35871868 dermatopathology melanocytic tumors of the skin an introduction ppt
TRANSCRIPT
Melanocytic tumors of the skin:Melanocytic tumors of the skin:IntroductionIntroduction
Deba P Sarma, MDDeba P Sarma, MD
OmahaOmaha
MelanocyteMelanocyte
MelanocyteMelanocyte
MITF immunostain
Melanocytic lesionsMelanocytic lesions
Benign- 95%Benign- 95% Malignant- 4%Malignant- 4% Undetermined- 1%Undetermined- 1%
Dr. Sarma’s classification of Dr. Sarma’s classification of pigmented lesionspigmented lesions
Benign: Benign: Lentigo simplexLentigo simplex Solar lentigoSolar lentigo Nevus (Junctional, Dermal, Nevus (Junctional, Dermal,
Compound,Compound, Blue, Spitz, Dysplastic)Blue, Spitz, Dysplastic)
Potentially malignant: Potentially malignant: Atypical melanocytic hyperplasiaAtypical melanocytic hyperplasiaMalignant:Malignant: Melanoma in-situMelanoma in-situ Invasive melanomaInvasive melanoma
Lentigo, Freckle, Mole, NevusLentigo, Freckle, Mole, Nevus
Lentigo: From Latin word for lentil. A dark spot on Lentigo: From Latin word for lentil. A dark spot on skin that looks like a lentil bean and does not fade in skin that looks like a lentil bean and does not fade in the winter.the winter.
Freckle:Freckle: Small brownish spot turning darker or Small brownish spot turning darker or increasing in number upon exposure to the sun and increasing in number upon exposure to the sun and fading in winter. (Freckle=Speckle)fading in winter. (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.
Lentigo simplex
Elongated rete ridgesBasal melanosisNo junctional nestNo solar elastosis
Solar lentigo
Elongated rete ridgesBasal melanosisNo junctional nestDermal solar elastosis
Nevus = MoleNevus = Mole
Life of a nevusLife of a nevus
Congenital nevusCongenital nevus
Common neviCommon nevi
JunctionalJunctional CompoundCompound DermalDermal
Nevus: Junctional
Flat epidermal lesionJunctional nests with clefts
Nevus: Compound
Raised or flat (older person) lesionJunctional clefted nests and dermal nests
F 25, left abdomenF 25, left abdomen
Dysplastic nevusDysplastic nevus
Nevus: Blue
Flat lesionNo junctional nestDermal pigmented spindled melanocytes
Nevus: Epithelioid (Spitz nevus)
70% occurs in pts < 20 yrsRaised, junctional or compound nevusEpithelioid clefted nests oriented vertically Cytologic and nuclear pleomorphism
MelanomaMelanoma
TypesTypes
Melanoma in-situMelanoma in-situ
Melanoma (Invasive melanoma)Melanoma (Invasive melanoma)
Melanoma Melanoma
Lentigo maligna & lentigo maligna melanomaLentigo maligna & lentigo maligna melanoma
Superficial spreading ( Pagetoid): In-situ & Superficial spreading ( Pagetoid): In-situ & invasiveinvasive
Acral-lentiginous: In-situ & invasiveAcral-lentiginous: In-situ & invasive
Nodular: InvasiveNodular: Invasive
Desmoplastic: InvasiveDesmoplastic: Invasive
Melanoma in-situ: Lentigo maligna typeMelanoma in-situ: Lentigo maligna type
Neoplastic melanocytes spread from the junction upwardsand along the adnexa.No dermal invasion.
Melanoma in-situ: Lentigo maligna typeMelanoma in-situ: Lentigo maligna type
Epidermal atrophy, solar elastosisConfluent and nested proliferation of pleomorphic melanocytes
Superficial spreading in-situ & invasive Superficial spreading in-situ & invasive melanomamelanoma
Nodular melanomaNodular melanoma
Raised, ulcerated, no radial spread, deep dermal invasion
Acral lentiginous melanomaAcral lentiginous melanoma
Epidermal atrophy, dermal actinic change, mononuclear celland spindle cell infiltration
Desmoplastic melanoma
Pleomorphic spindle cells within desmoplastic stroma.Note the mitotic figure.
S-100: Positive
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 ( sunlight, tanning booths and
lamps).lamps).
Skin typesSkin types
VVI
IV
I II III
History of melanomaHistory of melanoma
First-degree relatives: Father, mother, First-degree relatives: Father, mother, brother, sister, childbrother, sister, child
Personal history of melanomaPersonal history of melanoma
Melanoma pt.: Family history in 10% Melanoma pt.: Family history in 10%
Estd new cancer cases, USA, 2008Estd new cancer cases, USA, 2008 American 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%)
Melanoma sitesMelanoma sites
Five-year survival rateFive-year 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
Editorials 1985-2008Editorials 1985-2008
April;144: 533-534. Ackerman AB. No April;144: 533-534. Ackerman AB. No one should die of malignant melanoma. one should die of malignant melanoma. J Am Acad Dermatol. 1985 Jan; 12: 115-J Am Acad Dermatol. 1985 Jan; 12: 115-6.6.
Kittler H. Early recognition at last. Arch Kittler H. Early recognition at last. Arch Dermatol. 2008Dermatol. 2008