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Dermatology
Melanoma
Built from Dermatology, 5th Edition
What’s inside
8 sections · 101 slides
Overview
- What this topic covers
- What melanoma is
Molecular Pathogenesis and Host Immune Response
The signaling pathways that drive melanoma, and how the immune system fights back
- How melanoma develops at the genetic level
- MAPK and PI3K signaling pathways
- MAPK and PI3K-AKT signaling pathways in melanoma
- Stepwise route from normal melanocyte to melanoma
- BRAF V600E and targeted therapy
- Molecular pathogenesis: alteration and mechanism
- Molecular pathogenesis: alteration and mechanism (continued)
- Molecular pathogenesis: clinical significance
- Molecular pathogenesis: clinical significance (continued)
- Molecular pathogenesis: clinical significance (continued)
- Molecular pathogenesis: clinical significance (continued)
- Melanoma as a target for the immune system
- Completely regressed cutaneous melanoma
- Activating a tumor-killing T cell
- Checkpoint inhibitor immunotherapy
- Escape mechanisms of malignant tumors, including melanoma
Epidemiology
How common melanoma is, and why incidence keeps climbing while mortality has stabilized
- The global and US burden of melanoma
- Rising incidence, more nuanced mortality
- US melanoma incidence and mortality trends, 1975-2019
- Who is affected most severely
- Thinner tumors, but incidence still climbing
Risk Factors for Cutaneous Melanoma
Genetic susceptibility, mole patterns, and ultraviolet radiation exposure
- Three categories of melanoma risk factor
- Risk factors for the development of cutaneous melanoma
- Risk factors for the development of cutaneous melanoma (continued)
- Genetic risk: CDKN2A and familial melanoma
- Familial melanoma susceptibility genes
- Other high-penetrance genes and the “sentinel cancer” idea
- Low-penetrance pigmentation genes
- BAP1 tumor syndrome
- Genetic screening in familial melanoma
- Who should be offered genetic testing
- Recommendations for genetic screening for familial melanoma
- Melanocytic nevi: a dual role in risk
- Common nevus count and melanoma risk
- Common melanocytic nevi as a melanoma risk indicator
- Atypical nevi and melanoma risk
- Atypical melanocytic nevi as a melanoma risk indicator
- Ultraviolet radiation: two patterns of damage
- Evidence for a role of chronic and childhood sun exposure
- UVA, UVB, and melanocyte biology
- Tanning beds: a preventable, quantified risk
- Sun protection and sunscreen evidence
Types of Primary Cutaneous Melanoma
Superficial spreading, nodular, lentigo maligna, and acral lentiginous melanoma
- Classifying primary cutaneous melanoma
- Four classic growth-pattern subtypes
- Frequency of four different subtypes of primary cutaneous melanoma in four racial groups
- Superficial spreading melanoma: overview
- Longstanding superficial spreading melanoma
- Superficial spreading melanoma: growth phases
- Superficial spreading melanoma: clinical and dermoscopic features
- Superficial spreading melanoma arising in a nevus
- Melanoma in situ on the foot of an 84-year-old man
- Melanoma in situ, under 3 mm across
- Nodular melanoma
- Nodular melanoma
- Lentigo maligna melanoma
- Lentigo maligna melanoma
- Lentigo maligna (melanoma in situ, lentigo maligna type)
- Acral lentiginous melanoma: overview
- Acral lentiginous melanoma
- Subungual melanoma and Hutchinson sign
- Melanoma of the nail matrix
Other Melanoma Variants
Unusual clinical and histologic presentations that can confound diagnosis
- Amelanotic melanoma
- Amelanotic melanoma
- Spitzoid melanoma and Spitz melanoma
- Atypical Spitz tumors: the gray zone
- Desmoplastic melanoma
- Histopathologic features of desmoplastic melanoma
- Clear cell sarcoma (“melanoma of soft parts”)
- Blue nevus-like melanoma
- Melanoma arising in a cellular blue nevus
- Primary dermal melanoma
- Ocular melanoma
- Ocular melanoma: management
- Mucosal melanoma
Melanoma in Pregnancy and in Children
Two special populations with their own diagnostic and management considerations
- Melanoma and pregnancy: epidemiology
- Melanoma and pregnancy: safe evaluation and management
- Melanoma and pregnancy: outcome and timing of future pregnancy
- Melanoma in children and adolescents
Diagnosis
Clinical warning signs, dermoscopy, and telling melanoma apart from its many mimics
- Why early detection matters
- The ABCDE rule
- Beyond ABCDE: the ugly duckling and other clinical clues
- The limits of visual diagnosis
- Conditions that mimic melanoma
- Non-melanocytic clinical simulators of melanoma
- Non-melanocytic clinical simulators of melanoma (continued)
- Non-melanocytic clinical simulators of melanoma (continued)
- Melanocytic lesions that simulate melanoma
- Dermoscopy: a two-step algorithm
- What dermoscopy is and how it is used
- Dermoscopic features that raise concern for melanoma
- Dermoscopic criteria and their diagnosis
- Dermoscopic criteria and their diagnosis (continued)
- Dermoscopic criteria: histopathologic basis
- Dermoscopic criteria: histopathologic basis (continued)
- Photography and non-invasive imaging
- 80%
- Melanoma: key takeaways
- A note on this chapter extract
- Dermatology, 5th Edition (2-Volume Set)