Melanocytic Tumors of the Skin. an Introduction. PPT

7/29/2019 Melanocytic Tumors of the Skin. an Introduction. PPT

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Melanocytic tumors of the skin:

Introduction

Deba P Sarma, MD

Omaha


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Melanocyte


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Melanocyte

MITF immunostain


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Melanocytic lesions

Benign- 95%

Malignant- 4%

Undetermined- 1%


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Dr. Sarmas classification of pigmentedlesions

Benign:Lentigo simplexSolar lentigoNevus (Junctional, Dermal, Compound,

Blue, Spitz, Dysplastic)

Potentially malignant:Atypical melanocytic hyperplasia

Malignant:Melanoma in-situInvasive melanoma


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Lentigo, Freckle, Mole, Nevus

Lentigo: From Latin word for lentil. A dark spot on skin thatlooks like a lentil bean and does not fade in the winter.

Freckle: Small brownish spot turning darker or increasing innumber upon exposure to the sun and fading in winter.(Freckle=Speckle)

Mole : Spot, common name for nevus.

MOLE = NEVUS

Nevus: Latin word meaning birthmark.


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Lentigo simplex

Elongated rete ridgesBasal melanosis

No junctional nest

No solar elastosis


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Solar lentigo

Elongated rete ridges

Basal melanosis

No junctional nest

Dermal solar elastosis


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Nevus = Mole


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Life of a nevus


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Congenital nevus


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Common nevi

Junctional

Compound Dermal


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Nevus: Junctional

Flat epidermal lesion

Junctional nests with clefts


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Nevus: Compound

Raised or flat (older person) lesion

Junctional clefted nests and dermal nests


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F 25, left abdomen


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Dysplastic nevus


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Nevus: Blue

Flat lesion

No junctional nest

Dermal pigmented spindled melanocytes


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Nevus: Epithelioid (Spitz nevus)

70% occurs in pts < 20 yrs

Raised, junctional or compound nevus

Epithelioid clefted nests oriented vertically

Cytologic and nuclear pleomorphism


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Melanoma

Types

Melanoma in-situ

Melanoma (Invasive melanoma)


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Melanoma

Lentigo maligna & lentigo maligna melanoma

Superficial spreading ( Pagetoid): In-situ &invasive

Acral-lentiginous: In-situ & invasive

Nodular: Invasive

Desmoplastic: Invasive


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Melanoma in-situ: Lentigo maligna type

Neoplastic melanocytes spread from the junction upwards

and along the adnexa.

No dermal invasion.


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Melanoma in-situ: Lentigo maligna type

Epidermal atrophy, solar elastosis

Confluent and nested proliferation of pleomorphic melanocytes


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Superficial spreading in-situ & invasive melanoma


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Nodular melanoma

Raised, ulcerated, no radial spread, deep dermal invasion


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Acral lentiginous melanoma


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Epidermal atrophy, dermal actinic change, mononuclear cell

and spindle cell infiltration

Desmoplastic melanoma


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Pleomorphic spindle cells within desmoplastic stroma.Note

the mitotic figure.


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S-100: Positive


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Risk factors

Uncontrollable:

Skin type(race)

History of melanoma

Molesand atypical moles

Age: 70 +

Gender: M > F

Controllable:

UV radiation( sunlight, tanning booths and lamps).


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Skin types

VVI

IV

I II III


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History of melanoma

First-degree relatives: Father, mother, brother,sister, child

Personal history of melanoma

Melanoma pt.: Family history in 10%


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Estd new cancer cases, USA, 2008American Cancer Society

Male: Female:

1. Prostate (25%) 1. Breast (31%)

2. Lung (15%) 2. Lung (14%)

3. Colorectum (10%) 3. Colorectum (10%)

4. Bladder (7%) 4. Uterus (5%) 5. NH Lymphoma (5%) 5. NH Lymphoma (4%)

6. Melanoma (5%) 6. Thyroid (4%)

7. Kidney (4%) 7. Melanoma (4%)


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Melanoma sites


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Five-year survival rate

Overall 90%

Localized 99%

With regional spread 45%

Good news: 80% localized at diagnosis


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Editorials 1985-2008

April;144: 533-534. Ackerman AB. No oneshould die of malignant melanoma. J AmAcad Dermatol. 1985 Jan; 12: 115-6.

Kittler H. Early recognition at last. ArchDermatol. 2008

Melanocytic Tumors of the Skin. an Introduction. PPT

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