Vignettes
Resources
Workup
- Stage I/II (localized) → SLNB is indicated if > 0.8mm thick or < 0.8mm but ulcerated – no other work up done routinely
- Rationale for SLNB
- Confirm stage
- Select patients for adjuvant therapy
- Select patients for clinical trials
- Stage IIB to IIIB (typically done by oncology) → pan PET/CT, CBC, LDH
- Stage IIIC to IV → same as above + brain CT or MRI
- Serum markers for metastatic melanoma:
- S100B (associated with mortality)
- Melanoma inhibitory activity (MIA)
- Rationale for SLNB
- Tumor thickness (most important)
- Mitotic rate > 1mm2
- Older age
- Male gender
- Trunk, head and neck
- Regional lymph node tumour burden: macroscopic > microscopic
- Distant metastases site: visceral > non-visceral
Superficial spreading melanoma
- Common nevus
- Atypical nevus
- Seborrheic keratosis
- Thrombosed hemangioma
- Angiokeratoma
- Pigmented basal cell carcinoma
- Pigmented actinic keratosis
Nodular
- Common nevus
- Blue nevus
- Pigmented Spitz
- Pigmented basal cell carcinoma
- Seborrheic keratosis
- Pyogenic granuloma
Lentigo maligna melanoma
- Solar lentigo
- Pigmented actinic keratosis
- Flat / macular seborrheic keratosis
- Superficial / pigmented basal cell carcinoma
- Solar keratosis (pigmented variant)
Acral melanoma
- Wart
- Hematoma
- Nevus
- Pyogenic granuloma
- Melanonychia
On palm and soles:
-
- Black heel (hemorrhage caused by trauma)
- Plantar warts
- Trophic ulcers
- Plantar callosity
- Tinea nigra
Subungual:
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- Subungual hematoma
- Bowen disease
- Verruca
- Paronychia
- Drug-induced nail pigmentation
Amelanotic
- Superficial basal cell carcinoma
- Bowen disease
- Benign lichenoid keratosis
- Pyogenic granuloma
- Merkel cell carcinoma