1. Malignant Melanoma By Bill V. Way, DO Dan Ladd Jr., DO

2. A-B-C-D-E’s of Melanoma A - Asymmetry - several types B - Border Irregularity C - Colors - multiple D - Diameter - bigger than a pencil eraser E - Elevation, Erythema

3. ASYMMETRY - WHAT DOES IT MEAN? One side differs from the other side Shape Color Elevation Borders Does the lesion mirror itself in every way? May be subtle.

4. BORDERS May be “notched” or “jagged” May simply be blurred or indistinct. Can be indicative of the irregular growth of malignant melanocytes. Requires close inspection of lesion, preferably with a magnifying glass, may be subtle - take it seriously.

5. COLOR Many benign lesions have 2 colors, tan and brown, but the color is symmetrically placed, ie., brown central with round peripheral tan ring. Look for multiple or asymmetrically positioned colors - may see red, white, tan brown or black. Again requires magnification, can be subtle.

6. DIAMETER Always measure the greatest diameter. Include lighter or indistinct areas in your measurement, not just the darker pigment. Remember: PENCIL ERASER = 6 mm. Document size carefully if you are going to watch a lesion over time - consider the compliance level of your patient.

7. ELEVATION Remember that if the lesion is melanoma, elevation above the surface means depth below, and is the single worst prognostic factor. Elevation need not be eccentrically located, the classic “fried egg” may appear fairly symmetric but requires biopsy. PALPATE !

8. LET’S TRY A FEW…

10. Path: Junctional Nevus with Dysplastic Features,

12. Path: Compound Nevus with Features of “Dysplastic” (Clark) Nevus

14. Path: Compound Nevus

16. Path: Pigmented Seborrheic Keratosis

18. Path: Compound Nevus

20. Path: Melanocytic Nevus, Compound Type

22. Path: Compound “Dysplastic” Melanocytic Nevus

26. Path: Possible Early Evolving Melanoma In Situ

28. Path: Malignant Melanoma, Clarks Level IV, Breslow’s Thickness 1.9 mm

30. Path: Melanoma In-Situ

32. Path: Evolving Melanoma In Situ

34. Path: Evolving Melanoma In-Situ

36. Path: Malignant Melanoma, Breslow’s Thickness 0.9 mm

37. THE END