melanocytic tumors of the skin. an introduction

8/9/2019 Melanocytic Tumors of the Skin. an Introduction.

1/35

Melanocytic tumors of the skin:Melanocytic tumors of the skin:

IntroductionIntroduction

Deba P Sarma, MDDeba P Sarma, MD

OmahaOmaha


2/35

MelanocyteMelanocyte


3/35

MelanocyteMelanocyte

MITF immunostain


4/35

Melanocytic lesionsMelanocytic lesions

BenignBenign-- 95%95%

MalignantMalignant-- 4%4%

UndeterminedUndetermined-- 1%1%


5/35

Dr. Sarmas classification of pigmentedDr. Sarmas classification of pigmentedlesionslesions

Benign:Benign:Lentigo simplexLentigo simplexSolar lentigoSolar lentigoNevus (Junctional, Dermal, Compound,Nevus (Junctional, Dermal, Compound,

Blue, Spitz, Dysplastic)Blue, Spitz, Dysplastic)

Potentially malignant:Potentially malignant:Atypical melanocytic hyperplasiaAtypical melanocytic hyperplasia

Malignant:Malignant:Melanoma inMelanoma in--situsituInvasive melanomaInvasive melanoma


6/35

Lentigo, Freckle, Mole, NevusLentigo, Freckle, Mole, Nevus

Lentigo: From Latin word for lentil. A dark spot on skin thatLentigo: From Latin word for lentil. A dark spot on skin thatlooks like a lentil bean and does not fade in the winter.looks like a lentil bean and does not fade in the winter.

Freckle: Small brownish spot turning darker or increasing inFreckle: Small brownish spot turning darker or increasing innumber upon exposure to the sun and fading in winter.number upon exposure to the sun and fading in winter.(Freckle=Speckle)(Freckle=Speckle)

Mole : Spot, common name for nevus.Mole : Spot, common name for nevus.

MOLE = NEVUSMOLE = NEVUS

Nevus: Latin word meaning birthmark.Nevus: Latin word meaning birthmark.


7/35

Lentigo simplex

Elongated rete ridges

Basal melanosis

No junctional nest

No solar elastosis


8/35

Solar lentigo

Elongated rete ridges

Basal melanosis

No junctional nest

Dermal solar elastosis


9/35

Nevus = MoleNevus = Mole


10/35

Life of a nevusLife of a nevus


11/35

Congenital nevusCongenital nevus


12/35

Common neviCommon nevi

JunctionalJunctional

CompoundCompound

DermalDermal


13/35

Nevus: Junctional

Flat epidermal lesion

Junctional nests with clefts


14/35

Nevus: Compound

Raised or flat (older person) lesion

Junctional clefted nests and dermal nests


15/35

F 25, left abdomenF 25, left abdomen


16/35

Dysplastic nevusDysplastic nevus


17/35

Nevus: Blue

Flat lesion

No junctional nest

Dermal pigmented spindled melanocytes


18/35

Nevus: Epithelioid (Spitz nevus)

70% occurs in pts < 20 yrs

Raised, junctional or compound nevus

Epithelioid clefted nests oriented vertically

Cytologic and nuclear pleomorphism


19/35

MelanomaMelanoma

TypesTypes

Melanoma inMelanoma in--situsitu

Melanoma (Invasive melanoma)Melanoma (Invasive melanoma)


20/35

MelanomaMelanoma

Lentigo maligna & lentigo maligna melanomaLentigo maligna & lentigo maligna melanoma

Superficial spreading ( Pagetoid): InSuperficial spreading ( Pagetoid): In--situ &situ &invasiveinvasive

AcralAcral--lentiginous: Inlentiginous: In--situ & invasivesitu & invasive

Nodular: InvasiveNodular: Invasive

Desmoplastic: InvasiveDesmoplastic: Invasive


21/35

Melanoma inMelanoma in--situ: Lentigo maligna typesitu: Lentigo maligna type

Neoplastic melanocytes spread from the junction upwards

and along the adnexa.

No dermal invasion.


22/35

Melanoma inMelanoma in--situ: Lentigo maligna typesitu: Lentigo maligna type

Epidermal atrophy, solar elastosis

Confluent and nested proliferation of pleomorphic melanocytes


23/35

Superficial spreading inSuperficial spreading in--situ & invasive melanomasitu & invasive melanoma


24/35

Nodular melanomaNodular melanoma

Raised, ulcerated, no radial spread, deep dermal invasion


25/35

Acral lentiginous melanoma Acral lentiginous melanoma


26/35

Epidermal atrophy, dermal actinic change, mononuclear cell

and spindle cell infiltration

Desmoplastic melanoma


27/35

Pleomorphic spindle cells within desmoplastic stroma.Note

the mitotic figure.


28/35

S-100: Positive


29/35

Risk factorsRisk factors

Uncontrollable:Uncontrollable:

Skin typeSkin type (race)(race)History of melanomaHistory of melanoma

MolesMoles and atypical molesand atypical moles

Age: 70 + Age: 70 +

Gender: M > FGender: M > F

Controllable:Controllable:

UV radiationUV radiation ( sunlight, tanning booths and lamps).( sunlight, tanning booths and lamps).


30/35

Skin typesSkin types

VVI

IV

I IIIII


31/35

History of melanomaHistory of melanoma

FirstFirst--degree relatives: Father, mother, brother,degree relatives: Father, mother, brother,

sister, childsister, child

Personal history of melanomaPersonal history of melanoma

Melanoma pt.: Family history in 10%Melanoma pt.: Family history in 10%


32/35

Estd new cancer cases, USA, 2008Estd new cancer cases, USA, 2008American Cancer SocietyAmerican Cancer Society

Male:Male: Female:Female:

1. Prostate (25%) 1. Breast (31%)1. Prostate (25%) 1. Breast (31%)

2. Lung (15%) 2. Lung (14%)2. Lung (15%) 2. Lung (14%)

3. Colorectum (10%) 3. Colorectum (10%)3. Colorectum (10%) 3. Colorectum (10%)

4. Bladder (7%) 4. Uterus (5%)4. Bladder (7%) 4. Uterus (5%)

5. NH Lymphoma (5%) 5. NH Lymphoma (4%)5. NH Lymphoma (5%) 5. NH Lymphoma (4%)

66.. Melanoma (5%)Melanoma (5%) 6. Thyroid (4%)6. Thyroid (4%)

7. Kidney (4%)7. Kidney (4%) 7. Melanoma (4%)7. Melanoma (4%)


33/35

Melanoma sitesMelanoma sites


34/35

FiveFive--year survival rateyear survival rate

Overall 90%Overall 90%

Localized 99%Localized 99%

With regional spread 45%With regional spread 45%

Good news: 80% localized at diagnosisGood news: 80% localized at diagnosis


35/35

Editorials 1985Editorials 1985--20082008

April;144: 533April;144: 533--534. Ackerman AB. No one534. Ackerman AB. No oneshould die of malignant melanoma. J Amshould die of malignant melanoma. J AmAcad Dermatol. 1985 Jan; 12: 115Acad Dermatol. 1985 Jan; 12: 115--6.6.

Kittler H. Early recognition at last. ArchKittler H. Early recognition at last. ArchDermatol. 2008Dermatol. 2008

melanocytic tumors of the skin. an introduction

Documents