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1、MelanomaEdwardBuckingham,M.D.CombinedPlasticsConferenceSeptember6,2000Melanoma-OutlineGeneralstatisticsanddevelopmentRiskfactorsandpatientassessementPathologyandprognosisWork-upandstagingSurgicaltreatmentLymphnodecontroversy/sentinelnodeAdjuvanttherapyMelanoma-DataIncidenceincreasefastestMo
2、rtalityincrease2ndonlytolung5thmostprevalent,incidence7%/yearincrease5%skincancer,75%skincancerdeath1/75in2000,1/1500in193520%H&N,51%facial,26%scalp,16%neck,9%earDevelopmentofNeviMelanocytesdendritic,neuralcrest,basalcelllayersynthesisofmelanin1/10tokeratinocyteshyperplasia-tanning/lentigin
3、es,increasedratioNevustransformationpoorlyunderstooddendritic-roundednolongerlentigionouspattern-nestsDevelopmentofNeviJunctionalnevinestsalongdermal-epidermaljunctionCompoundnevi“invade”dermis,firstasneststhencordsandsinglecellsDermalnevijunctionalcomponentlostEvolutionofNeviMelanocyteHype
4、rplasiaJunctionalNeviCompoundNeviDermalNeviDevelopementofMelanomaQuestionablebenignmelanocytesprogressivehyperplasia/dysplasiaRadialgrowthinepidermis,linesofradii,noexpansivenestsornodulesslowunrestricted,nometastaticpotentialDevelopmentofMelanomaVerticalgrowthverticallyintodermisexpansivea
5、ndcoalescentnestsandnodulesmetastaticpotentialdermallymphaticandvascularinvasionGrowthpatternsbiphasic-slowradialmonthstoyears-rapidverticalgrowthmonophasic-rapidverticalgrowthonlyEvolutionofMelanomaDysplasticNevibordermelanocyticneviandmalignantmelanomaclinicalresemblesmalignantmelanomalen
6、tiginouscompoundnevus,prominentbridgingacrossreteridgesaberrantininter-retespaceslamellarfibrosisofpapillarydermis,variablelymphoidresponseDysplasticNeviDysplasticNeviTypesofMelanomaAcrallentiginousMucosalmelanomaSuperficalspreadingmelanomaLentigomalignamelanomaNodularmelanomaSuperficialspr
7、eadingmostcommonheadandneck,50%4thto5thdecadeclinicalmixtureofbrown/tan,pink/whiteirregularborders,biphasicgrowthirregularnestsinepidermisunderlyinglymphoidinfiltrateenlargednestsandsinglecellsinallepidermallayersSuperficialspreadingLentigomaligna20%ofhe
