Melanoma in afya

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10% of all cancer deaths (80% skin cancer deaths) ?? worldwide
dramatic increase in incidence since 1960s
higher risk in fair skinned
intermittent high intensity sun exposure is impt (like BCC but unlike SCC which relates to total cumulative exposure)
Men - trunk, women - legs (historically) - scalp - poor prognosis
Risk factors - FH, benign naevi / freckles, Hx severe sunburn esp in childhood, atypical naevi, early years in tropics, Hx melanoma or other skin cancer
30-50% arise in pre-existing naevi
clinically - not painful, may be itchy or have hair, colour and outline irregularity is impt
survival relates to histology - Breslow thickness (5yr disease free survival - 92% <1.5mm, 36% >3.5mm), ulcerated, number of mitoses

''types ...''
superficial spreading - most common
nodular - males, bleed, vertical from start so poor prognosis
lentigo maligna - progress slowly to melanoma
acral lentiginous - most common in darker skin, esp on soles and palms
subungual - late diagnosis - pigment spills into nail fold
Amelanotic - poor prognosis as diagnosed late
Mucosal - rare
Depigmented - irregular haloes may be seen
 
''Glasgow check list'' (7 point)
change in size, irregular shape or colour - major
>5mm, inflammed, bleed, itch - minor
 
''Mx'' - surgical excision (LN doesn't help), some targeted chemo is becoming available
FUp - look for local / distant recurrence - for 1-5 years (according to stage)

''Prognosis''
most impt factor - invasion depth of tumour (Breslow depth)
|Breslow Thickness|Approximate 5 year survival|
|< 1 mm|95-100%|
|1 - 2 mm|80-96%|
|2.1 - 4 mm|60-75%|
|> 4 mm|50%|

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