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  1. Melanomas originate from epidermal melanocytes.
  2. Among nevi, malignant melanoma is seen to develop most commonly in functional nevi.
  3. Most of these lesions arise in the skin, other sites of origin include the oral and anogenital mucosal
  4. surfaces, the esophagus, the meninges and notably the eye.
  5. The most important clinical sign of the disease is a change in the color in a pigmented lesion.
  6. Risk factors for cutaneous melanoma.

Table: 2002 American Join committee on cancer TNM Classification for cutanous melonama.


T classification


Ulceration Status


 < 1.0 mm

A: Withoug ulceration and level II/III

B: With ulceration or level IV/V


1.01 – 2.0 mm

A: Without ulceration

B: With ulceration


2.01 – 4.0 mm

A: Without ulceration

B: With ulceration


>4.0 mm

A: without ulceration

B: with ulceration

N Classification

No. of Metastatic Nodes

Nodal Metastatic Mass


1 node

A: Micrometastasis

B: Macrometastasis


2-3 nodes

A: Micrometastasis a

B: Macrometastasis b

C: In transit met (s)/ satellte(s) without metastatic nodes


4 or more metastatic nodes, or matted nodes, or in-transit met(s) / satellite(s) with metastatic node(s)


M Classification


Serum Lactate

Dehydrogenase Level


Distant skin, subcutaneous or nodal metastases



Lung metastases



All other visceral metastases

Any distant metastasis




  1. Micrometastases are diagnosed after sentinel or elective lymphoadenectomy.
  2. Macrometastases are defined as clinically detectable nodal metastases confirmed by therapeutic lymphadenectomy or nodal metastases that exhibit gross extracapsular extension. 
  1. Clark staging:
    level I: all tumor cells above basement membrane (in situ)
    level II: tumor extends to papillary dermis
    level III: tumor extends to interface between papillary and reticular dermis
    level IV: tumor extends between bundles of collagen of reticular dermis
    level V: tumor invasion of sucutaneous tissue (87% metastases)
  2. Breslow staging:
    Thin: < 0.75 mm depth of invasion
    Intermediate: 0.76 - 3.99 mm depth of invasion
    Thick: > 4 mm depth of invasion
  3. Malignant melanoma: gallium imaging
    >50% sensitivity for primary and metastatic sites:
    73% sensitivity if lesion is > 2 cm
    17% sensitivity if < 2 cm
  4. Clinical features of malignant melanomQ
    1. Prognosis
    2. Most important prognostic factor is the stage at the time of presentation.
    3. The prognosis depends on thickness of the primary tumor
  • Poor Prognosis:
    1. If lesions are present on scalp, hands, feet, mucous membrane.
    2. Older individual
    3. Presence of ulcer
    4. High mitotic rate
    5. Presence of microscopic tumor satellites (foci of tumor >0.05 mm in diameter in the reticular dermis or subcutaneous fat, distinct from the main body of tumor).
  • Good Prognosis:
    1. Site of lesion: forearm, leg (except feet)
    2. Women
Type Site Average Age at diagnosis, Years Duration of known Existence years Color
Lentigo maligna melanoma Sun-exposed surfaces, particularly malar region of cheek and temple 70 5-20a or longer In flat portions, shades of brown and tan predominant, but whitish gray occasionally present; in nodules, shades of reddish brown, bluish gray, bluish black.
Superficial spreading melanoma Any site (more common on upper back and, in women, on
lower legs)
40-50 1-7 Shades of brown mixed with bluish red (violaceous), bluish black, reddish brown and often whitish pink, and the border of lesion is at least in part visibly and/or palpably elevated.
Modular melanoma Any site 40-50 Months to less than 5 years Reddish brown (purple) or bluish black; either uniform in color or mixed with brown or black.
Acral lengitinous melanoma Palm, sole, nail bed, mucous membrane 60 1-10 In flat portions, dark brown predominantly; in raised
lesions (plaques) brown-black or blue-black predominantly.
  1. The earliest metastasis are often to regional lymph nodes.
  2. The MC staging method used is CLARK’S METHOD (assesses the level of invasion).
  3. Most widely used antigenic marker for malignant melanoma re —
    1. S-100 protein
    2. HMB-45 (more specific)
Shave biopsy or curettage of a suspected melanoma is contraindicated.
  • Melanoma stages: 5 year survival rates:
Stage 0: Melanoma in situ (Clark Level I), 99.9% survival
Stage I/II: Invasive melanoma, 85–99% survival
  1. T1a: Less than 1.00 mm primary tumor thickness, without ulceration, and mitosis < 1/mm2
  2. T1b: Less than 1.00 mm primary tumor thickness, with ulceration or mitoses ≥ 1/mm2
  3. T2a: 1.00–2.00 mm primary tumor thickness, without ulceration
Stage II: High risk melanoma, 40–85% survival
  1. T2b: 1.00–2.00 mm primary tumor thickness, with ulceration
  2. T3a: 2.00–4.00 mm primary tumor thickness, without ulceration
  3. T3b: 2.00–4.00 mm primary tumor thickness, with ulceration
  4. T4a: 4.00 mm or greater primary tumor thickness without ulceration
  5. T4b: 4.00 mm or greater primary tumor thickness with ulceration
Stage III: Regional metastasis, 25–60% survival
  1. N1: Single positive lymph node
  2. N2: Two to three positive lymph nodes OR regional skin/in-transit metastasis
  3. N3: Four positive lymph nodes OR one lymph node and regional skin/in-transit metastases
Stage IV: Distant metastasis, 9–15% survival
  1. M1a: Distant skin metastasis, normal LDH
  2. M1b: Lung metastasis, normal LDH
  3. M1c: Other distant metastasis OR any distant metastasis with elevated LDH

Description: Graphic copy


Treatment - TOC is primarily surgical excision with wide margin.

Description: Graphic copy

Stage IV  Goal of treatment is PALLIATIVE
- Single-agent DACARBAZINE is considered the standard treatment.
  • WARTS (Verrucae) Q
    1. Warts are patches of hyperkeratotic overgrown skin.
    2. They are caused by Human Papillomavirus (HPV) (commonest virus induced TUMOR).
    3. They may occur at any age but are most common in children, adolescents and young adults.
    4. There are three types of warts.
      1. Common warts
      2. Senile warts
      3. Venereal warts or papilloma acuminate.
    5. The common warts are classified into 3 groups:
Verruca Vulgaris
  • Most frequent type
  • Occurs anywhere on the skin or oral mucosa — the common area is the hands.
Verruca plana (flat wart)
  • Mainly seen on the face and dorsal surface of the hand.
Verruca plantaris (or Palmaris)
  • Mainly occurs on the palm or sole.
  1. Senile wart (Basal cell papilloma / seborrhoeic warts / seborrhoeic keratosis)-Mainly occurs in elderly people passed middle age.

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