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Difference between revisions of "Malignant melanoma"
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*Histology is '''not definitive''' for metastatic melanoma vs. primary melanoma; epidermal involvement may be seen in mets. | *Histology is '''not definitive''' for metastatic melanoma vs. primary melanoma; epidermal involvement may be seen in mets. | ||
**History/clinical is important for differentiation. | **History/clinical is important for differentiation. | ||
====Margin assessment==== | ====Margin assessment==== | ||
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#*MART-1 (Melan A) is considered to overestimate melanocytes; it should ''not'' be used.<ref name=pmid21797920>{{Cite journal | last1 = Kim | first1 = J. | last2 = Taube | first2 = JM. | last3 = McCalmont | first3 = TH. | last4 = Glusac | first4 = EJ. | title = Quantitative comparison of MiTF, Melan-A, HMB-45 and Mel-5 in solar lentigines and melanoma in situ. | journal = J Cutan Pathol | volume = 38 | issue = 10 | pages = 775-9 | month = Oct | year = 2011 | doi = 10.1111/j.1600-0560.2011.01763.x | PMID = 21797920 }}</ref> | #*MART-1 (Melan A) is considered to overestimate melanocytes; it should ''not'' be used.<ref name=pmid21797920>{{Cite journal | last1 = Kim | first1 = J. | last2 = Taube | first2 = JM. | last3 = McCalmont | first3 = TH. | last4 = Glusac | first4 = EJ. | title = Quantitative comparison of MiTF, Melan-A, HMB-45 and Mel-5 in solar lentigines and melanoma in situ. | journal = J Cutan Pathol | volume = 38 | issue = 10 | pages = 775-9 | month = Oct | year = 2011 | doi = 10.1111/j.1600-0560.2011.01763.x | PMID = 21797920 }}</ref> | ||
#*S-100 also marks follicular dendritic cells; it is ''not'' a preferred marker. | #*S-100 also marks follicular dendritic cells; it is ''not'' a preferred marker. | ||
====Breslow thickness==== | |||
*[[AKA]] ''maximum tumour thickness''. | |||
*Depth measured from stratum granulosum to deepest intradermal tumour cell - predictive of survival.<ref name=Ref_PCPBoD8>{{Ref PCPBoD8|595}}</ref> | |||
Melanoma staging is based on the Breslow thickness:<ref>{{Cite journal | last1 = Nowecki | first1 = ZI. | last2 = Rutkowski | first2 = P. | last3 = Michej | first3 = W. | title = The survival benefit to patients with positive sentinel node melanoma after completion lymph node dissection may be limited to the subgroup with a primary lesion Breslow thickness greater than 1.0 and less than or equal to 4 mm (pT2-pT3). | journal = Ann Surg Oncol | volume = 15 | issue = 8 | pages = 2223-34 | month = Aug | year = 2008 | doi = 10.1245/s10434-008-9965-3 | PMID = 18506535 }}</ref><ref>URL: [http://www.cap.org/apps/docs/committees/cancer/cancer_protocols/2013/SkinMelanoma_13protocol_3300.doc http://www.cap.org/apps/docs/committees/cancer/cancer_protocols/2013/SkinMelanoma_13protocol_3300.doc]. Accessed on: 2 January 2014.</ref> | |||
*pT1 <= 1.0 mm. | |||
**pT1a: no ulceration, <1 mitoses/mm<sup>2</sup>. | |||
**pT1b: ulceration present ''or'' >=1 mitoses/mm<sup>2</sup>. | |||
*pT2 1.01 mm to 2.0 mm. | |||
**pT2a: no ulceration. | |||
**pT2b: ulceration present. | |||
*pT3 2.01 mm to 4.0 mm. | |||
**pT3a: no ulceration. | |||
**pT3b: ulceration present. | |||
*pT4 >4.0 mm. | |||
**pT4a: no ulceration. | |||
**pT4b: ulceration present. | |||
=====Clark level===== | |||
*[[AKA]] ''anatomic level''. | |||
*Not as reproducible as ''Breslow thickness'' - not used. | |||
Anatomic level - definition: | |||
*I = epidermis only ([[AKA]] melanoma in situ). | |||
*II = extends into [[papillary dermis]] but does '''not''' fill or expand. | |||
*III = fills and expands papillary dermis. | |||
*IV = extends into reticular dermis. | |||
*V = extends into subdermis. | |||
====Subtypes==== | ====Subtypes==== | ||