1. Skin Cancer and Malignant Melanoma
Igor Y. Galaychuk, MD, DSc,
Professor, Head of Oncology
and Radiology Department,
Ternopil State Medical University

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

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

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

5. 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

6. (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)

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

8. ABCD rules for diagnosis of melanoma:

9. Epiluminescence microscopy (dermatoscopy)

10. Epiluminescence microscopy (ABCD)
ЕЛМ

11. Diagnostics system MoleMax:

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

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

14. 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)

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

16. 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

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

18. Operative wound closed by flaps’ transposition

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

20. Melanoma: scars, recurrence, in transit Mts1 2 3 4

21. Superficial melanoma with skin lymphangeitis and in-transit metastasis

22. Wound xenoplasty after wide local excision of melanoma

23. Skin autografting of granulated wound

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

25. 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
– меланома шкіри на спині, T3bN0M0
Лікування:
- БФ-РТ, СВД 80 Гр,
Операція
ПХТ + лаферон (2 курси)
– метастази в л/вузли і селезінку

26. “In transit” metastases

27. Metastatic melanoma Palliative  - therapy Hormonotherapy
Supportive care

28. Skin cancer
Basal Cell Carcinoma,
T1N0M0
(growth pattern)

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

30. Skin cancer
Basal Cell Carcinoma,
T1N0M0
(ulcer pattern)

31. Skin cancer
Squamous Cell Carcinoma,
T4N0M0

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

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

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

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

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

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

38. Skin Cancer: complete recovery 12 months later

39. Дякую за увагу!
Тернопільське озеро