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Skin Lesion PowerPoint Presentation

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Description : This medical presentation on cancer titled "Skin Lesion" presents a case on skin lesion.

Tags : Cancer, skin lesion, mole, Differential Diagnosis, Dysplastic Nevus, Malignant Melanoma, Basal Cell Carcinoma, Squamous Cell Carcinoma, Junctional Nevus, Actinic Keratosis, solar skin damage, Biopsy of Lesion, Surgical Excision

Published on : May 01, 2021 | Views : 2754 | Downloads : 5

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Slide 1-

Skin Lesion James Warneke, MD University of Arizona
Slide 2-

Mr. Smith Patient is a 64 year-old man with a history of a mole on his chest that has been present for years, but has recently grown is size. The mole has not bleed.
Slide 3-

History What other points of the history do you want to know?
Slide 4-

History, Mr. Smith Characterization of symptoms Temporal sequence Alleviating / Exacerbating factors: Pertinent PMH, ROS, MEDS. Relevant family hx. Associated signs and symptoms Consider the Following
Slide 5-

History, Mr Smith Characteristics of mole Change in color Nodular areas Family History of melanoma History of sun exposure and sunburns History of previous atypical moles
Slide 6-

What is your Differential Diagnosis?
Slide 7-

Differential Diagnosis Based on History Dysplastic Nevus Malignant Melanoma Basal Cell Carcinoma Squamous Cell Carcinoma Junctional Nevus Actinic Keratosis
Slide 8-

Physical Examination What would you look for?
Slide 9-

Physical Examination, Mr. Smith General: fair skin and blue eyes Skin: Multiple moles and evidence or solar skin damage on face and arms Large mole on anterior chest with Asymmetry, border irregularity, color variation and diameter greater than 6mm Lymph nodes – none palpable in axilla, neck or groin
Slide 10-

Physical Examination
Slide 11-

Interventions at this point?
Slide 12-

Biopsy of Lesion Biopsy thickest area Biopsy should be down to subcutaneous fat Biopsy entire lesion if small Large lesions should have punch biopsy or wedge Orient extremity incisions in axial direction so re-excisions can be axial
Slide 13-

Would you like to revise your Differential Diagnosis?
Slide 14-

Results of Biopsy Melanoma What is important to check on the pathology report?
Slide 15-

Biopsy Results Pattern of Melanoma Superficial spreading – most common Nodular – vertical growth Acral lentiginous – nails, palms and sole of foot, usually have in-situ precursor Lentigo Maligna – in-situ melanoma in sun exposed area of the face and back of hand
Slide 16-

Biopsy Results Breslow’s Thickness – measured with an optic micrometer Clark’s Level I In-situ II Papillary dermis III Superficial reticular dermis IV Deep reticular dermis V Subcutaneous fat
Slide 17-

Biopsy Results Ulceration of Epithelium Other Factors – deep margin involved with melanoma, regression, lymphocytic infiltration.
Slide 18-

Biopsy Results of Mr. Smith Superficial spreading melanoma with areas of nodular invasion Breslow’s thickness 2.5mm Clark’s level IV Non-ulcerated Deep margin free of melanoma
Slide 19-

Laboratory and X-ray What blood test should be ordered? What X-ray studies are indicated?
Slide 20-

Laboratory and X-ray Serum LDH is indicated for lesions deeper than 1.0mm PA and Lateral Chest X-ray for lesions deeper than 1.0mm
Slide 21-

Laboratory and X-ray of Mr. Smith LDH is within normal limits CXR shows no evidence of metastatic disease
Slide 22-

Further Management What should be done next?
Slide 23-

Management Surgical Excision How wide of an excision should be done? When should a lymph node biopsy be planned?
Slide 24-

Management of Mr. Smith Margin of excision should be 2.0 cm from all borders of the pigmented lesion Lesions <1.0mm 1.0 cm margins Lesions 1.0-2.0 mm 1.0-2.0 cm margins Lesions >2.0 mm 2.0 cm margins The depth of the excision is to the underlying fascia
Slide 25-

Management of Mr. Smith For an acceptable cosmetic result, an ellipse of skin is usually excised with length 2.5-3.5 times the width. In this patient the lesion is wide, and the ellipse would be 6cm X 15cm To close this defect primarily, the lateral edges are undermined for 2-3cm to allow the skin to stretch
Slide 26-

Evaluation of Lymph Nodes Lesions <1.0mm do not need lymph nodes biopsied Lesions >1.0mm thickness should have sentinel lymph node biopsy All lesions which have an enlarged palpable lymph node in an adjacent lymph node basin, should have that lymph node biopsied
Slide 27-

Sentinel Lymph Node Biopsy Lymphscintigraphy with Tc99 radiolabeled to colloid is done day of procedure to detect lymph drainage and to use intraoperatively with the gamma probe Lymphazurin blue dye is injected into the dermis next to the melanoma to visually detect the sentinel lymph node
Slide 28-

Marking of Lymph Basin With Lymphscintigraphy in Mr. Smith
Slide 29-

Injection of Lymphazurin Blue Dye in Mr. Smith
Slide 30-

Evaluation of Mr. Smith’s Lymph Nodes
Slide 31-

Sentinel Lymph Nodes in Mr. Smith Sentinel lymph node biopsy found two lymph nodes which where blue Both blue lymph nodes were hot with the hand-held gamma probe Pathology by routine histology and immunohistochemistry did not detect any melanoma in the lymph nodes
Slide 32-

What Stage is Mr. Smith’s Melanoma?
Slide 33-

Staging of Mr. Smith’s Melanoma Primary Tumor (T) 2.5mm with no ulceration is T3a Regional Lymph Nodes (N) no regional node metastasis is NO Metastasis (M) none is MO Stage is IIA T3a NO MO
Slide 34-

Prognosis What is the estimated 10 year survival of Mr. Smith?
Slide 35-

10 Year Survival of Mr. Smith Melanoma T3a with NO has a 10 year survival of 65% With the inclusion of sentinel lymph node biopsy, the micrometastatic nodes with melanoma will have a worse prognosis of 50%, and the negative sentinel nodes will have a increased survival to 80-90 %
Slide 36-

Questions?
Slide 37-

Summary of Melanoma 54,200 new melanomas per year in US 7600 deaths from melanoma per year in US 1 in 57 white males 1 in 81 white females 89% 5-year survival for 1992-1998
Slide 38-

Acknowledgment The preceding educational materials were made available through the ASSOCIATION FOR SURGICAL EDUCATION In order to improve our educational materials we welcome your comments/ suggestions at: feedbackPPTM@surgicaleducation.com