Melanoma Lecture 2.doc

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Western University
Anatomy and Cell Biology
Anatomy and Cell Biology 4461B
Geordie Shepherd

LP Lecture 2: Melanoma The ABC Rule • Contributes to low mortality rates of approx 20% annually Alerts physicians to suspicious lesions • • A - asymmetry of lesion B - border irregularity • • C - color variation • D - diameter > 6mm • E - existing melanocytic nevi with recent change in color, size or shape • F - finding a new pigmented lesion, especially in persons > 40 years Biology of Cutaneous Melanoma • Transition from melanocytes to melanoma involves several intermediates • Nevus (mole) • Dysplastic nevus • Radial growth phase (RGP) • Melanoma in situ (restricted to the epidermis) • Superficial invasion into the papillary zone • Present as macules or minimally raised lesions • Usually pigmented • Poorly metastatic (0-5% mortality) • Vertical Growth Phase (VGP) • Invasion into the dermis • Can access rich vascular beds that reside in hypodermis - increased metastatic risk • Often arise from an RGP as a nodular outgrowth • Nodular melanomas develop VGP without RGP • Metastatic melanoma Melanoma Subtypes Superficial Spreading Melanoma • • Most common type • Pagetoid (upward) growth of melanocytes • Associated with sun exposure • Nodular Melanoma • Lack RGP • May be non-pigmented • Worst prognosis • Often thick • Acral Lentiginous Melanoma • Typically acral (palmar, plantar, subungal) • Can be mucousal (anorectal, nasopharangeal) • UV-independent • Prolonged RGP • Lentigo Melanoma • Typically in the elderly • Sun damaged areas (face) • RGP that can progress to VGP • Desmoplastic Melanoma • Uncommon
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