Skin Cancer and Malignant Melanoma Igor Y. Galaychuk, MD, DSc, Professor, Head of Oncology and Radiology Department, Ternopil State Medical University e-mail: Halaychuk@tu.edu.te.ua www.igalaych.iatp.org.ua

Skin melanoma: statistical data in Ukraine 19,3 % - death within a year, M. – 26,2 %; F. – 14,9 % 49,7 % - 5-year survival 67,7 % - І-ІІ stages

Comparative Statistics: UA – USA Ukraine USA 5-year survival 49,7 % 88,0 % Melanoma in situ 37,5 % Year: 2000  

Biologic progression of melanoma Melanocyte  nevus  dysplastic nevus  меlanoма “in situ”  superficial spreading melanoma  nodular melanoma  metastatic melanoma

Malignant Melanoma: Risk Factors Age > 40 yr. Race: white Sun exposure: UVA, UVB Hereditary factors: “melanoma families“, atypical mole syndrome or dysplastic nevus syndrome Trauma of moles, Giant congenital nevi Oncogene mutations

(American Academy of Dermatology) Screening: Self-Examination for Melanoma: examine your body front and back in the mirror, arms and palms, legs and feet, neck and scalp – If you have any doubt about a mole, see a dermatologist-oncologist (American Academy of Dermatology)

Professional education: students family doctors dermatologists surgeons cosmetologists morphologists oncologists ! nurses ABCD-test

ABCD rules for diagnosis of melanoma:

Epiluminescence microscopy (dermatoscopy)

Epiluminescence microscopy (ABCD) ЕЛМ

Diagnostics system MoleMax:

Growth patterns of melanoma: superficial spreading melanoma – 70% nodular melanoma – 15-20% lentigo maligna melanoma – 4 -10% acral lentigo-melanoma – 2-8% amelanotic melanoma – 5%

Thickness of melanoma TNM: T1 < 1 mm T2 1-2 mm T3 2-4 mm Radial growth phase Vertical growth phase

Evaluation for Metastasis: N0-3, M0-1 Regional Lymph Nodes: N0 – no metastasis, N1 – one lymph node with metastasis, N2 – 2-3 lymph nodes with Mts., N3 – 4 and > metastatic lymph nodes. Distant Metastasis: M0 – no metastasis, M1a: Mts in subcutaneous tissue, M1b: Mts in lung, M1c: Mts in other visceral organs (brain, liver, etc)

Nodular Melanoma Т4bNхM0 Biopsy techniques For cytologic diagnosis: - fine-needle aspiration, - superficial scraping. For histologic diagnosis: complete excision (Clark’ levels, Breslow’s thickness)

Surgical approach to lymphogenous metastases of melanoma   Sentinel node biopsy, or regional lymph node dissection     Regional lymphangiectomy   melanoma   operation Surgical approach to lymphogenous metastases of melanoma  

Complex treatment of primary melanoma Т3bN1аМ0 (X-ray + Chemo Complex treatment of primary melanoma Т3bN1аМ0 (X-ray + Chemo.  Surgery + Chemo. + INF)

Operative wound closed by flaps’ transposition

Lentigo maligna melanoma (arise from Hutchinson’s freckle) 1 year after Radiation Therapy

Melanoma: scars, recurrence, in transit Mts 1 2 3 4

Superficial melanoma with skin lymphangeitis and in-transit metastasis

Wound xenoplasty after wide local excision of melanoma

Skin autografting of granulated wound

Spleen metastasis of melanoma (2001); CT scan in 3 years after splenectomy (2004) 04. 2001 06. 2004

Меланома: метастази в селезінку і лімфовузли Melanoma metastases into spleen (surgical specimen) and lymph node Меланома: метастази в селезінку і лімфовузли Хворий К., 34 роки 03.2000 – меланома шкіри на спині, T3bN0M0 Лікування: - БФ-РТ, СВД 80 Гр, Операція ПХТ + лаферон (2 курси) 04.2001 – метастази в л/вузли і селезінку 04.2001

“In transit” metastases

Metastatic melanoma Palliative  - therapy Hormonotherapy Supportive care

Skin cancer Basal Cell Carcinoma, T1N0M0 (growth pattern)

Precancerous diseases: Факультативні: гіперкератози, шкірний ріг, папіломи, фіброми, гемангіоми, бородавки Облігатні: пігментна ксеродерма, хвороба Боуена, еритроплазія Кейра

Skin cancer Basal Cell Carcinoma, T1N0M0 (ulcer pattern)

Skin cancer Squamous Cell Carcinoma, T4N0M0

TNM-Classification of Skin Cancer: Тis – carcinoma in situ Т1 –  2 cm Т2 – 2 - 5 cm Т3 – > 5 см Т4 – t-r invades cartilage, muscle, or bone. N0, N1 M0, M1

Skin Cancer Squamous Cell Carcinoma of lower eyelid with invasion in bulbar conjunctiva, T4N0M0

Skin Cancer Squamous Cell Carcinoma of Cheek, T4N0M0 results of local phytotherapy for a year!!!

Skin Cancer Results after half course of gamma-therapy, 45 Gy

Skin Squamous Cell Cancer of Neck: Postoperative wound is temporary covered with Pig skin xenografts

Skin Cancer: granulation wound (1), skin autografting (2) Wound after removing of xenografts

Skin Cancer: complete recovery 12 months later

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