By doctor Patrick Treacy
A 23yo Siberian female patient presented with a changing lesion on her abdomen. The patient stated the lesion was present for about two years and it started off from within a freckle, which started to grow larger and somewhat darken in appearance.
It had the clinical appearance of a melanoma and the dermoscopy 3-point checklist (designed to allow non-experts not to miss detection of melanomas) was used to determine whether this had a high likelihood of malignancy.
Glasgow 7-point checklist:
- Change in size
- Irregular shape
- Irregular colour
- Diameter >7mm
- Inflammation
- Oozing
- Change in sensation
Treatment of Melanoma
The primary mode of treatment for localized cutaneous melanoma is surgery. Surgical margins of 5 mm are currently recommended for melanoma in situ, and margins of 1 cm are recommended for melanomas ≤1 mm in depth (1). For tumors of intermediate thickness (1–4 mm Breslow depth), randomized prospective studies show that 2-cm margins are appropriate, although 1-cm margins have been proven effective for tumors of 1- to 2-mm thickness (2) (3). Margins of 2 cm are recommended for cutaneous melanomas greater than 4 mm in thickness (high-risk primaries) to prevent potential local recurrence in or around the scar site.
Numerous adjuvant therapies have been investigated for the treatment of localized cutaneous melanoma following complete surgical removal. Adjuvant interferon (IFN) alfa-2b is the only adjuvant therapy approved by the US Food and Drug Administration for high-risk melanoma (4). While early-stage melanomas can often be cured with surgery, more advanced melanomas can be much harder to treat. But in recent years, newer types of immunotherapy and targeted therapies have shown a great deal of promise and have changed the treatment of this disease.
Malignant melanoma is the most deadly cutaneous neoplasm. Numerous risk factors for development of melanoma have been identified, including white skin, fair hair, light eyes, sun sensitivity and a tendency to freckle. Other factors, include family history of melanoma, dysplastic nevi, increased numbers of typical nevi, large congenital nevi and immunosuppression. Although sun exposure is a risk factor for melanoma, cutaneous melanomas can also arise in areas of the body not exposed to the sun. Sun exposure in childhood and having more than one blistering sunburn in childhood are associated with an increased risk of melanoma (5). Most melanomas arise as superficial tumors confined to the epidermis. The prognosis for melanoma is closely related to the thickness of the tumour. In order to effectively treat melanomas, drugs that target proteins that normally suppress the T-cell immune response or block ones that help them evade the immune system provide the best chance for treating patients with advanced melanoma. In early studies, combination drugs have shrunk tumors in about one half of patients with melanoma.
