Malignant Melanoma by Dr. Richert and Dr. Flynn Please read and consider the inf

Question

Malignant Melanoma
by Dr. Richert and Dr. Flynn
Please read and consider the information in the following scenario.

A 75-year-old Caucasian woman was seen at a nearby community clinic for a raised lesion on her right thigh. She had noticed that the pale tan to light gray color of the lesion was changing. Examination by the referring experienced dermatologist showed a rough and coarsely granular, oval lesion with a slightly irregular border measuring 1.7 x 0.9 cm. Clinically, this lesion was thought to resemble an irritated seborrheic keratosis and was biopsied because of its size, a slight variability in color, and a clinical history of color change. The biopsy requisition diagnosis read "Irritated Seborrheic Keratosis." Histopathologic examination of a deep-shave biopsy showed the low-power silhouette of a seborrheic keratosis, including squamous papilloma-like features and delicate, laminated pseudocysts of horn. The final diagnosis was malignant melanoma, superficial spreading type, Clark’s level III, Breslow 1.44 mm, probable vertical growth phase, and simulating a seborrheic keratosis.

Discussion Question

Outline the diagnosis of skin cancer in this case, and compare and contrast the nature of basal cell carcinoma, squamous cell carcinoma, and malignant melanoma.            

Explanation / Answer

Skin Cancer Overview

There are three major types of skin cancers: basal cell carcinoma (BCC), squamous cell carcinoma (SCC), and melanoma. The first two skin cancers are grouped together as non-melanoma skin cancers. Other unusual types of skin cancer include Merkel cell tumors and dermatofibrosarcoma protruberans.

Here are the basics on skin cancers:

Like many cancers, skin cancers start as precancerous lesions. These precancerous lesions are changes in skin that are not cancer, but could become cancer over time. Medical professionals often refer to these changes as dysplasia. Some specific dysplastic changes that occur in skin are as follows:

Recent studies show the number of skin cancer cases in the U.S. growing at an alarming rate. Fortunately, increased awareness on the part of Americans and their health care providers has resulted in earlier diagnosis and improved outcomes.

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