Melanoma classification: Difference between revisions

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{{CMG}} {{AE}} {{YD}}; {{SSK}}
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==Overview==
==Overview==
Melanoma may be classified into either cutaneous or subcutaneous melanomas. The most common 4 subtypes of cutaneous melanoma include superficial spreading melanoma, nodular melanoma, acral lentiginous melanoma, and lentigo maligna melanoma. Less common subtypes of melanoma include desmoplastic/spindle cell melanoma, nevoid melanoma, spitzoid melanocytic melanoma, angiotropic melanoma, blue nevus-like melanoma, and composite melanoma.
[[Melanoma]] may be classified into either [[Skin|cutaneous]] or [[Skin|non-cutaneous]] [[Melanoma|melanomas]]. The most common 4 sub-types of [[Skin|cutaneous]] [[melanoma]] include [[Superficial (human anatomy)|superficial]] spreading [[melanoma]], [[Nodule (medicine)|nodular]] [[melanoma]], [[acral lentiginous melanoma]], and [[lentigo maligna melanoma]]. Less common sub-types of [[melanoma]] include [[Desmoplasia|desmoplastic]]/[[spindle cell]] [[melanoma]], [[nevoid melanoma]], [[Spitzoid melanoma|spitzoid melanocytic melanoma]], [[angiotropic melanoma]], [[blue nevus]]-like [[melanoma]], and [[composite melanoma]].


==Classification of Melanoma==
==Classification of Melanoma==
Shown below is a table that demonstrates that various subclasses of melanoma:<ref name=book1>{{cite book|last=Schanderdorf D, Kochs C, Livingstone E |date=2013 |title=Handbook of Cutaneous Melanoma: A Guide to Diagnosis and Treatment |publisher=Springer }}</ref><ref name=book2>{{cite book|last=Mooi W, Krausz T|date=2007 |title=Pathology of Melanocytic Disorders 2nd Ed. |publisher=CRC Press}}</ref>
Shown below is a table that demonstrates the various sub-classes of [[melanoma]]:<ref name="book1">{{cite book|last=Schanderdorf D, Kochs C, Livingstone E |date=2013 |title=Handbook of Cutaneous Melanoma: A Guide to Diagnosis and Treatment |publisher=Springer }}</ref><ref name="book2">{{cite book|last=Mooi W, Krausz T|date=2007 |title=Pathology of Melanocytic Disorders 2nd Ed. |publisher=CRC Press}}</ref>
{| {{table}}
{| {{table}} cellpadding="4" cellspacing="0" style="border:#c9c9c9 1px solid; margin: 1em 1em 1em 0; border-collapse: collapse;"
| align="center" style="background:#f0f0f0;"|'''Subtype'''
| align="center" style="background: #4479BA;" | {{fontcolor|#FFF|'''Subtype'''}}
| align="center" style="background:#f0f0f0;"|'''Frequency'''
| align="center" style="background: #4479BA;" | {{fontcolor|#FFF|'''Frequency'''}}
| align="center" style="background:#f0f0f0;"|'''Clinical Features'''
| align="center" style="background: #4479BA;" | {{fontcolor|#FFF|'''Clinical Features'''}}
|-
|-
|colspan=3|'''''Common Subtypes'''''
| colspan="3" |'''''Common Subtypes'''''
|-
|-
|Superficial spreading melanoma||70%||
|[[Superficial (human anatomy)|Superficial]] spreading [[melanoma]]||70%||
*Most common subtype
*Most common sub-type
*Usually affects sun exposed sites among both men and women aged 50-70 years
*Usually affects sun exposed sites among both men and women aged 50-70 years
*Characterized by presence of abundant junctional intraepidermal spread of malignant melanocytes
*Characterized by the ''presence'' of abundant junctional [[Epidermis (skin)|intra-epidermal]] spread of [[malignant]] [[Melanocyte|melanocytes]]
|-
|-
|Nodular melanoma||15-25%||
|[[Nodular melanoma]]||15-25%||
*Second most common subtype
*Second most common subtype
*Usually affects sun exposed sites among both men and women aged 50-70 years
*Usually affects sun exposed sites among both men and women aged 50-70 years
*Characterized by absence of junctional intraepidermal spread of malignant melanocytes
*Characterized by the ''absence'' of junctional [[Epidermis (skin)|intra-epidermal]] spread of [[malignant]] [[Melanocyte|melanocytes]]
|-
|-
|Acral lentiginous melanoma||5%||
|[[Acral lentiginous melanoma]]||5%||
*Not associated with chronic ultraviolet exposure
*Not associated with [[Chronic (medical)|chronic]] [[ultraviolet]] exposure
*Affects the extremities among inidividuals of all races
*Affects the [[Limb (anatomy)|extremities]] of individuals of all [[Race|races]]
*Common among elderly Caucasian and non-Causasian individuals
*Common among the elderly Caucasian and non-Caucasian individuals
|-
|-
|Lentigo maligna melanoma||1-5%||
|[[Lentigo maligna melanoma]]||1-5%||
*Preceded by lentigo maligna
*Preceded by [[lentigo maligna]]
*Common among elderly Caucasian patients
*Common among the elderly Caucasian [[Patient|patients]]
*Usually appears as a flat, non-palpable lesion that affects sun exposed sites, especially the head and neck (extremities less common)
*Usually appears as a flat, non-palpable [[lesion]] that affects sun exposed sites, especially the [[head]] and [[neck]] ([[Lesion|lesions]] on [[Limb (anatomy)|extremities]] are less common)
|-
|-
| Non-cutaneous melanoma||5%||
| [[Skin|Non-cutaneous]] [[melanoma]]||5%||
*Melanoma that does not affect the skin
*[[Melanoma]] that does not affect the [[skin]]
*Usually affects the eye (ocular melanoma) or the mucus membranes (mucosal melanoma)
*Usually affects the [[eye]] ([[ocular]] [[melanoma]]) or the [[Mucous membrane|mucus membranes]] ([[Mucous membrane|mucosal]] [[melanoma]])
|-
|-
| colspan=3| '''''Less Common Subtypes'''''
| colspan="3" | '''''Less Common Subtypes'''''
|-
|-
| Spindle cell melanoma||Rare||
| [[Desmoplasia|Desmoplastic]]/[[Spindle cell]] [[melanoma]]||Rare||
*Lesion typically amelanotic
*[[Lesion]] typically amelanotic and has a [[morphology]] similar to a [[scar tissue]]
*Appears indolent but is highly infiltrative  
*Appears indolent but is highly [[Infiltration (medical)|infiltrative]]
*Characterized by local recurrence and perineural spread
*Characterized by local recurrence and [[Perineurium|perineural]] spread
*Usually affects males aged 60-70 years in sun exposed sites
*Usually affects males aged 60-70 years in sun exposed sites
*May be de novo or associated with a pre-existing melanoma
*May be [[de novo]] or can be associated with a pre-existing [[melanoma]]
*Has several subtypes:
*Has several subtypes:
::*Pure: paucicellular
::*Pure: paucicellular
::*Desmoplastic-neurotropic melanoma: characterized by neurotropism
::*[[Desmoplasia|Desmoplastic]]-neurotropic [[melanoma]]: characterized by neurotropism
::*Pure neurotropic melanoma: no desmoplasia with spindle cell melanoma of neurotropic phenotype
::*Pure neurotropic [[melanoma]]: no [[desmoplasia]] with [[spindle cell]] [[melanoma]] of neurotropic [[phenotype]]
::*Mixed/Combined: epithelial and spindle cells
::*Mixed/Combined: [[Epithelium|epithelial]] and [[spindle cells]]
|-
|-
| Nevoid melanoma||Rare||
| [[Nevoid melanoma]]||Rare||
*Lesion has features of both melanoma and melanocytic nevus on histopathological analysis
*[[Lesion]] has features of both [[melanoma]] and [[melanocytic nevus]] on [[Histopathology|histopathological]] [[analysis]]
*Clinical features resemble those of typical melanoma
*Clinical features resemble those of a typical [[melanoma]]
|-
|-
| Spitzoid melanocytic neoplasm||Rare||
| [[Spitzoid melanoma|Spitzoid melanocytic neoplasm]]||Rare||
*Lesion has features of both melanoma and Spitz (epithelioid) tumor
*[[Lesion]] has features of both [[melanoma]] and Spitz ([[epithelioid]]) [[tumor]]
*Typically affects sun exposed sites among children and young adults, but adults with Spitz tumors are more often diagnosed with Spitzoid melanoma
*Typically affects sun exposed sites among children and young adults, but adults with Spitz [[Tumor|tumors]] are more often [[Diagnosis|diagnosed]] with [[Spitzoid melanoma]]
*Compared to benign Spitz tumors, Spitzoid melanomas are usually large (>5 mm)
*Compared to [[benign]] Spitz [[Tumor|tumors]], [[Spitzoid melanoma|Spitzoid melanomas]] are usually large (>5 mm)
|-
|-
| Angiotropic melanoma||Rare||
| [[Angiotropic melanoma]]||Rare||
*Lesion characterized by angiotropism, whereby melanoma grows in proximity (within 1-2 mm) to blood and/or lymphatic tissue but no tumor within the vascular lamina itself
*[[Lesion]] characterized by angiotropism, whereby the [[melanoma]] grows in proximity (within 1-2 mm) to [[blood]] and/or [[Lymphatic system|lymphatic tissue]] but no [[tumor]] within the [[vascular]] [[lamina]] itself
*The tumor may originally be another subtype of melanoma
*The [[tumor]] may originally be another sub-type of [[melanoma]]
*Clinical features similar to typical melanoma
*Clinical features similar to typical [[melanoma]]
|-
|-
| Blue nevus-like melanoma||Rare||
| [[Blue nevus]]-like [[melanoma]]||Rare||
*Melanoma that develops from a pre-existing blue nevus
*[[Melanoma]] that develops from a pre-existing [[blue nevus]]
*One of the rarest forms of melanoma
*One of the rarest forms of [[melanoma]]
*Appear as a blue nevus that has recently been rapidly expanding with irregular contours
*Appears as a [[blue nevus]] that has recently been rapidly expanding with irregular contours
*Typically affects middle-aged men
*Typically affects middle-aged men
|-
|-
| Composite melanoma||Rare||
| [[Composite melanoma]]||Rare||
*Melanoma that develops in proximity to other pre-existing epithelial malignancies (e.g. basal/squamous cell carcinoma)
*[[Melanoma]] that develops in the proximity of other pre-existing [[Epithelium|epithelial]] [[Cancer|malignancies]] (e.g. [[Basal cell carcinoma|basal]]/[[squamous cell carcinoma]])
*May be characterized by one of the following:
*May be characterized by one of the following:
::*Collision tumor: Collision of melanoma and another nearby malignant tumor
::*Collision [[tumor]]: Collision of [[melanoma]] and another nearby [[malignant]] [[tumor]]
::*Colonization: Colonization of melanocytes in a tumor
::*Colonization: Colonization of [[Melanocyte|melanocytes]] in a [[tumor]]
::*Combined: Two distinct tumors appear to have mixed features of the melanoma and the other tumor
::*Combined: Two distinct [[Tumor|tumors]] appear to have mixed features of the [[melanoma]] and the other [[tumor]]
::*Biphenotypic: One tumor that has features of melanoma and another epithelial malignancy
::*[[Biphenotypic melanoma|Biphenotypic]]: One [[tumor]] that has features of [[melanoma]] and another [[Epithelium|epithelial]] [[Cancer|malignancy]]
|}
|}


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[[Category:Up-To-Date]]
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Latest revision as of 01:44, 2 January 2019

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Yazan Daaboul, M.D.; Serge Korjian M.D.

Overview

Melanoma may be classified into either cutaneous or non-cutaneous melanomas. The most common 4 sub-types of cutaneous melanoma include superficial spreading melanoma, nodular melanoma, acral lentiginous melanoma, and lentigo maligna melanoma. Less common sub-types of melanoma include desmoplastic/spindle cell melanoma, nevoid melanoma, spitzoid melanocytic melanoma, angiotropic melanoma, blue nevus-like melanoma, and composite melanoma.

Classification of Melanoma

Shown below is a table that demonstrates the various sub-classes of melanoma:[1][2]

Subtype Frequency Clinical Features
Common Subtypes
Superficial spreading melanoma 70%
  • Most common sub-type
  • Usually affects sun exposed sites among both men and women aged 50-70 years
  • Characterized by the presence of abundant junctional intra-epidermal spread of malignant melanocytes
Nodular melanoma 15-25%
  • Second most common subtype
  • Usually affects sun exposed sites among both men and women aged 50-70 years
  • Characterized by the absence of junctional intra-epidermal spread of malignant melanocytes
Acral lentiginous melanoma 5%
Lentigo maligna melanoma 1-5%
Non-cutaneous melanoma 5%
Less Common Subtypes
Desmoplastic/Spindle cell melanoma Rare
  • Lesion typically amelanotic and has a morphology similar to a scar tissue
  • Appears indolent but is highly infiltrative
  • Characterized by local recurrence and perineural spread
  • Usually affects males aged 60-70 years in sun exposed sites
  • May be de novo or can be associated with a pre-existing melanoma
  • Has several subtypes:
Nevoid melanoma Rare
Spitzoid melanocytic neoplasm Rare
Angiotropic melanoma Rare
Blue nevus-like melanoma Rare
  • Melanoma that develops from a pre-existing blue nevus
  • One of the rarest forms of melanoma
  • Appears as a blue nevus that has recently been rapidly expanding with irregular contours
  • Typically affects middle-aged men
Composite melanoma Rare

References

  1. Schanderdorf D, Kochs C, Livingstone E (2013). Handbook of Cutaneous Melanoma: A Guide to Diagnosis and Treatment. Springer.
  2. Mooi W, Krausz T (2007). Pathology of Melanocytic Disorders 2nd Ed. CRC Press.

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