Chapter 083. Cancer of the Skin (Part 2)

Clinical CharacteristicsThere are four types of cutaneous melanoma (Table 83-2). In three of these—superficial spreading melanoma, lentigo maligna melanoma, and acral lentiginous melanoma—the lesion has a period of superficial (so-called radial) growth during which it increases in size but does not penetrate deeply. It is during this period that the melanoma is most capable of being cured by surgical excision. The fourth type—nodular melanoma—does not have a recognizable radial growth phase and usually presents as a deeply invasive lesion, capable of early metastasis. When tumors begin to penetrate deeply into the skin, they are in the so-called vertical growth...
Nội dung trích xuất từ tài liệu:
Chapter 083. Cancer of the Skin (Part 2) Chapter 083. Cancer of the Skin (Part 2) Clinical Characteristics There are four types of cutaneous melanoma (Table 83-2). In three ofthese—superficial spreading melanoma, lentigo maligna melanoma, and acrallentiginous melanoma—the lesion has a period of superficial (so-called radial)growth during which it increases in size but does not penetrate deeply. It is duringthis period that the melanoma is most capable of being cured by surgical excision.The fourth type—nodular melanoma—does not have a recognizable radial growthphase and usually presents as a deeply invasive lesion, capable of early metastasis.When tumors begin to penetrate deeply into the skin, they are in the so-calledvertical growth phase. Melanomas with a radial growth phase are characterized byirregular and sometimes notched borders, variation in pigment pattern, andvariation in color. An increase in size or change in color is noted by the patient in70% of early lesions. Bleeding, ulceration, and pain are late signs and are of littlehelp in early recognition. Superficial spreading melanoma is the most frequentvariant observed in the white population. Melanomas arising in dysplastic nevi(see below) are usually of this type. The back is the most common site formelanoma in men. In women, the back and the lower leg (from knee to ankle) arecommon sites. Nodular melanomas are dark brown-black to blue-black nodules.Lentigo maligna melanoma is usually confined to chronically sun-damaged, sun-exposed sites (face, neck, back of hands) in older individuals. Acral lentiginousmelanoma occurs on the palms, soles, nail beds, and mucous membranes. Whilethis type occurs in whites, it is most frequent (along with nodular melanoma) inblacks and East Asians. Table 83-2 Clinical Features of Malignant Melanoma Type Site Average Duration Color Age at of Known Diagnosis, Existence, Years Years Lentigo Sun- 70 5–20a or In flatmaligna exposed longer portions, shadesmelanoma surfaces, of brown and tan particularly predominant, malar region but whitish gray of cheek and occasionally temple present; in nodules, shades of reddish brown, bluish gray, bluish black Superficial Any 40–50 1–7 Shades ofspreading site (more brown mixedmelanoma common on with bluish red upper back (violaceous), and, in bluish black, women, on reddish brown, lower legs) and often whitish pink, and the border of lesion is at least in part visibly and/or palpably elevated Nodular Any 40–50 Months Reddishmelanoma site to less than 5 blue (purple) or years bluish black; either uniform in color or mixed with brown or black Acral Palm, 60 1–10 In flatlentiginous sole, nail portions, darkmelanoma bed, mucous brown membrane ...