Pigmented Lesion - Melanoma in situ

Diagnosis: Pigmented Lesion - Melanoma in situ

This is a 59 year old female patient with a malignant pigmented lesion that shows Melanoma in situ on Upper limb

Clinical Presentation

This is a 59 year old female patient with a malignant pigmented lesion that shows Melanoma in situ on Upper limb

Clinical History

Submitted by Ellie Goulding MD. Originally posted November 30, 2016.

Treatment

See case discussion.

Differential Diagnosis

• Dysplastic (atypical) nevus • Seborrheic keratosis • Blue nevus • Pigmented basal cell carcinoma • Pigmented dermatofibroma • Thrombosed hemangioma • Solar lentigo

Key Learnings

• ABCDE criteria: Asymmetry, Border irregularity, Color variation, Diameter >6mm, Evolving • "Ugly duckling sign" — the lesion that looks different from the patient's other moles • Breslow thickness is the single most important prognostic factor • Sentinel lymph node biopsy recommended for lesions ≥0.8mm or with ulceration • Subtypes: superficial spreading (most common), nodular, lentigo maligna, acral lentiginous • Acral lentiginous melanoma: most common type in dark-skinned individuals — check palms, soles, nails • Hutchinson sign in subungual melanoma: pigment extending to nail fold • Immunotherapy (anti-PD-1, anti-CTLA-4) and targeted therapy (BRAF/MEK inhibitors) revolutionized treatment of advanced melanoma

Tags: pigmented, lesion, melanoma, situ, ellie goulding md