malignant melanoma

MALIGNANT MELANOMA

Pigmentation is a hallmark of melanoma

Features suggestive of melanoma include recent onset of a pigmented lesion, change in an existing pigmented lesion, irregular margins, asymmetrical shape, colour change or presence of multiple colours, and diameter greater than 6 mm in diameter.

CONJUNCTIVA Risk factors: - White race - Older age - H/o repeated intense sunlight

exposure Pathology : Anaplastic ,malignant appearing

melanocytic cells involve substantia propria.

CLASSIFICATION pre-existing naevus (junctional or

compound) Primary melanoma (de novo) PAM with atypia

Amelanotic tumours are pink and have a characteristic smooth ‘fish-flesh’ appearance

- Difficult to diagnose.

Ocular manifestations: Dark brown elevated lesion –perilimbal

region –interpalpebral.

S/L : Reddish,brown stippled/homogeneous dark brown ,intralesional microcysts,prominent blood vessels

- focal nodular epibulbar mass.

TREATMENT Simple observation Incisional biopsy – Complete excision &

cryotherapy Contact radiation Topical chemotherapy Exenteration – frank orbital invasion/

massive unresectable

IRIS Symptom: Visible spot /discolouration on iris/no

symptom

Risk Factors: - H/o intense sustained sunlight exposure - Conditions like Ocular melanocytosis , Dysplatic nevus syndrome. -

Ocular manifestations: - Localized dark brown to tan - well circumscribed, cohesive ,intrinsic

vascularity /shaggy ,dispersive. - Pupillary peaking - Ectropion iridis - Iris splinting

Pathology : Atypical melanocytic cells- prominent

nucleoli - N/C ratio - mitotic figures Fusiform shape – spindle cells Spherical shape – epitheloid cells

Diagnosis: - Transpupillary /transconjunctival transscleral transillumination - Anterior segment photography - Ultrasound biomicroscopy - Biopsy [incisional/ Fine needle aspiration.

TREATMENT Observation Excision [iridectomy /iridocyclectomy] Plaque radiotherapy Enucleation.

CHOROIDAL & CILIARY BODY Symptoms : - Blurred vision - Visual field defect - Flashes - Floaters - no symptom

SIGN:

CHOROIDAL Dark brown to golden solid tumour Biconvex ,lenticular on cross section Mushroom configuration[break tru bruch

membrane] Non rhegmatogenous RD –Clear serous

sub retinal fluid/bloody. Prominent clumps of orange lipofuscin

pigment.

CILIARY BODY Elevated ,nodular dark brown –peripheral

fundus.

Pathology :Anaplastic melanocytic cells – high N/C ratio prominent

nucleoli mitotic figuresSpindle cells, mixed cells, Epitheloid cells, Vascular loops & networks.

DIAGNOSIS: B –SCAN: Solid acoustically dark

[sonolucent] biconvex or mushroom

configuration Acoustic brightness on cap A scan: Low amplitude internal reflectivity stepwise decremental reduction in echo spike amplitude high amplitude at cap

Fluorescein Angiography : Dome shaped- early phase – filling of retinal,intratumoural

vessels Late phase – Non uniform hyperfluorescent

staining

Mushroom shaped- Early phase – filling of intratumoural vessels Late phase – Generalized staining of apical

nodule , sub retinal fluid.

MRI : Hyperintense relative to dark vitreous

on T1 Hypointense relative to bright vitreous

on T2

TREATMENT: Enucleation Radiation therapy Observation Photocoagulation Non coagulative laser therapy Microsurgical resection Exenteration Hyperthermia therapy PDT Cryotherapy Chemotherapy

EYELIDS Lentigo maligna Melanoma

LENTIGO MALIGNA

(melanoma in situ, intraepidermal melanoma /Hutchinson freckle)

Uncommon condition that develops in sun-damaged skin in elderly individuals. Malignant change may occur, with infiltration of the dermis.

   Histology - intraepidermal proliferation of spindle-shaped

atypical melanocytes that replace the basal layer of the epidermis

   Signs      A slowly expanding pigmented macule with an irregular

border     Nodular thickening and areas of irregular pigmentation are

highly suggestive of malignant transformation

    Treatment is usually by excision.

MELANOMA

  Histology shows large atypical melanocytes within the dermis

         Signs

   Superficial spreading melanoma is characterized by a plaque with an irregular outline and variable pigmentation

    Nodular melanoma is typically a blue-black nodule

surrounded by normal skin

   3    Treatment is usually by wide excision and may include local lymph node removal.

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