malignant melanoma
TRANSCRIPT
MALIGNANT MELANOMA
Pigmentation is a hallmark of melanoma
Features suggestive of melanoma include recent onset of a pigmented lesion, change in an existing pigmented lesion, irregular margins, asymmetrical shape, colour change or presence of multiple colours, and diameter greater than 6 mm in diameter.
CONJUNCTIVA Risk factors: - White race - Older age - H/o repeated intense sunlight
exposure Pathology : Anaplastic ,malignant appearing
melanocytic cells involve substantia propria.
CLASSIFICATION pre-existing naevus (junctional or
compound) Primary melanoma (de novo) PAM with atypia
Amelanotic tumours are pink and have a characteristic smooth ‘fish-flesh’ appearance
- Difficult to diagnose.
Ocular manifestations: Dark brown elevated lesion –perilimbal
region –interpalpebral.
S/L : Reddish,brown stippled/homogeneous dark brown ,intralesional microcysts,prominent blood vessels
- focal nodular epibulbar mass.
TREATMENT Simple observation Incisional biopsy – Complete excision &
cryotherapy Contact radiation Topical chemotherapy Exenteration – frank orbital invasion/
massive unresectable
IRIS Symptom: Visible spot /discolouration on iris/no
symptom
Risk Factors: - H/o intense sustained sunlight exposure - Conditions like Ocular melanocytosis , Dysplatic nevus syndrome. -
Ocular manifestations: - Localized dark brown to tan - well circumscribed, cohesive ,intrinsic
vascularity /shaggy ,dispersive. - Pupillary peaking - Ectropion iridis - Iris splinting
Pathology : Atypical melanocytic cells- prominent
nucleoli - N/C ratio - mitotic figures Fusiform shape – spindle cells Spherical shape – epitheloid cells
Diagnosis: - Transpupillary /transconjunctival transscleral transillumination - Anterior segment photography - Ultrasound biomicroscopy - Biopsy [incisional/ Fine needle aspiration.
TREATMENT Observation Excision [iridectomy /iridocyclectomy] Plaque radiotherapy Enucleation.
CHOROIDAL & CILIARY BODY Symptoms : - Blurred vision - Visual field defect - Flashes - Floaters - no symptom
SIGN:
CHOROIDAL Dark brown to golden solid tumour Biconvex ,lenticular on cross section Mushroom configuration[break tru bruch
membrane] Non rhegmatogenous RD –Clear serous
sub retinal fluid/bloody. Prominent clumps of orange lipofuscin
pigment.
CILIARY BODY Elevated ,nodular dark brown –peripheral
fundus.
Pathology :Anaplastic melanocytic cells – high N/C ratio prominent
nucleoli mitotic figuresSpindle cells, mixed cells, Epitheloid cells, Vascular loops & networks.
DIAGNOSIS: B –SCAN: Solid acoustically dark
[sonolucent] biconvex or mushroom
configuration Acoustic brightness on cap A scan: Low amplitude internal reflectivity stepwise decremental reduction in echo spike amplitude high amplitude at cap
Fluorescein Angiography : Dome shaped- early phase – filling of retinal,intratumoural
vessels Late phase – Non uniform hyperfluorescent
staining
Mushroom shaped- Early phase – filling of intratumoural vessels Late phase – Generalized staining of apical
nodule , sub retinal fluid.
MRI : Hyperintense relative to dark vitreous
on T1 Hypointense relative to bright vitreous
on T2
TREATMENT: Enucleation Radiation therapy Observation Photocoagulation Non coagulative laser therapy Microsurgical resection Exenteration Hyperthermia therapy PDT Cryotherapy Chemotherapy
EYELIDS Lentigo maligna Melanoma
LENTIGO MALIGNA
(melanoma in situ, intraepidermal melanoma /Hutchinson freckle)
Uncommon condition that develops in sun-damaged skin in elderly individuals. Malignant change may occur, with infiltration of the dermis.
Histology - intraepidermal proliferation of spindle-shaped
atypical melanocytes that replace the basal layer of the epidermis
Signs A slowly expanding pigmented macule with an irregular
border Nodular thickening and areas of irregular pigmentation are
highly suggestive of malignant transformation
Treatment is usually by excision.
MELANOMA
Histology shows large atypical melanocytes within the dermis
Signs
Superficial spreading melanoma is characterized by a plaque with an irregular outline and variable pigmentation
Nodular melanoma is typically a blue-black nodule
surrounded by normal skin
3 Treatment is usually by wide excision and may include local lymph node removal.
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