Melanocytic tumors of the skin: Introduction

Deba P Sarma, MD Omaha

Melanocyte

Melanocyte

MITF immunostain

Melanocytic lesions

Benign- 95% Malignant- 4% Undetermined- 1%

Dr. Sarmas classification of pigmented lesions

Benign:
Lentigo simplex Solar lentigo Nevus (Junctional, Dermal, Compound, Blue, Spitz, Dysplastic)

Potentially malignant: Atypical melanocytic hyperplasia Malignant: Melanoma in-situ Invasive melanoma

Lentigo, Freckle, Mole, Nevus

Lentigo: From Latin word for lentil. A dark spot on skin that looks like a lentil bean and does not fade in the winter.

Freckle: Small brownish spot turning darker or increasing in number upon exposure to the sun and fading in winter. (Freckle=Speckle)

Mole : Spot, common name for nevus. MOLE = NEVUS

Nevus: Latin word meaning birthmark.

Lentigo simplex

Elongated rete ridges Basal melanosis No junctional nest No solar elastosis

Solar lentigo

Elongated rete ridges Basal melanosis No junctional nest Dermal solar elastosis

Nevus = Mole

Life of a nevus

Congenital nevus

Common nevi

Junctional Compound Dermal

Nevus: Junctional

Flat epidermal lesion Junctional nests with clefts

Nevus: Compound

Raised or flat (older person) lesion Junctional clefted nests and dermal nests

F 25, left abdomen

Dysplastic nevus

Nevus: Blue

Flat lesion No junctional nest Dermal pigmented spindled melanocytes

Nevus: Epithelioid (Spitz nevus)

70% occurs in pts < 20 yrs Raised, junctional or compound nevus Epithelioid clefted nests oriented vertically Cytologic and nuclear pleomorphism

Melanoma
Types Melanoma in-situ Melanoma (Invasive melanoma)

Melanoma
Lentigo maligna & lentigo maligna melanoma

Superficial spreading ( Pagetoid): In-situ & invasive Acral-lentiginous: In-situ & invasive
Nodular: Invasive Desmoplastic: Invasive

Melanoma in-situ: Lentigo maligna type

Neoplastic melanocytes spread from the junction upwards and along the adnexa. No dermal invasion.

Melanoma in-situ: Lentigo maligna type

Epidermal atrophy, solar elastosis Confluent and nested proliferation of pleomorphic melanocytes

Superficial spreading in-situ & invasive melanoma

Nodular melanoma

Raised, ulcerated, no radial spread, deep dermal invasion

Acral lentiginous melanoma

Desmoplastic melanoma

Epidermal atrophy, dermal actinic change, mononuclear cell and spindle cell infiltration

Pleomorphic spindle cells within desmoplastic stroma.Note the mitotic figure.

S-100: Positive

Risk factors

Uncontrollable: Skin type (race) History of melanoma Moles and atypical moles Age: 70 + Gender: M > F Controllable: UV radiation ( sunlight, tanning booths and lamps).

Skin types
I II III

IV

VI

History of melanoma

First-degree relatives: Father, mother, brother, sister, child Personal history of melanoma Melanoma pt.: Family history in 10%

Estd new cancer cases, USA, 2008

American Cancer Society

Male: Female: 1. Prostate (25%) 1. Breast (31%) 2. Lung (15%) 2. Lung (14%) 3. Colorectum (10%) 3. Colorectum (10%) 4. Bladder (7%) 4. Uterus (5%) 5. NH Lymphoma (5%) 5. NH Lymphoma (4%) 6. Melanoma (5%) 6. Thyroid (4%) 7. Kidney (4%) 7. Melanoma (4%)

Melanoma sites

Five-year survival rate

Overall 90% Localized 99% With regional spread 45%

Good news: 80% localized at diagnosis

Editorials 1985-2008
April;144: 533-534. Ackerman AB. No one should die of malignant melanoma. J Am Acad Dermatol. 1985 Jan; 12: 115-6. Kittler H. Early recognition at last. Arch Dermatol. 2008