Melanoma

Melanoma peaks at age 20-45 years, typically in fair-skinned persons with a history of severe sunburn. Other risk factors are past history of melanoma and family histories of melanoma and dysplastic naevi. Clinical types are superficial spreading melanoma, nodular melanoma and acral lentigi-nous melanoma (occurring in palm, sole, nail bed and mucus membrane). If possible, total excisional biopsy is preferred.

The extent of treatment, risk of regional metastasis, risk of recurrence and overall prognosis is dependent on tumour thickness which is best determined by Breslow scale on

Figure 20.12. Verrucous carcinoma of the lower lip.

the biopsy specimen:

Historically, Clarks levels of histological invasion also predict prognosis:

• LevelI: In situ, above papillary dermis.

• LevelII: Penetrates papillary dermis.

• Level III: Involves papillary dermis.

• Level IV: Enters reticular dermis.

• Level V: Enters subcutaneous fat.

Treatment is by surgical excision of skin and subcutaneous tissue with 1.5-3 cm of margin depending on the site and thickness of the melanoma. The best data available show no difference in outcome between removing the underlying fascia and not. Elective regional lymph node dissection is optional for tumour thickness over 1.5 mm. For lesions arising in the temporal or upper cheek area, total parotidectomy as well as neck dissection may be required to treat adequately regional nodal metastases. In recent years, sentinel node biopsy is increasingly accepted for melanoma over 1.5 mm in thickness.

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Complete Guide to Preventing Skin Cancer. We all know enough to fear the name, just as we do the words tumor and malignant. But apart from that, most of us know very little at all about cancer, especially skin cancer in itself. If I were to ask you to tell me about skin cancer right now, what would you say? Apart from the fact that its a cancer on the skin, that is.

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