Malignant Melanoma

Malignant Melanoma

What is Malignant Melanoma?

malignant melanoma in situ

Introduction

It is a Malignant Neoplasm of Epidermal Melanocytes and known as most deadliest of Human Neoplasm.

Etiology of Malignant Melanoma

  1. Sunlight Exposure (UV Light)
  2. Artificial UV Source (Tanning Lamp)
  3. Familial - 1st degree relative (2% - 5%)
  4. Xeroderma Pigmentosum
  5. Higher Socioeconomic Status (Outdoor Activities)

Clinicopathologic Classification of Malignant Melanoma

  1. Cutaneous (Most Common)
  2. Non-Cutaneous
  3. Superficial Spreading
  4. Lentigo Maligna
  5. Acral Lentiginous (Most Aggresive)
  6. Amelanotic
  7. Nodular

Clinical Feature of Malignant Melanoma

  1. Incidence - 1/lac/year (Dark Skinned), 50/lac/year (Light Skinned)
  2. Location - Palm, Soles, Mucous Membrane
  3. Precursor Lesion - Acquired Naevus, Dysplastic Naevus, Congenital Naevus, Cellular Blue Naevus

Oral Manifestation Malignant Melanoma

  1. Uncommon in Oral Mucosa (1.6%)
  2. Female Predominance (2×F ˃ M)
  3. Age - 40 - 70 years
  4. Site Predilection - Palate, Maxillary Gingiva, Alveolar Gingiva
  5. Other Sites - Buccal Mucosa, Mandibular Gingiva, Tongue, Lips, Floor of Mouth
  6. Lesion Appearance - Deeply Pigmented, Ulcerated or Hemorrhagic which tends to increase in size
  7. Prodromal Symptoms - Focal Pigmentation (Months or Years back)

Clinical Diagnosis of Malignant Melanoma

( ABCDE Rule )

  • Asymmetry
  • Border - Irregular / Blurred / Notched / Ragged Edges
  • Colour - Pigmentation (Brown / Black /Red / White)
  • Diameter - ˃ 6 mm
  • Elevation - Raised Surface

Histopathologic Feature of Malignant Melanoma

Malignant Melanoma shows Tumor Invasion in deeper histologic cutaneous structure

skin tumors

Clark System (Grades of Tumor Invasion)

Clark Level Characteristics
Level 1 Confined to Epidermis (in situ)
Level 2 Invasion of Papillary Dermis
Level 3 Filling of Papillary Dermis but not extending to Reticular Dermis
Level 4 Invasion of Reticular Dermis
Level 5 Invasion of deep Subcutaneous Tissue

Treatment of Malignant Melanoma

  1. Chemotherapy
  2. Immunotherapy
  3. Surgical - Skin Grafting, Wide Local Incision, Mohs Surgery

Prognosis of Malignant Melanoma

  • Better - Lentigo Maligna (Female Patient)
  • Poor - Nodular, Superficial spreading
  • Worst - Oral Melanotic Lesion