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1、ImagingMelanoma:ImagingMelanoma:FocusonPatientwithUnsuspectedFocusonPatientwithUnsuspectedMetastasesMetastasesSashaSashaGirouardGirouard,HMSIII,HMSIIIGillianLieberman,MDGillianLieberman,MDApril16,2010April16,2010OurPatient:ClinicalPresentationOurPatient:ClinicalPresentation48yea
2、r-oldwomancomplainsofraised,itchy,non-bleedinglesionMelanomaonherrightchest,justinferiortoherclavicle,inSeptember2006LesionbiopsiedbydermatologyinNovember2006–0.9mmClarkslevelIVmelanomaWolffK,JohnsonRA,"Section12.MelanomaPrecursorsandPrimaryCutaneousMelanoma"(Chapter).WolffK,Joh
3、nsonRA:Fitzpatrick'sColorAtlas&SynopsiswithulcerationandtwomitoseswithofClinicalDermatology,6e:http://www.accessmedicine.com.ezp-perhighpoweredfieldprod1.hul.harvard.edu/content.aspx?aID=5187071.ReferredtooncologyandsurgeryWhatshouldbedonenext?Whatshouldbedonenext?Inordertounder
4、standthenextInordertounderstandthenextstepsforthispatient’sstepsforthispatient’smanagement,wemustfirstgainmanagement,wemustfirstgainanappreciationformelanomaanappreciationformelanomaandit’sstaging.andit’sstaging.MelanomaMelanomaMostlethalskincancerOverthepast3decades,therehasbee
5、nanincreasedrateofmelanomaincidence,though5yearsurvivalratehasimprovedoverall15thmostcommoncancerinUSformen;6thmostcommoncancerinUSforwomen2Only15.5%patientswithmetastaticmelanomasurvivefor5years;the5-yearsurvivalrateforlocalizedmelanomais99%1Approximately80%ofmelanomasarediagno
6、sedatalocalizedstage2TMNStagingTMNStagingSystemSystemStagingdictatesprognosisandtreatmentoptionsStagingalsoinfluenceswhatimagingstudiesarechosen,butthereisnoclearalgorithmtofollowBuzaid,Gershenwald,andRoss.Tumornodemetastasis(TMN)stagingsystemandotherprognosticfactorsincutaneous
7、melanoma.UpToDate.Jan2010.StageGroupingsStageGroupingsStagesIandII-localizedprimarymelanomas–StageI:lowrisk–StageII:higherriskofreoccurrenceStageIII-involvementofregionallymphnodesStageIV-distantmetastasesBuzaid,Gershenwald,andRoss.Tumornodemetastasis(TMN)stagingsystemandotherpr
8、ognosticfactorsincutaneousmelanoma.UpToDate.Jan
