Accepted
at 5:19 p.m. Jun, 27, 2025
by
jaynguyen
Author:
cvasavda
Type of change:
Updated content
Rationale for change
easier to read
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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)
Personal Notes
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Missed Questions
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DermPath
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Dermoscopy
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VisualDx
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DermNet
Radial growth phase
Vertical growth phase
Buckshot scatter
Melan-A staining showing early invasion
Cytologic atypia
Vertical growth phase
Buckshot scatter
Melan-A staining showing early invasion
Cytologic atypia
Full Spectrum of Dermatology
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Dermnemonics
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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)
Textbook
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Additional Resources
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One by one
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