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1、MelanomaEdwardBuckingham,M.D.CombinedPlasticsConferenceSeptember6,2000Melanoma-OutlineGeneralstatisticsanddevelopmentRiskfactorsandpatientassessementPathologyandprognosisWork-upandstagingSurgicaltreatmentLymphnodecontroversy/sentinelnodeAdjuvanttherapyMelanoma-DataIncidenceincre
2、asefastestMortalityincrease2ndonlytolung5thmostprevalent,incidence7%/yearincrease5%skincancer,75%skincancerdeath1/75in2000,1/1500in193520%H&N,51%facial,26%scalp,16%neck,9%earDevelopmentofNeviMelanocytesdendritic,neuralcrest,basalcelllayersynthesisofmelanin1/10tokeratinocyteshype
3、rplasia-tanning/lentigines,increasedratioNevustransformationpoorlyunderstooddendritic-roundednolongerlentigionouspattern-nestsDevelopmentofNeviJunctionalnevinestsalongdermal-epidermaljunctionCompoundnevi“invade”dermis,firstasneststhencordsandsinglecellsDermalnevijunctionalcompon
4、entlostEvolutionofNeviMelanocyteHyperplasiaJunctionalNeviCompoundNeviDermalNeviDevelopementofMelanomaQuestionablebenignmelanocytesprogressivehyperplasia/dysplasiaRadialgrowthinepidermis,linesofradii,noexpansivenestsornodulesslowunrestricted,nometastaticpotentialDevelopmentofMela
5、nomaVerticalgrowthverticallyintodermisexpansiveandcoalescentnestsandnodulesmetastaticpotentialdermallymphaticandvascularinvasionGrowthpatternsbiphasic-slowradialmonthstoyears-rapidverticalgrowthmonophasic-rapidverticalgrowthonlyEvolutionofMelanomaDysplasticNevibordermelanocyticn
6、eviandmalignantmelanomaclinicalresemblesmalignantmelanomalentiginouscompoundnevus,prominentbridgingacrossreteridgesaberrantininter-retespaceslamellarfibrosisofpapillarydermis,variablelymphoidresponseDysplasticNeviDysplasticNeviTypesofMelanomaAcrallentiginousMucosalmelanomaSuperf
7、icalspreadingmelanomaLentigomalignamelanomaNodularmelanomaSuperficialspreadingmostcommonheadandneck,50%4thto5thdecadeclinicalmixtureofbrown/tan,pink/whiteirregularborders,biphasicgrowthirregularnestsinepidermisunderlyinglymphoidinfiltrateenlargednestsandsinglecellsinallepidermal
8、layersSuperficialspreadingLentigomaligna20%ofhe
