- Vemurafenib (BRAF enzyme inhibitor - shuts down MAP-kinase pathway that allows melanoma to grow uncontrollably)
- rapid tumour regression, but resistance develops quickly
- SE: photosensitivity, development of other skin cancers
- Ipilimumab (monoclonal antibody against CTLA-4 - works by enhancing T cell activation and cytokine production)
- 5-10% of patients have a good response but tolerance rarely develops
- SE: fatigue, diarrhoea, nausea, rash, pruitus
- refer to a dermatologist, regular follow up every 6-12 mo for monitoring, check for mets or other primary skin cancers
Source
OHCS 8th edn 2009
Dr Clark 2014