Top / Left to Right: Superficial Spreading Type - Superficial Spreading Type
Bottom / Left to Right: Lentigo Maligna Type / Regression of Melanoma
Types of Melanoma
Superficial Spreading
70% of all Melanomas
Spreads along surface, before invading deeper
Irregular shaped, flat or elevated, multiple colors
Trunk, legs and upper back - most commonly involved areas
Lentigo Maligna
Very early Melanoma, with a good prognosis
Older age group
Face, upper trunk and arms
Nodular
Black nodule, usually invading deeply
Acral
Found on the palms of hands, soles of the feet and under the nails
Desmoplastic
Lacks pigment and can be a very aggressive Melanoma
Incidence
Highest in fair skin individuals & those with sun exposure
Prognosis
Pathological Classification by depth of penetration into the skin
Clark's Level of Penetration
Level I - confined to Epidermis
Level II - penetrates the upper dermis or Papillary layer
Level III - fills the upper dermis or Papillary layer
Level IV - penetrates the lower dermis or Reticular layer
Level V - invades deeply into the fat
Breslow's Classification - Based Depth of Invasion into the Skin
0.75mm or less
0.76mm to 1.50mm
1.51mm to 4.0mm
4.0mm or greater
0.75mm or less = almost 100% survival for 10 years
Greater than 3.0mm = Poor Prognosis
Treatment
Surgical excision - wide, based on the depth of penetration
1-2-3 Rule
Remove a 1cm cuff of normal tissue on all sides of the Melanoma for penetration 1mm or less
Remove a 2cm cuff of normal tissue on all sides of the Melanoma for penetration 2mm or less
Remove a 3cm cuff of normal tissue on all sides of the Melanoma for penetration greater than 2mm
Sentinel Lymph Node Removal or Lymphadenectomy
Biopsy of lymph node(s) - First dye is injected into the skin surrounding the Melanoma to find the lymph node drainage. Then the 1st node in the chain is removed and analyzed
Lymphadenectomy (removal of all lymph nodes in the area) is done if there is involvement of the Sentinel node(s)
Radiation Therapy - generally done to relieve tumor symptoms
Chemotherapy - systemic or local - used to control tumor spread
Biological or Immunotherapy
Agents used to stimulate the Immune System
Block blood vessel formation
Directly attack the tumor cells
BCG ( Bacillus-Calmette-Guerin, TB strain ) or Vaccine
Interleukin 2 ( Lymphokines )
Basal Cell Carcinoma - Squamous Cell Carcinoma - Melanoma
CALL
Reconstructive Plastic Surgeon Dr Costanzo, Thousand Oaks
805 / 373-9919 or 818 / 706-2070