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  #1  
Old 06-14-2011
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Skin Diagnosis of malignant melanoma

Diagnosis of malignant melanoma can be made
a. careful examination of the skin for abnormal cutaneous lesions
b. physical examination for metastatic spread
c. bone scan
d. biopsy and pathological examination of the suspicious lesions
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  #2  
Old 06-14-2011
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Quote:
Originally Posted by aghammoud85 View Post
diagnosis of malignant melanoma can be made
a.careful examinationof the skin for abnormal cutaneous lesions
b.phy examination for metastatic spread
c.bone scan
d.biopsy and pathological examination of the suspicious lesions
ans is d...
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  #3  
Old 06-14-2011
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D biopsy and pathology

another case

A 50-year-old woman presents to the physician, because a pigmented lesion on her leg has become pruritic. She states that she has had the lesion for 15 years but was not bothered by it until it become pruritic 4 weeks ago. The 6-mm plaque is blue-gray with streaks of pink, has an irregular border that is asymmetrical and well defined. What is the most appropriate next step in the management of this patient?

Answer Choices
A. Electrodesiccation
B. Excisional biopsy
C. Mohs micrographic surgery
D. Photograph-assisted followup
E. Thin shave biopsy
Explanation
Option B (Excisional biopsy) is correct. The lesion is highly suggestive of melanoma, because it is asymmetrical, has irregular borders, is varied in color and is 6 mm in diameter (ABCD). Whenever melanoma is suspected, an excisional biopsy should be performed to completely remove the lesion.

Option A (Electrodesiccation) is incorrect. Electrodesiccation is therapeutic option in basal cell carcinoma (BCC). However, the diagnosis is not yet established, and electrodesiccation is contraindicated in melanoma.

Option C (Mohs micrographic surgery) is incorrect. Mohs micrographic surgery is a highly effective technique for removal of BCC. It can be used to treat a wide variety of other skin cancers. However, diagnosis is most important at this point, and depth of invasion must be determined using a biopsy that allows full-thickness measurement.

Option D (Photograph-assisted followup) is incorrect. This is appropriate if there a nevus is detected that does not meet the ABCDE rule: asymmetry in shape, border is irregular, color is not uniform, diameter is large (>6 mm), and the lesion is elevated or enlarging. In this case, the features suggest melanoma.

Option E (Thin shave biopsy) is incorrect. A thin shave biopsy would fail to determine the thickness of the lesion and would thus be contraindicated, because of the importance of knowing the depth of invasion.

High-yield Hit 1
Malignant melanoma
This tumor is increasing in incidence and occurs particularly in fair-skinned people with exposure to UV light, people with more than 5 atypical moles, people with more than 50 moles, people with inability to tan, patients with severe sunburn (typically before age 14 years), and people with a family history of melanoma. Some melanomas arise in pre-existing moles. Malignancy should be expected if a pigmented lesion shows the following:
Rapid enlargement.
Bleeding.
Increasing variegated pigmentation, particularly blue-black or gray.
Ulceration.
An indistinct border.
Persistent itching.
Small "satellite" lesions around the principal lesion.
The prognosis is related to the thickness of the tumor assessed histologically. All suspicious lesions should be treated with excisional biopsy. For large lesions, punch biopsy is appropriate. The 5-year survival rate for patients with a tumor less than 1 mm thick is greater than 90%. If the thickness is greater than 3.5 mm, the 5-year survival rate is less than 35%.
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  #4  
Old 06-14-2011
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thank u man it is great reply
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  #5  
Old 06-15-2011
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Quote:
Originally Posted by aghammoud85 View Post
thank u man it is great reply


she is Miss patho

she is very active member here
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  #6  
Old 06-16-2011
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Default MM case

A 52-year-old man has noticed that a long-standing mole has started to itch and bleed. He first noticed the pruritus and easy tendency to bleed 2 weeks ago. The lesion is asymmetric, has irregular borders, a variegated color, and is 9 mm in diameter. It is located on the upper shoulder. What is the most significant prognostic indicator of this patient's condition?

Answer Choices
A. Diameter of lesion
B. Location of lesion
C. Mitotic rate of lesion
D. Thickness of lesion
E. Ulceration of lesion
Explanation
Option D (Thickness of lesion) is correct. This patient has melanoma, as suggested by the asymmetry, border irregularity, color variegation, and diameter larger than 6 mm. The single most important prognostic indicator for melanoma is the thickness of invasion.

Option A (Diameter of lesion) is incorrect. The diameter of the lesion is used in the rule (asymmetry, border irregularity, color variegation, diameter larger than 6 mm , and the lesion is elevated or enlarging) for the signs of melanoma, where a diameter greater than 6 mm is suggestive of melanoma. The ultimate diameter is less important than the thickness.

Option B (Location of lesion) is incorrect. Lesions that are located on the periphery tend to have a better prognosis. Unfortunately, most lesions are centrally located in males. Lesions on the legs are more common in females.

Option C (Mitotic rate of lesion) is incorrect. The mitotic rate of the lesion can suggest how aggressive the lesion is and a high mitotic rate is associated with a poorer prognosis, but it has not been shown to be as important a prognostic indicator compared with thickness of invasion.

Option E (Ulceration of lesion) is incorrect. Ulceration of a lesion automatically results in an upstaging of the risk. However, this is less important than thickness.


High-yield Hit 1
Malignant melanoma
This tumor is increasing in incidence and occurs particularly in fair-skinned people with exposure to UV light, people with more than 5 atypical moles, people with more than 50 moles, people with inability to tan, patients with severe sunburn (typically before age 14 years), and people with a family history of melanoma. Some melanomas arise in pre-existing moles. Malignancy should be expected if a pigmented lesion shows the following:
Rapid enlargement.
Bleeding.
Increasing variegated pigmentation, particularly blue-black or gray.
Ulceration.
An indistinct border.
Persistent itching.
Small "satellite" lesions around the principal lesion.
The prognosis is related to the thickness of the tumor assessed histologically. All suspicious lesions should be treated with excisional biopsy. For large lesions, punch biopsy is appropriate. The 5-year survival rate for patients with a tumor less than 1 mm thick is greater than 90%. If the thickness is greater than 3.5 mm, the 5-year survival rate is less than 35%.
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