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Patient Case: Malignant Melanoma

Patient Case: Malignant Melanoma

Discussion

A 47-year-old woman presents to the dermatology clinic with concern over a dark, irregular mole on her upper back. She reports that the mole has changed in size, shape, and color over the past six months. Initially, it was a small, evenly pigmented brown spot, but it has since grown larger, developed irregular borders, and now has areas of dark brown, black, and reddish hues. She also notes occasional itching but denies pain or bleeding.

She has fair skin, a history of frequent sunburns in childhood, and a family history of melanoma in her father. On examination, a 1.8 cm asymmetric lesion with irregular borders and variegated pigmentation is noted. A dermoscopic evaluation reveals atypical pigmentation patterns.

A biopsy is performed, confirming superficial spreading melanoma with a Breslow depth of 1.2 mm. The patient is referred for further staging and treatment, including surgical excision with appropriate margins and consideration of sentinel lymph node biopsy.

Questions
  1. Which of the following clinical features is most concerning for melanoma?
    a) A well-defined, symmetrical brown lesion
    b) A mole that is uniformly tan in color
    c) A rapidly growing, asymmetrical lesion with irregular borders and multiple colors
    d) A small, round, pink papule that has remained unchanged for years
  2. What is the most important prognostic factor for melanoma survival?
    a) Tumor location
    b) Breslow thickness
    c) Degree of pruritus (itching)
    d) Patient's age
  3. What is the first-line treatment for early-stage malignant melanoma?
    a) Wide local excision
    b) Topical steroids
    c) Cryotherapy
    d) Chemotherapy
  4. Which of the following is the most significant risk factor for melanoma?
    a) Chronic bacterial skin infections
    b) Ultraviolet (UV) radiation exposure
    c) High carbohydrate diet
    d) Use of mild soaps and moisturizers
Reveal answers

Answers

  1. (c) A rapidly growing, asymmetrical lesion with irregular borders and multiple colors
    • The ABCDE rule (Asymmetry, Border irregularity, Color variation, Diameter >6mm, Evolution) is crucial for identifying melanoma.
  2. (b) Breslow thickness
    • The depth of invasion (Breslow thickness) is the most critical factor in predicting melanoma prognosis and risk of metastasis.
  3. (a) Wide local excision
    • Surgical excision with adequate margins is the primary treatment for early-stage melanoma. Sentinel lymph node biopsy may be considered for staging.
  4. (b) Ultraviolet (UV) radiation exposure
    • Excessive sun exposure, particularly in childhood, is a major risk factor for melanoma, along with fair skin and a history of blistering sunburns.