Melanoma-0003 - Melanoma Edward Buckingham M.D Combined...

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Melanoma Edward Buckingham, M.D. Combined Plastics Conference September 6, 2000
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Melanoma - Outline General statistics and development Risk factors and patient assessement Pathology and prognosis Work-up and staging Surgical treatment Lymph node controversy/sentinel node Adjuvant therapy
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Melanoma - Data Incidence increase fastest Mortality increase 2nd only to lung 5th most prevalent, incidence 7%/year increase 5% skin cancer, 75% skin cancer death 1/75 in 2000, 1/1500 in 1935 20% H&N, 51% facial, 26% scalp, 16% neck, 9% ear
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Development of Nevi Melanocytes dendritic, neural crest, basal cell layer synthesis of melanin 1/10 to keratinocytes hyperplasia- tanning/lentigines, increased ratio Nevus transformation poorly understood dendritic- rounded no longer lentigionous pattern- nests
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Development of Nevi Junctional nevi nests along dermal-epidermal junction Compound nevi “invade” dermis, first as nests then cords and single cells Dermal nevi junctional component lost
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Evolution of Nevi
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Melanocyte Hyperplasia
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Junctional Nevi
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Compound Nevi
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Dermal Nevi
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Developement of Melanoma Questionable benign melanocytes progressive hyperplasia/dysplasia Radial growth in epidermis, lines of radii, no expansive nests or nodules slow unrestricted , no metastatic potential
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Development of Melanoma Vertical growth vertically into dermis expansive and coalescent nests and nodules metastatic potential dermal lymphatic and vascular invasion Growth patterns biphasic- slow radial months to years- rapid vertical growth monophasic- rapid vertical growth only
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Evolution of Melanoma
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Dysplastic Nevi border melanocytic nevi and malignant melanoma clinical resembles malignant melanoma lentiginous compound nevus, prominent bridging across rete ridges aberrant in inter-rete spaces lamellar fibrosis of papillary dermis, variable lymphoid response
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Dysplastic Nevi
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Dysplastic Nevi
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Types of Melanoma Acral lentiginous Mucosal melanoma Superfical spreading melanoma Lentigo maligna melanoma Nodular melanoma
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Superficial spreading most common head and neck, 50%
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