Malignant Melanoma

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Malignant Melanoma

• By
• Bill V. Way, DO
• Dan Ladd Jr., DO

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A-B-C-D-Es of Melanoma

• A - Asymmetry - several types
• B - Border Irregularity
• C - Colors - multiple
• D - Diameter - bigger than a pencil eraser
• E - Elevation, Erythema

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ASYMMETRY - WHAT DOES IT MEAN?

• One side differs from the other side
• Shape
• Color
• Elevation
• Borders
• Does the lesion mirror itself in every way?
• May be subtle.

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BORDERS

• May be notched or jagged
• May simply be blurred or indistinct.
• Can be indicative of the irregular growth of
  malignant melanocytes.
• Requires close inspection of lesion, preferably
  with a magnifying glass, may be subtle - take it
  seriously.

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COLOR

• Many benign lesions have 2 colors, tan and brown,
  but the color is symmetrically placed, ie., brown
  central with round peripheral tan ring.
• Look for multiple or asymmetrically positioned
  colors - may see red, white, tan brown or black.
• Again requires magnification, can be subtle.

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DIAMETER

• Always measure the greatest diameter.
• Include lighter or indistinct areas in your
  measurement, not just the darker pigment.
• Remember PENCIL ERASER 6 mm.
• Document size carefully if you are going to watch
  a lesion over time - consider the compliance
  level of your patient.

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ELEVATION

• Remember that if the lesion is melanoma,
  elevation above the surface means depth below,
  and is the single worst prognostic factor.
• Elevation need not be eccentrically located, the
  classic fried egg may appear fairly symmetric
  but requires biopsy.
• PALPATE !

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LETS TRY A FEW
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Path Junctional Nevus with Dysplastic Features,
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Path Compound Nevus with Features of
Dysplastic (Clark) Nevus
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Path Compound Nevus
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Path Pigmented Seborrheic Keratosis
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Path Compound Nevus
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Path Melanocytic Nevus, Compound Type
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Path Compound Dysplastic Melanocytic Nevus
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Path Compound Dysplastic Melanocytic Nevus
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Path Possible Early Evolving Melanoma In Situ
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Path Malignant Melanoma,Clarks Level IV,
Breslows Thickness 1.9 mm
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Path Melanoma In-Situ
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Path Evolving Melanoma In Situ
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Path Evolving Melanoma In-Situ
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Path Malignant Melanoma, Breslows Thickness 0.9
mm
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THE END