Malignant Melanoma

By

Bill V. Way, DO

Dan Ladd Jr., DO

A-B-C-D-E’s of Melanoma

• A - Asymmetry - several types

• B - Border Irregularity

• C - Colors - multiple

• D - Diameter - bigger than a pencil eraser

• E - Elevation, Erythema

ASYMMETRY - WHAT DOES IT MEAN?

• One side differs from the other side

• Shape

• Color

• Elevation

• Borders

• Does the lesion mirror itself in every way?

• May be subtle.

BORDERS

• May be “notched” or “jagged”

• May simply be blurred or indistinct.

• Can be indicative of the irregular growth of malignant melanocytes.

• Requires close inspection of lesion, preferably with a magnifying glass, may be subtle - take it seriously.

COLOR

• Many benign lesions have 2 colors, tan and brown, but the color is symmetrically placed, ie., brown central with round peripheral tan ring.

• Look for multiple or asymmetrically positioned colors - may see red, white, tan brown or black.

• Again requires magnification, can be subtle.

DIAMETER

• Always measure the greatest diameter.

• Include lighter or indistinct areas in your measurement, not just the darker pigment.

• Remember: PENCIL ERASER = 6 mm.

• Document size carefully if you are going to watch a lesion over time - consider the compliance level of your patient.

ELEVATION

• Remember that if the lesion is melanoma, elevation above the surface means depth below, and is the single worst prognostic factor.

• Elevation need not be eccentrically located, the classic “fried egg” may appear fairly symmetric but requires biopsy.

• PALPATE !

LET’S TRY A FEW…

Path: Junctional Nevus with Dysplastic Features,

Path: Compound Nevus with Features of “Dysplastic” (Clark)

Nevus

Path: Compound Nevus

Path: Pigmented Seborrheic Keratosis

Path: Compound Nevus

Path: Melanocytic Nevus, Compound Type

Path: Compound “Dysplastic” Melanocytic Nevus

Path: Compound “Dysplastic” Melanocytic Nevus

Path: Possible Early Evolving Melanoma In Situ

Path: Malignant Melanoma,Clarks Level IV,

Breslow’s Thickness 1.9 mm

Path: Melanoma In-Situ

Path: Evolving Melanoma In Situ

Path: Evolving Melanoma In-Situ

Path: Malignant Melanoma, Breslow’s Thickness 0.9 mm

THE END