SEM image of melanoma

Diagnosis: SEM image of melanoma

Source: Dr. Timothy Triche, National Cancer Institute

Clinical Presentation

Source: Dr. Timothy Triche, National Cancer Institute

Clinical History

Submitted by dermRounds Dermatology Network. Originally posted June 21, 2008.

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: sem, image, melanoma, dermrounds dermatology network