CUTANEOUS

MELANOMA MALIGNA
Yono Hadi Agusni
Dept of Dermatovenereology
Padjadjaran University

Melanoma maligna
Melanoma results from the
malignant transformation of
melanocytes

Richard G.B. Langley

Epidemiology
USA : 1960 : 1 in 600

1992 : 1 in 105

2000 : 1 in 75
Cutaneous melanoma currently
represent 3 percent of all types of
newly diagnosed cancer

Mortality
1994 5-year survival rate 88,2 %

Risk factors
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Sun exposure
Reaction of skin to sunlight
Phenotype
Occupation and Social status
Familial melanoma
Melanocytic nevi
Gender and Hormonal factors

Type of Melanoma
maligna
1.
2.
3.
4.
5.

Lentigo maligna
Lentigo maligna melanoma
Superficial spreading melanoma
Nodular melanoma
Acral lentiginous melanoma

Lentigo maligna (LM)

LM a flat (macular) intraepidermal
neoplasm and the precursor or
evolving lesion of LMM
Thomas B. Fitzpatrick

Melanoma in-situ (?)

Richard G.B. Langley

LM/1

Epidemiology (2)

Age : 45 - 65 year
Sex : man = woman
Race : very rare in black or brown skin
Incidence : 5-10% of cutaneous melanoma
Predisposing factors :
sun-induced nonmelanoma skin cancer

older population

outdoor workers

LM/2

Physical examination
Skin lesions :
Distribution : sun-exposed area
Type : uniformly flat, macule
Color : brown to black
Size : 3.0 - 20.0 cm ( or larger)
Shape : irregular border, often with a
notch, geographic shape

LM/3

Physical examination (2)

General medical examination :
Search for regional lymphadenopathy

LM/4

Laboratory

None

Dermatopathology
Increased numbers of
melanocytes, usually atypical and
bizzare and distributed along the
basal layer;

Differential diagnosis
Solar lentigo

Treatment
Surgery

Lentigo maligna
melanoma (LMM)
LM develops focal papular and
nodular areas that signal invasion
into dermis.

Epidemiology

Age : median age is 65 years

Sex : male = female
Race : very rare in brown or black skinned
Incidence : 5-10 % cutaneous melanoma
Predisposing factors :
sun-induced non melanoma skin cancer
older population
outdoor occupations
LMM1

Physical examination
Skin lesions :
Distribution : sun-exposed area
Type : Flat with focal area of
papules or nodules
Color : same with LM plus gray
area and blue area. Papule maybe
black, blue or pink

LMM2

 General medical examination :

search for regional lymphadenopathy

LMM3

Laboratorium

none

LMM4

Dermatopathology
Increase the number of melanocytes, usually
atypical and bizzare and distributed along the basal
layer, at certain places in the dermis, malignant
melanocytes have invaded and formed huge nest.

Thomas B. Fitzpatrick

LMM5

Differential diagnosis
Seborrheic keratosis
Solar lentigo

LMM6

Treatment :

surgery

LMM7

Prognosis

Depend on stage of tumor at the time of

diagnosis made.

LMM8

Superficial spreading
melanoma(SSM)
SSM has a distinctive morphology :
a uniformly elevated, flattened
lesion (plaque), usually with a
strikingly variegated brown, bluegray color pattern and an
iregularly irregular border.

Epdemiology
Age : 30 - 50 years
Sex : Slightly higher incidence in females
Race :
White-skinned predominantly
only 2% brown/black skinned
brown / black usually occuring on the
extremities. Half arising on sole of the
foot.

SSM2

Epidemiology (2)
Incidence : 70% of all melanomas
arising in white persons
History : evolves over a period of
1-5 years

SSM4

Physical examination
Skin lesions :
Distribution : isolated/single lesion

multiple are rare

Type : flattened papule, becoming plaque

then developing one / more

nodules

SSM5

Physical examination (2)

Color : dark brown, black with
admixture of pink, gray andblue-gray
hues. White areas indicate regressed
portions.
Shape : asymmetrical, oval with
irregurelarly irregular borders and often
with one or more notches

SSM6

Physical examination (3)

General medical examination :

search for lymph nodes

SSM7

Laboratorium :

none

SSM8

Dermatopathology
Pagetoid distribution of large melanocytes throught
the epidermis, occuring singly or in the nests
The melanocytes often have regularly dispersed
fine particles of melanin.

SSM9

Treatment

Surgery
Chemotherapy

SSM10

Prognosis
Melanoma is responsible for about
6500 deaths per year in USA
Thomas B. Fitzpatrick

SSM 11

Nodular melanoma
(NM)
NM is one type of melanoma that
arises quite rapidly (4months to 2
years) from normal skin or from
melanotic nevus as a nodular
(vertical) growth without an
adjacent epidermal component.

Epidemiology
Age : Median age is 50 years
Sex : male = female
Race : occurs in all races

! Japanese : 8 time more than

SSM
Incidence : 15-30% of the melanoma
in US

NM2

Physical examination
Skin lesions :
Distribution : same as SSM
Type : Uniformly elevated blueberry
like nodule / ulcerated /
Color : dark blue - black or pink
Size : 1-3 cm, / larger
Shape : oval/round usually with smooth.

NM3

General medical
examination

Always search for node

NM4

Laboratory
examinations

none

NM5

Dermatopathology
Arises at the dermoepidermal junction and extend
vertically in the dermis.
Tumor may show large epitheloid cells, spindle
cells, small malignant melanocytes or mixture of all
three

NM6

Differential diagnosis

Hemangioma
Pyogenic hemangioma
Pigmented basal cell carcinoma

NM7

Treatment
Surgery
Chemotherapy

NM8

Prognosis
Worse than other melanoma
Prognosis related to the thickness
at the time of diagnosis.

William A. Caro

NM9

Acral Lentiginous
melanoma (ALM)

Occurs as a flat pigmented lesion

on the sole, palm and subungual
region.

Epidemiology
Age : median age is 65
Sex : male = female
Race : ALM is the principal melanoma
in Japanese, Africans and black
Americans.
! ALM accounts for 50 to 70 % of
melanoma in Japanese.

ALM 2

Epidemiology(2)
Incidence : 7 - 9% of all melanoma
Predisposing factors :
Subungual melanoma is most
frequent type of ALM in white
persons, but trauma has not been
proved to be a factor

ALM3

Physical examination (1)

Skin lesions :
Distribution : Soles, palm, fingers and toes
Type : Macular lesion in the radial growth
phase with focal papules and nodules
developing during the vertical growth phase
Color : brown, black, blue and depigmented
pale areas.

ALM5

Physical examination (2)

Size : up to 12 cm
Shape : irregularly borders like
lenitigo maligna melanoma
General medical examination :
search for regional
lymphadenopathy

ALM 6

Differential diagnosis
ALM (plantar type):

plantar warts

nevus
ALM (subungual type):

post traumatic lesion

fungal infection

ALM8

Laboratory examination
:

none

Dermatopathology
Characteristic large melanocyte with
prominent dendrites along basal cell
layer may extend as large nest into
the dermis, as long eccrine ducts.

Thomas B. Fitzpatrick

ALM9

Treatment
Surgery
Perfusion with chemotherapeutic
agents.

ALM10