Select a Community
Are you sure you want to trigger topic in your Anconeus AI algorithm?
You are done for today with this topic.
Would you like to start learning session with this topic items scheduled for future?
Further questioning
33%
6/18
Topical corticosteroid
0%
0/18
Reassurance
22%
4/18
Simple shave biopsy
6%
1/18
Full thickness biopsy
Select Answer to see Preferred Response
The lesion on the thigh is concerning for melanoma. To further assess her risk for melanoma, the physician must ask about melanoma risk factors including history of skin cancer, family history of skin cancer, and if the lesion has changed in regards to shape, size, or coloring. Melanoma is a tumor of melanocytes most commonly found on the skin, particularly areas of intermittent sun-exposure, such as the backs of legs in women and backs of males. The ABCDE mnemonic is used in the evaluation of pigmented lesions: asymmetry, border irregularities, color variation, diameter (>6 mm), and evolution. Melanoma is the most dangerous of skin cancers with a melanoma-specific 5-year survival for patients with metastatic disease of only 15%. Shenenberger discusses the management of cutaneous melanoma in the primary care setting. While it is agreed that all lesions suspicious for melanoma should be biopsied, the specific method of biopsy performed is debatable. The generally preferred method is a complete elliptical excision of the suspicious lesion with a small margin of normal-appearing skin (approximately 3 mm). A scoop shave biopsy (saucerization) or a punch biopsy can be also appropriate options depending on the experience of the physician and the clinical situation. Markovic et al. review the staging, prognosis, and treatment of malignant melanoma. The Breslow depth is the most frequently used system for staging and is the most important factor in prognosis. The measurement is taken from the top of the granular layer of epidermis to the deepest melanoma cell. For this reason, shallow shave biopsies are not recommended. Illustration A shows an examples of a lesion concerning for melanoma. Note the irregular borders and uneven coloration. Illustration B shows the relationship between Breslow thickness and survival, from Owen SA et al. Cancer. 2001. Incorrect Answers: Answer 2: Topical corticosteroid is appropriate for this woman's contact dermatitis, not for this suspicious pigmented lesion. Answer 3: Melanoma is a very dangerous cancer, so if there is any suspicion, watchful waiting would not be appropriate. Answer 4: A simple shave biopsy is never appropriate for melanoma. A scoop shave biopsy may be appropriate in certain situations. Answer 5: This lesion may need to be biopsied, but first the risk of melanoma should be assessed.
5.0
(2)
Please Login to add comment