benign and malignant melanocytic lesions

7/23/2019 Benign and Malignant Melanocytic Lesions

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BENIGN ANDBENIGN AND

MALIGNANTMALIGNANTMELANOCYTIC LESIONSMELANOCYTIC LESIONS

BENIGN ANDBENIGN AND

MALIGNANTMALIGNANTMELANOCYTIC LESIONSMELANOCYTIC LESIONS


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INTRODUCTIONINTRODUCTION

Melanocytes are

Neural crest der!ed cells

Located n t"e #asal layer o$ t"e s%n& "ar

$ollcles& s'ua(ous co!ered (ucosal(e(#ranes& le)to(enn*es& etc

T"er $uncton )roducton o$ (elann

T"e rato o$ (elanocytes + #asal %eratnocytess ,+- to ,+,.


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INTROINTRO

Racal d$$erences n s%n )*(ent s due to

a(ount o$ (elann n %eratnocytes rat"er

t"an t"e nu(#er o$ (elanocytes

Melanocytes are )ost!e to t"e $ollo/n*stans0

1ontan2 Masson sl!er stan& Tyrosnase&

DO3A& S2,.. )roten& Neural s)ec$cenolase& Mart , 4A ,.56& 7(entn& and

8MB2-94(anly n act!ated (elanocytes6


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BENIGN LESIONSBENIGN LESIONS

Lent*o 4Lent*nes6

Local:ed "y)er)lasa o$ (elanocytes

Occurs n all a*es2 es)ecally n n$ancy to older

c"ldren

No se; or racal )redlecton

Cause and )at"o*eness un%no/n

May n!ol!e (ucous (e(#rane as /ell as s%n

A))ear as s(all 492,.((6 o!al tan2#lue colour

Do not dar%en /"en e;)osed to sunl*"t


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NE7OCELLULAR NE7USNE7OCELLULAR NE7US

43*(ented Ne!us& Mole643*(ented Ne!us& Mole6

Ne!us< #rt"(ar%

Al(ost e!ery one "a!e $e/ (oles

Melanocytc ne!us usually ac'ured Beco(es clncally a))arent a$ter , year Most o$ t"e( /ll a))ear #tn =2>t"year o$ a*e

Nearly all /ll "a!e (an$ested #y =. years

E!ery Caucasans2 "a!e #et/een =.25. ne! Ne!o2cellular ne!us re$ers to any con*ental

or ac'ured neo)las( o$ (elanocytes


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Clncal 1eaturesClncal 1eatures

Tan to #ro/n& un$or(ly )*(ented

S(all 2 ?>((

Macules or )a)ules /t" /ell de$ned#oarders

7arants o$ Ne!ocellular Ne! 4(elanocytc

ne!6 + Class$ed accordn* to t"e locaton o$ ne! cell

n relaton to e)der(al and der(al land(ar%s


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@unctonal Ne!us@unctonal Ne!us

Ne!us n /"c" t"e (elanocytc

)rol$eraton s restrcted to t"e #asal

)orton o$ t"e e)der(s unctonal area

4der(al e)der(al nter$ace6

Locaton )al(s and soles

1lat or sl*"tly ele!ated& non2"arly

(elanocytc nests


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Intrader(al Ne! 2 Ne!us cells and nests

con$ned to der(s

Co()ound ne! ne!us cells and nests at

t"e der(al e)der(al nter$ace t"e

uncton and der(s+ Co(#nes $eatures

o$ unctonal and ntrader(al ty)e S)ndle and e)t"elod cell ne!us o$ S)t:

A co()ound ne!us /t" elon*ated andor

e)t"elod ne!us cells and nests )resent at t"eder(al2e)der(al uncton and n t"e der(s

It s "stolo*cally #:arre #ut #en*n


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Intrader(al ne!usIntrader(al ne!us

All t"e (elanocytes are n t"e der(s

Co((on adult ty)e ne!us

May #e )a)llo(atous& )edunculated& or$lat2o$ten "ary

S(all nests seen around )lose#aceous

untMal*nant (elano(a )ractcally ne!er arse

$ro( ntrader(al ne!


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Dys)lastc Ne!Dys)lastc Ne!

Lar*er t"an (ost ac'ured ne! 49((6

May occur as "undreds o$ lesons on #ody

sur$ace

1lat (acules2sl*"tly rased lesons /t" dar%ercenter and rre*ular $lat )er)"ery

8a!e tendency to occur n non2sun2e;)osed as

/ell as sun e;)osed #ody sur$aces Docu(ented n (ult)le (e(#ers o$ t"e $a(ly

3rone to de!elo) Mal*nant (elano(a2

4)recursor o$ MM6


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Ne!us7arant

Da*nostc1eatures

Cytolo*c1eatures

ClncalS*n$cant

Con*entalne!us Dee) der(aland so(et(essu#cutaneus*ro/t" aroundadne;ae&neuro!ascular

#undles and#lood !essels

Identcal toordnaryac'ured ne!

3resent at #rt"&lar*e !arants&"a!e ncreased(elano(a rs%

Blue ne!us Non nestedder(aln$ltraton& o$ten/t" assocated$#ross

8*"ly dendrtc&"ea!ly)*(entedne!us cells

Blac% #luenoduleF O$tencon$used /t"(elano(a

S)ndle ande)t"elod cellne!us 4S)t: Ne!6

1asccular *ro/t"4(ay #eco()ound6

Lar*e& )lu() cells/t" )n% #luecyto)las(&

$us$or( cells

Co((on nc"ldren& red )n%nodule& o$ten

con$used /t""e(an*o(a


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Ne!us7arant

Da*nostc1eatures

Cytolo*c1eatures

ClncalS*n$cant

8alo ne!us 1asccular*ro/t"

Identcal toordnaryac'ured ne!

8ost ((uneres)onsea*anst ne!uscells and

surroundn*nor(al(elanocytes

Dys)lastc ne!us Lar*e& coalescentntrae)t"elalnests

Cytolo*cal aty)a 3otental)recursor o$(al*nant(elano(a


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Cellular Blue Ne!usCellular Blue Ne!us

Dstnct ty)e o$ #lue ne!us

Clncally sus)ected as (al*nant2lar*e s:e and ntense)*(entaton

Co((on locaton+ #uttoc% and sacrococcy*eal areas

Ot"er areas+ scal)& $ace& "ands and $eet

Mcrosco)cally2 e;tre(ely cellular

Can e;tend nto su#cuts

D$$er $ro( MM #y a#sence o$ unctonal act!ty&e)der(al n!ason& )er)"eral n$la((aton& necrossand lac% o$ aty)a

E;cson s t"e treat(ent o$ c"oce /t" *ood )ro*noss


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Con*ental Ne!usCon*ental Ne!us

It s lar*e n s:e& "as tendency to n!ol!e t"eretcular der(s and su#cuteneous tssue

Gant con*ental ne!us s a !arant o$ con*entalne!us #ut /t" e;tens!e s:e ,--c(=or (ore4t"e /"ole e;tre(ty& t"e /"ole scal) or t"e (osttrun%6

May #e assocated /t" (enn*eal or cere#ral(elanoss 4so called neurocutaneous

(elanoss6 Also assocated /t" satellte (elanoss May *!e rse to Mal*nant (elano(a


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MALIGNANT MELANOMAMALIGNANT MELANOMA

Relat!ely co((on neo)las(

Untl recently /as consdered un$or(ly deadly

Most arse n t"e s%n #ut ot"er stes nclude+ oral andano*ental (ucosal sur$aces& eso)"a*us& (enn*es and

t"e eye T"e ncdence o$ MM s on t"e rse 2necesstatn* !*orous

sur!ellance

Sunl*"t )lays a *reat role n t"e de!elo)(ent o$ MM

Men2 on t"e u))er #ac%& /"ereas /o(en on t"e #ac% and le*s L*"tly )*(ented nd!duals are at "*"er rs% t"an dar%ly

)*(ented s%n )eo)le

Ot"er ds)osn* $actors nclude+ )re e;stn* ne! 4e*F dys)lastc6&"eredtary $actors and e;)osure to carcno*ensF

T"e $e/ (elano(a n #lac% A$rcans de!elo) n soles& )al(s& nal#eds and (ucosal (e(#ranes


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Maorty arse a$ter )u#erty #ut can also

occur n c"ldren

Ot"er )reds)osn* $actors nclude *enetcally deter(ne dsease e*F ;eroder(a

)*(entosu(

ty)e , Rec%ln*"ausen dsease

General:ed (elanoss Lesons rese(#ln* !tl*o

Can )resent as (ult)le )r(ary tu(ors


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Clncal 1eaturesClncal 1eatures

Usually asy()to(atc Itc"n* (ay #e an early (an$estaton

C"an*e o$ colour n a )*(ented leson2

(ost ()ortant clncal s*n MM e;"#t !aratons n )*(entaton2

s"ades o$ #lac%& red& dar% #lue and *ray

H"te colour or $les" "y)o)*(entaton(ay #e $eatures o$ (al*nant c"an*e

Irre*ular nor(ally notc"ed #oarders


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Clncal /arnn* o$ MM 4su((ary6 Enlar*e(ent o$ )re2e;stn* (ole

Itc"n* or )an n a )r e;stn* (ole De!elo)(ent o$ a ne/ )*(ented lesons durn*

adult l$e

Irre*ularty o$ t"e #oarders o$ a )*(ented lesons

7are*aton o$ color /t"n a )*(ented leson


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Gro/t" )atterns and Mor)"olo*yGro/t" )atterns and Mor)"olo*y

8utc"nsons $rec%le 4lent*o (al*na6 Ty)cally occurs n sun2e;)osed areas o$ elderly /"te

)erson es)ecally on t"e c"ee%

1lat& slo/ly *ro/n* leson& tan to #lac% colour

M(c actnc (elanoss

8a!e radal *ro/t"2"or:ontal *ro/t" /t" e)der(al and

su)er$cal der(al layers& $or a )rolon*ed t(e

Mal*nant Melano(a $ro( 8utc"nsons $rec%le s o$ten

s)ndle cell ty)e and s o$ lo/ *rade (al*nancy

Des(o)lastc (elano(a also de!elo) $ro( 8utc"nsons

$rec%le and s o$ s)ndle cell ty)e #ut (ore a**ress!e


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Su)er$cal s)readn* (elano(a 4)re(al*nantSu)er$cal s)readn* (elano(a 4)re(al*nant

(elanoss or )a*etod (elano(a6(elanoss or )a*etod (elano(a6

Co((on $or( o$ (elano(a

Can occur any/"ere on t"e #ody sur$ace

8as !are*ated a))earance 2 tan& #ro/n& #lac%& #lue&

)n% and /"te

Irre*ular #orders /t" )ro(nent notc"ndentaton

Radal *ro/t" s t"e ntal c"aracterstc

Dee) n!ason s acco()aned #y t"e a))earance o$ an

ele!ated nodule on t"e sur$ace

Ht" t(e& t"e )attern o$ *ro/t" assu(es a !ertcalco()onent2and t"e (elano(a no/ *ro/s do/n/ard


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Nodular Melano(aNodular Melano(a

Can )resent as a s(oot" nodule co!ered

#y nor(al e)der(s

Or as an ele!ated #lue2#lac% )la'ue or as

)oly)od ulcerated (ass

A$$ects all #ody sur$aces& s o$ s"orterduraton

Occurs n youn*er a*e *rou) t"an t"e t/o

a#o!e

De(onstrates !ertcal *ro/t" )attern


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Acral Lent*nous Melano(aAcral Lent*nous Melano(a

8as ntrae)der(al co()onent o$ lent*nous

ty)e S(lar n (any res)ect /t" 8utc"nsons

$rec%le

8o/e!er& t"e ntrae)der(al (elanocytes tendto #e (ore #:arre& /t" t"e n!ol!ed e)der(s

#en* "y)er)lastc /t" /dened )a)llary der(s

Co((on stes nclude soles& )al(s& su#un*ual

areas& anus and (ucocutaneous uncton o$ oraland nasal ca!tesF

More co((on n Blac% and Orental )eo)le


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Re*ressonRe*resson

3artal re*resson s co((on $eature n (elano(a&

)artcularly n 8utc"nsons $rec%le ty)e Total re*resson s less co((on& #ut nu(erous cases

"a!e #een re)orted t"at t"e )r(ary tu(or re*ressed

co()letely a$ter *!n* rse to nodal and dstant

(etastases

NB+ In 92,9J o$ )t /t" (etastatc tu(ors& t"e )r(ary s

ne!er $ound


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S)read and MetastassS)read and Metastass

So(e (elano(as s"o/ re(ar%a#le tendency o$

!ascular n!ason an*otro)"c (al*nant (elano(a

Metastases n re*onal ly()" nodes are !ery co((on

Dstant (etastases o$ten occur n l!er& lun*s& GIT& #one

and CNS #ut occur any/"ere

At auto)sy (etastases to t"e "eart are $ound n "al$ o$

)atents

Cutaneous (etastass can #e d$$cult to dstn*us" $ro(

t"e s%n )r(ary leson E)der(otro)c (etastass

Be"a!or2!ery un)redcta#le


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3ro*nostc $actors3ro*nostc $actors

9 years sur!!al rate a$ter treat(ent s >.J4Nor/ay6

Tu(or sta*e2,. years sur!!al rate /as K.J $or

local:ed dsease& and =.J $or (etastatcdseaseF

Sta*e 4,2local:ed& II2re*onal cutaneous

and III2satellte or n transt6


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Le!el o$ n!ason and tu(or t"c%ness

9 le!els o$ n!ason 4Clar%s syste(+

Intrae)der(al& )a)llary der(s&

to nter)"ase o$ )a)llary and retcular der(s&

n t"e retcular der(s and

n t"e su#cutaneous $at6

Mcro2sta*e or Breslo/ s t"c%ness2$ro( t"e ulcer

to t"e dee)est )ont o$ n!ason 4?.FK> ((& .FK>2

,F9 (( and ,F9 ((6


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S"a)e o$ t"e leson 2 /orse $or )oly)od t"an $or

do(e s"a)ed

Se; $e(ales #etter t"an (ales

A*e (ore $a!ora#le n youn*er (ales #ut notn $e(ales

E$$ect o$ )re*nancy 2 Contro!ersal

Anato(c locaton Su#un*ual "a!e ad!erse)ro*noss as /ell as scal)& (and#ular areas&

(dlne trun% and *entala


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S:e da(eter "as no nde)endent )ro*nostc

s*n$cance

Clnco)at"olo*c ty)e Su)er$cal s)readn*#etter t"an nodular& #ut once t"e !ertcal

n!ason s )resents& clnco)at"olo*cal ty)e s

not an nde)endent )ro*nostc (ar%er

Cytolo*c $eatures no drect relatons") /t"

)ro*noss


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De*ree o$ )*(entaton does notn$luence )ro*noss

Mtotc act!ty )o/er$ul )ro*nostc(ar%er t"an ulceraton

Cell )rol$erat!e act!ty relatons") /t"

t"c%ness o$ t"e tu(or #ut n dou#t/"et"er t carres nde)endent )ro*nostcn$or(aton

Der(al n$la((atory n$ltraton Densely()"ocytc n$ltraton s assocated /t"#etter )ro*noss


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Ulceraton one o$ ()ortant )ro*nostc(ar%er

Re*resson 2 contro!ersal

Stann* )attern no consstentrelatons")

Mcrosco)c satellte 8as "*"assocaton /t" Ly()" node (etastass

3re2e;stn* #en*n ne!us #etter /"ent"ere s coe;stn* ac'ured (elanocytcne!us

benign and malignant melanocytic lesions

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