Malignant Melanoma

• lesion margins: regular/irregular.

• histogenic type: lentigo maligna/superficial spreading/nodular/acral lentiginous/desmo-plastic/neurotropic.

• growth phase: radial/vertical.

• cross-sectional profile.

• pigmentation.

• lymphoid response at base.

• signs of regression.

• associated melanocytic naevus.

• vascular invasion.

• perineural invasion.

• neurotropism.

• microscopic satellitosis.

• excision margins

- nearest peripheral: clear (mm)/involved (in situ/invasive).

- nearest deep: clear (mm)/involved (in situ/invasive).

• extent of local tumour spread.

- pTis melanoma in situ.

a. without ulceration and level II/III.

b. with ulceration and level IV/V.

* a. without ulceration. b. with ulceration.

- pN1* 1 lymph node involved.

- pN2* 2-3 lymph nodes involved.

* a. micrometastasis. b. macrometastasis.

+ c. in-transit metastasis/satellites without metastatic lymph nodes.

- pM1a distant skin or nodal metastasis.

- pM1b lung metastasis.

- pM1c all other visceral metasases, any distant metastases with elevated serum LDH.

Lymph nodes: lymph nodes may be removed where there is tumour involvement in patients with squamous cell carcinoma or malignant melanoma. If the lymph node is subcutaneous a fine needle aspiration will be carried out to confirm the diagnosis prior to surgical removal. The node(s) should be weighed, measured, counted and submitted for histological examination

Sentinel node biopsy: sentinel node biopsy is used in some centres in patients with biopsy-proven malignant melanoma of the skin. The sentinel node is the first drainage node at the site of the excised malignant melanoma. This is removed and examined in the laboratory for microscopic tumour using multiple step sections through the node and using both haematoxylin and eosin and immunocytochemistry markers including S100, Melan-A and HMB45 to confirm small microscopic deposits of malignant melanoma.

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