Pathology (histo/gen/phys)
This upward migration of atypical melanocytes into the epidermis is a hallmark of melanoma.
Pagetoid spread
This population group has the highest incidence of melanoma due to genetic and environmental susceptibility.
non-hispanic whites
This acronym is used to evaluate suspicious pigmented lesions for melanoma. Name what each letter stands for
A- asymmetry
B-broders
C-color
D-diameter
E-evolution
A patient with metastatic melanoma harboring a BRAF V600E mutation is started on dabrafenib and this MEK inhibitor.
trametinib
This measurement in millimeters is the most important prognostic indicator in early melanoma.
Breslow depth
This mutation, found in ~50% of cutaneous melanomas, activates the MAPK pathway
B-RAF V600E
This type of sun exposure pattern is most strongly associated with melanoma risk.
blistering sun burns
A 27-year-old woman presents for a routine skin exam. She has several small, evenly pigmented brown macules on her arms and back. Each lesion is symmetric, has smooth borders, uniform color, and measures less than 5 mm. None have changed in appearance over time. Are these lesions concerning for melanoma- why or why not?
no they are not, do not meet ABCDE criteria and are therefore benign
A scaly, erythematous lesion is biopsied and shows nests of atypical keratinocytes invading the dermis with keratin pearls. This finding is characteristic of this non-melanoma skin cancer.
squamous cell carcinoma
A 0.9 mm thick melanoma with ulceration and high mitotic rate may warrant this procedure to assess micrometastasis.
sentinel lymph node biopsy
This tumor suppressor gene, frequently mutated in familial melanoma, encodes proteins that regulate the G1/S cell cycle checkpoint and is associated with loss of cell cycle control.
CDKN2A
A patient with multiple dysplastic nevi and a CDKN2A mutation is at increased risk due to this disrupted tumor suppressor pathway.
p16/p14ARF pathway involved in cell cycle regulation and tumor suppression
A 36-year-old woman presents for skin screening. She points out a mole that has recently become darker and developed a reddish hue. On exam, the lesion shows asymmetry, irregular borders, and areas of hyperpigmentation, hypopigmentation, and erythema.
Which component of the ABCDE criteria is best illustrated by the lesion’s evolving appearance and color changes?
E-evolution
A 35-year-old woman with fair skin and a history of blistering sunburns during childhood asks about ways to reduce her risk of developing melanoma. She enjoys outdoor activities and lives in a sunny climate.
Which evidence-based strategy is most effective in lowering her melanoma risk?
regular use of broad-spectrum sunscreen and sun-protective behaviors (e.g., shade, clothing, avoiding peak UV hours)
A 46-year-old woman presents with a 7 mm pigmented lesion on her upper back. The lesion is flat, irregularly pigmented, and poorly defined. Concerned about cosmetic outcomes, her dermatologist performs a saucerized shave biopsy. Histology confirms melanoma, but the specimen lacks the deepest portion of the lesion.
What is the primary limitation of this biopsy technique in this clinical scenario, and which alternative method would have better assessed tumor depth for staging?
incomplete sampling of the lesion base, which may impair Breslow depth measurement, and punch biopsy would provide full-thickness sampling for accurate staging
A 45-year-old woman undergoes biopsy of a pigmented lesion on her calf. Histology reveals nests of atypical melanocytes at the dermoepidermal junction, pagetoid spread into the upper epidermis, and mitotic figures within the dermis. The lesion measures 1.3 mm in Breslow depth and shows ulceration.
vertical growth phase, indicating invasive melanoma with increased risk of metastasis
A 33-year-old man presents for a routine skin exam. He reports having “lots of moles” since adolescence, some of which have irregular borders and varying shades of brown. His dermatologist notes numerous pigmented lesions scattered across his trunk and extremities, several with asymmetry and mild architectural disorder. He has no personal or family history of melanoma.
Which underlying skin condition, suggested by this clinical presentation, places him at elevated risk for developing melanoma?
dysplastic nevi
A 44-year-old woman presents for evaluation of a pigmented lesion on her upper arm. She reports that the lesion has not grown significantly in size but has recently developed areas of hypopigmentation and mild erythema. On exam, the lesion is asymmetric with irregular borders and shows patchy color loss and peripheral redness.
Which evolving clinical features suggest malignant transformation despite minimal change in diameter?
hypopigmentation from immune attack and erythema from neovascularization, both signs of evolving melanoma
A 52-year-old man presents with a pigmented lesion on his cheek. It is asymmetric, darkly pigmented, and has irregular borders. Dermoscopy reveals atypical pigment network and blue-white veil. However, biopsy shows nests of basaloid cells with peripheral palisading and retraction artifact.
Which diagnosis should be considered despite the lesion’s clinical resemblance to melanoma?
basal cell carcinoma
A 47-year-old woman is diagnosed with a 1.1 mm thick melanoma on her left shoulder. Histopathology reveals atypical melanocytes invading the dermis, with brisk infiltration of lymphocytes surrounding and penetrating the tumor nests. No ulceration is present.
How does the presence of these immune cells affect her prognosis, and what does it suggest about the host-tumor interaction?
tumor-infiltrating lymphocytes, and they indicate an active immune response associated with improved prognosis
A 29-year-old woman with a history of multiple dysplastic nevi presents for evaluation of a changing pigmented lesion on her thigh. She reports recent darkening and irregularity in shape. Dermoscopy reveals asymmetry and color variation. A biopsy shows nests of melanocytes at the dermoepidermal junction with nuclear pleomorphism, upward migration into the epidermis, and lack of maturation with depth. Mitotic figures are present in the dermis.
Which diagnosis is most consistent with these findings, and what histologic features distinguish it from a benign nevus?
melanoma, and it is distinguished by pagetoid spread, atypical melanocytes with hyperchromatic nuclei, lack of maturation, and dermal mitoses
A 58-year-old man with a history of renal transplant presents with a changing pigmented lesion on his forearm. Which underlying condition could be increasing his risk for developing melanoma?
immunosuppression
A 39-year-old man presents with a pigmented lesion on his back that has recently become lighter in the center. He denies trauma or treatment. On exam, the lesion shows central regression with surrounding pigmentation and mild inflammation.
What does this clinical presentation suggest about host-tumor interaction, and how might it influence prognosis?
spontaneous tumor regression due to immune response, associated with improved prognosis
A 56-year-old man with metastatic melanoma is enrolled in an immunotherapy trial. He receives a high-dose cytokine therapy that stimulates proliferation of cytotoxic T cells, B cells, and natural killer cells. Later, he is transitioned to a therapy that enhances antigen presentation by upregulating MHC class I expression on host cells, improving immune recognition of tumor antigens.
Which two immunomodulatory agents are being used, and how do they contribute to melanoma clearance?
aldesleukin (IL-2) to boost cytotoxic immune cells, and interferon-alpha to enhance MHC-I–mediated tumor antigen presentation
A 62-year-old man presents with a pigmented lesion on his upper back that has recently become painful and started bleeding. Biopsy reveals atypical melanocytes invading the dermis, with areas of epidermal breakdown and necrosis. Histology confirms ulceration overlying the tumor.
How does the presence of ulceration reflect the tumor’s biological behavior, and what impact does it have on staging and prognosis?
rapid tumor growth outpacing vascular supply, leading to tissue breakdown, and it upstages the melanoma with worse prognosis