Created at 8 p.m. Mar, 14, 2025
Author: Arcamenel
Related Note: 1695638743078 1
Rationale for change

dermnet path photos, link submitted

DermNet DermNet
Text
3 important histological features of melanoma:

{{c1::Discohesion}}: nest fragments into individual cells
"{{c2::Epidermal consumption}}": melanoma effaces epidermis → epidermal thinning and ulceration
Lack of {{c3::maturation}} of dermal component (sheets of melanocytes and large nests at the base)
Extra
Other features:
  • Asymmetry
  • Poor circumscription
  • Irregularly sized and shaped junctional nests with discohesion
  • Lentiginous/confluent growth along DEJ predominates over nests
  • Pagetoid scatter
  • Extension down adnexal epithelium
  • Dermal mitoses
  • Cytologic atypia (irregular, large nuclei w/ prominent red nucleoli)
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Dermatographix

Melanoma Histology, Staging, and Treatment of Localized Melanomas (DermatoGraphix)
Histology
•Fragmented nest: Discohesion (nest fragments into individual cells) with asymmetry, poor circumscription, irregularly sized, and shaped junctional nests
•Consuming a worm: Epidermal consumption (melanoma effaces the epidermis leading to epidermal thinning and ulceration)
•Immature birds underneath: Lack of maturation of dermal component
•Red eggs in nucleus-like nest: Cytologic atypia with irregular, large nuclei with prominent red nucleoli
•Woodpecker digging deep ulcer in tree: Most important staging parameter is Breslow thickness and ulceration

Staging
•Bee coming out of ulcerated hole: For T classifications, the presence of ulceration upgrades the stage to b
•1, 2, 3, 4 etched on the tree trunk: T classification corresponds to Breslow thickness and generally correlates with millimeters
•T1: ≤1.0 mm Breslow thickness
•T2: >1.0-2.0 mm
•T3: >2.0-4.0 mm (average is 3)
•T4: >4.0 mm
•#8 underneath #1: 0.8 mm is the cut-off for T1a without ulceration. If >0.8 mm or ulceration → stage T1b

Treatment
•Knife: Wide local excision (margins corresponding to Breslow depth)
#1,2,3,4:
•Breslow depth ≤1 mm → take 1 cm margin
•Breslow depth 1-2 mm → take 1-2 cm margins
•Breslow depth >2.0 mm → take 2 cm margin
•Green pearl necklace coming out of ulcer: Ulcer signifies at least stage T1b, at which point a sentinel lymph node biopsy should be considered (offered for higher stages)
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#Dermki::Alikhan::06_Neoplastic_Derm::06.03_Melanocytic_neoplasms #Dermki::DermatoGraphix::GenDerm::Melanoma::Histology,_Staging,_&_Localized_Treatment AnkiHub_Subdeck::Dermki::06_Neoplastic_Dermatology