A 75-year-old Caucasian woman was seen at a nearby community clinic for a raised

Question

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

Q.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.

Ans: Malignant melanoma of skin was diagnosed spreading type is mentioned that is Clark’s level III, Breslow 1.44 mm and Breslow meant for thickness and Clark’s level III is deep penetration into the layer of skin at various level.

1) Breslow Thickness 1.44 mm : First reported by Alexander Breslow, MD, in 1970, the Breslow thickness is defined as the total vertical height of the melanoma, from the very top (called the "granular layer") to the area of deepest penetration in the skin.An instrument called an "ocular micrometer" is used to measure the thickness of the excised (removed) tumor.

1 to 2 mm: 5-year survival is 80% to 96%

2)Clark Level III :

The Clark level refers to how deep the tumor has penetrated into the layers of the skin.This system was originally developed by W. H. Clark, MD, back in 1966. Clark levels are officially defined .

Level III: filling of the papillary dermis, but no extension in to the reticular (lower) dermis.

Contrast between the nature of basal cell carcinoma, squamous cell carcinoma, and malignant melanoma.

Basal cell carcinoma (BCC) is the most common malignant neoplasm of humans.it has been associated with a variety of other lesions or neoplasms in the same or a nearby anatomic location.Basal cell carcinoma (BCC) is an epithelial tumour of the skin. It seldom metastasizes, but has the potential for local invasion and destruction.Lesions may be translucent or slightly erythematous with a rolled border occasionally accompanied by bleeding, scaling or crusting. Aggressive growth tumors tend to show more frequent ulceration and large, untended neoplasms can be locally destructive of eyes, ears and nares.

Squamous cell carcinoma (SCC) is an uncontrolled growth of abnormal cells arising in the squamous cells, which compose most of the skin’s upper layers (the epidermis).Most cases of squamous cell cancer are caused by chronic overexposure to the sun. Tumors appear most frequently on the sun-exposed face, neck, bald scalp, hands, shoulders, arms and back. The rim of the ear and the lower lip are especially vulnerable to these cancers.

Malignant Melanoma of skin is the most serious form of skin cancer. However, if it is recognized and treated early, it has a high cure rate. If not treated early, or if it is a high risk melanoma, the cancer can advance and spread to other parts of the body. Malignant Melanoma is very hard to treat and often fatal. The American Cancer Society estimates that in 2011, there will be approximately 9000 fatalities in the US, with 70% of these occurring in men. The number of new cases of melanoma is estimated at 59,940; of these, 33,910 will be in men and 26,030 in women.

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