The Diagnosis of Melanoma Daniel Hewitt Dermatologist Burswood - - PowerPoint PPT Presentation

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Nov 17, 2023 419 likes •653 views

The Diagnosis of Melanoma Daniel Hewitt Dermatologist Burswood Dermatology Royal Perth Hospital A personal approach To not miss melanoma To accurately diagnose melanoma as early as possible This will lack detail in Clinical features of

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The Diagnosis of Melanoma

Daniel Hewitt Dermatologist

Burswood Dermatology Royal Perth Hospital

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A personal approach To not miss melanoma To accurately diagnose melanoma as early as possible

This will lack detail in… Clinical features of melanoma Dermatoscopic features of melanoma Epidemiology of melanoma

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Know yourself 1 Know the features of melanoma

2 Know your limitations

Know your patient 3 Understand the important risk factors

4 Assess the individual 5 Examine properly 6 Biopsy appropriately

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1 Know the features of melanoma

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ABCDE of Melanoma

A - ASYMMETRY; one half unlike the other half.
B - BORDER; irregular, scalloped or poorly defined border.
C - COLOUR; varied from one area to another; shades of

tan, brown, and black; sometimes white, red, or blue.

D - DIAMETER; melanomas are usually greater than 6mm

when diagnosed, but they can be smaller.

E -EVOLVING; a mole or skin lesion that looks different

from the rest or is changing in size, shape, or colour.

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Many clinical subtypes..

Superficial spreading melanoma (SSM)
Nodular melanoma (NM)
Lentigo maligna (LM) &

lentigo maligna melanoma (LMM)

Desmoplastic melanoma
Acral lentiginous melanoma (ALM)
Subungual melanoma

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15% of melanomas present with an expansile nodule - features can be summarized using: Elevated Firm Growing

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Beware the ugly duckling

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Significant change over 3 months is the key

Melanomas either grow from preceding melanocytic lesions

r grow as new lesions

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2 Know when you can’t make a diagnosis

If you are not sure biopsy or refer Err on the side of caution

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3 Understand the important risk factors

Personal history of melanoma Immediate family history of melanoma Dysplastic naevus syndrome Immunosuppression History of numerous sunburns

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4 Assess the individual

Some patients do know their skin

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Others do not – these need a more paternalistic approach

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5 Examine properly

Light, magnification Enitre skin surface

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“A total of 94 melanomas were detected during this 12-month period. Of these, 57 (60.6%) were incidentally detected by the dermatologist.”

Cherian P; Tait C. Melanoma in private practice: do Dermatologists make a difference?. Australasian Journal of Dermatology. 50(4):257-60, 2009 Nov.

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6 Biopsy appropriately

Excisional biopsy with narrow margin Large incisional biopsy if excision not possible Shave biopsy in special circumstances

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Do not punch biopsy Melanocytic hyperplasia = melanoma