MELANOMA MALIGNO

DR. KITO YOUNG FACS

CIRUJANO
INSTITUTO ONCOLOGICO
NACIONAL
CLINICA SAN FERNANDO

MELANOMA MALIGNO
Qu es un Melanoma Maligno. ?
Es un tipo de cncer de la piel que es
debido a crecimiento anormal y
diseminacin de melanocitos en la piel.

NEVUS O LUNAR

MELANOMA MALIGNO

Qu causa el Melanoma Maligno.?

La principal causa del melanoma maligno
es la exposicin de la piel a luz solar fuerte.
Radiacin ultravioleta con rayos UVA y
UVB.

Factores de Riesgo

Antecedentes personales de melanoma

Piel y cabello claro
Exposicin al sol
Nevus benigno
Antecedentes familiares de melanoma
Predisposicin gentica
Sndrome del lunar atpico

Anatoma Patolgica
Melanoma de extensin superficial

Anatoma Patolgica
Melanoma Maligno Nodular

Anatoma Patolgica
Lentigo Maligno Melanoma

Anatoma Patolgica
Lentigo Maligno Acral

Clnica
A- Lesin Asimtrica
B- Bordes Irregulares
C- Aspecto Multicolor
D- Dimetro Mayor de 6 cm.
E- Ulceracin superficial

Laboratorio
Radiografa de Trax
Pruebas de Funcin Heptica
Tomografa de emisin de Positrones

Estadios
< 1 mm
1 2 mm

2 4 mm

> 4 mm

Melanoma of the Skin

Regional lymph nodes for skin sites of the head and neck.

Compton, C.C., Byrd, D.R., et al., Editors. AJCC CancerStaging Atlas, 2nd Edition. New York: Springer, 2012. American Joint Committee on Cancer

Melanoma of the Skin

Schematic indicating the location of the lymph node levels in the neck as
described in Table 31.1.

Compton, C.C., Byrd, D.R., et al., Editors. AJCC CancerStaging Atlas, 2nd Edition. New York: Springer, 2012. American Joint Committee on Cancer

Melanoma of the Skin

Less common clinical or sentinel nodal metastasis. Illustrated is a distal forearm primary
tumor with involvement of the epitrochlear node.

Compton, C.C., Byrd, D.R., et al., Editors. AJCC CancerStaging Atlas, 2nd Edition. New York: Springer, 2012. American Joint Committee on Cancer

Melanoma of the Skin

Less common clinical or sentinel nodal metastasis. Illustrated is a posterior calf primary
tumor with involvement of the popliteal nodes.

Compton, C.C., Byrd, D.R., et al., Editors. AJCC CancerStaging Atlas, 2nd Edition. New York: Springer, 2012. American Joint Committee on Cancer

Melanoma of the Skin

Interval (ectopic) nodal metastasis from trunk primary tumor.

Compton, C.C., Byrd, D.R., et al., Editors. AJCC CancerStaging Atlas, 2nd Edition. New York: Springer, 2012. American Joint Committee on Cancer

Melanoma of the Skin

Two mitotic figures in a melanoma (arrow heads). Assessment of the number of mitoses
per square millimeter used to determine the prognostically relevant mitotic rate.

Compton, C.C., Byrd, D.R., et al., Editors. AJCC CancerStaging Atlas, 2nd Edition. New York: Springer, 2012. American Joint Committee on Cancer

Melanoma of the Skin

T1a is defined as melanoma 1.0 mm in thickness, with no ulceration, and mitotic

rate <1 mm2.

Compton, C.C., Byrd, D.R., et al., Editors. AJCC CancerStaging Atlas, 2nd Edition. New York: Springer, 2012. American Joint Committee on Cancer

Melanoma of the Skin

T1b is defined as melanoma 1.0 mm in thickness with ulceration or mitotic rate 1 mm 2.

Compton, C.C., Byrd, D.R., et al., Editors. AJCC CancerStaging Atlas, 2nd Edition. New York: Springer, 2012. American Joint Committee on Cancer

Melanoma of the Skin

T2a is defined as melanoma 1.01 to 2.0 mm in thickness without ulceration.

Compton, C.C., Byrd, D.R., et al., Editors. AJCC CancerStaging Atlas, 2nd Edition. New York: Springer, 2012. American Joint Committee on Cancer

Melanoma of the Skin

T2b is defined as melanoma 1.01 to 2.0 mm in thickness with ulceration.

Compton, C.C., Byrd, D.R., et al., Editors. AJCC CancerStaging Atlas, 2nd Edition. New York: Springer, 2012. American Joint Committee on Cancer

Melanoma of the Skin

T3a is defined as melanoma 2.01 to 4.0 mm in thickness without ulceration.

Compton, C.C., Byrd, D.R., et al., Editors. AJCC CancerStaging Atlas, 2nd Edition. New York: Springer, 2012. American Joint Committee on Cancer

Melanoma of the Skin

T3b is defined as melanoma 2.01 to 4.0 mm in thickness with ulceration.

Compton, C.C., Byrd, D.R., et al., Editors. AJCC CancerStaging Atlas, 2nd Edition. New York: Springer, 2012. American Joint Committee on Cancer

Melanoma of the Skin

T4a is defined as melanoma more than 4.0 mm in thickness without ulceration.

Compton, C.C., Byrd, D.R., et al., Editors. AJCC CancerStaging Atlas, 2nd Edition. New York: Springer, 2012. American Joint Committee on Cancer

Melanoma of the Skin

T4b is defined as melanoma more than 4.0 mm in thickness with ulceration.

Compton, C.C., Byrd, D.R., et al., Editors. AJCC CancerStaging Atlas, 2nd Edition. New York: Springer, 2012. American Joint Committee on Cancer

Melanoma of the Skin

N1a is defined as clinically occult metastasis (micrometastasis) in one lymph node.

Compton, C.C., Byrd, D.R., et al., Editors. AJCC CancerStaging Atlas, 2nd Edition. New York: Springer, 2012. American Joint Committee on Cancer

Melanoma of the Skin

N1b is defined as clinically apparent metastasis (macrometastasis) in one lymph node.

Compton, C.C., Byrd, D.R., et al., Editors. AJCC CancerStaging Atlas, 2nd Edition. New York: Springer, 2012. American Joint Committee on Cancer

Melanoma of the Skin

N2a is defined as clinically occult metastases (micrometastases) in 2-3 regional nodes.

Compton, C.C., Byrd, D.R., et al., Editors. AJCC CancerStaging Atlas, 2nd Edition. New York: Springer, 2012. American Joint Committee on Cancer

Melanoma of the Skin

N2b is defined as clinically apparent metastases (macrometastases) in

2-3 regional nodes.

Compton, C.C., Byrd, D.R., et al., Editors. AJCC CancerStaging Atlas, 2nd Edition. New York: Springer, 2012. American Joint Committee on Cancer

Melanoma of the Skin

N2c is defined as satellite* (including microsatellite**) or in transit metastasis without nodal metastasis. This figure illustrates an in transit metastasis, which is defined as clinically evident cutaneous
and/or subcutaneous metastases identified at a distance greater than 2 cm from the primary melanoma in the region between the primary and the first echelon of regional lymph nodes.
*Satellites are defined as grossly visible cutaneous and/or subcutaneous metastases occurring within 2 cm of the primary melanoma.
**Microsatellites are defined as any discontinuous nest of intralymphatic metastatic cells >0.05 mm in diameter that are clearly
separated by normal dermis (not fibrosis or inflammation) from the main invasive component of melanoma by a
distance of at least 0.3 mm.

Compton, C.C., Byrd, D.R., et al., Editors. AJCC CancerStaging Atlas, 2nd Edition. New York: Springer, 2012. American Joint Committee on Cancer

Melanoma of the Skin

N3 may be defined as 4 or more metastatic nodes, or matted nodes, or in transit

met(s)/satellite(s) with metastatic node(s).

Compton, C.C., Byrd, D.R., et al., Editors. AJCC CancerStaging Atlas, 2nd Edition. New York: Springer, 2012. American Joint Committee on Cancer

Melanoma of the Skin

N1 disease is defined as regional lymph node metastasis while M1a disease involves
distant metastasis to lymph nodes beyond the region of the primary tumor.

Compton, C.C., Byrd, D.R., et al., Editors. AJCC CancerStaging Atlas, 2nd Edition. New York: Springer, 2012. American Joint Committee on Cancer

Melanoma of the Skin

Stage of disease as determined by lymph node involvement relative to the location of the primary tumor. The
shaded areas indicate involvement of regional lymph nodes or N1 disease (Stage III). Nonshaded areas
indicate distant metastasis to lymph nodes outside the primary tumor or M1a disease (Stage IV).

Compton, C.C., Byrd, D.R., et al., Editors. AJCC CancerStaging Atlas, 2nd Edition. New York: Springer, 2012. American Joint Committee on Cancer

Melanoma of the Skin

Stage of disease as determined by lymph node involvement relative to the location of the primary tumor. The
shaded areas indicate involvement of regional lymph nodes or N1 disease (Stage III). Nonshaded areas
indicate distant metastasis to lymph nodes outside the primary tumor or M1a disease (Stage IV).

Compton, C.C., Byrd, D.R., et al., Editors. AJCC CancerStaging Atlas, 2nd Edition. New York: Springer, 2012. American Joint Committee on Cancer

Melanoma of the Skin

Stage of disease as determined by lymph node involvement relative to the location of the primary tumor. The
shaded areas indicate involvement of regional lymph nodes or N1 disease (Stage III). Nonshaded areas
indicate distant metastasis to lymph nodes outside the primary tumor or M1a disease (Stage IV).

Compton, C.C., Byrd, D.R., et al., Editors. AJCC CancerStaging Atlas, 2nd Edition. New York: Springer, 2012. American Joint Committee on Cancer

Melanoma of the Skin

Stage of disease as determined by lymph node involvement relative to the location of the primary tumor. The shaded
areas indicate involvement of regional lymph nodes or N1 disease (Stage III). Metastasis to either the axillary or
inguinal lymph nodes are both considered N1 (Stage III) disease due to the location of the primary tumor directly
in the center of the torso.

Compton, C.C., Byrd, D.R., et al., Editors. AJCC CancerStaging Atlas, 2nd Edition. New York: Springer, 2012. American Joint Committee on Cancer

Biopsia
1.- Escisional
2.- Incisional (Punch)

Inmunohistoqumica
1.- S-100
2.- HMB-45

Tratamiento Local
Mrgenes
Finos - 1 mm -------------- 1 cm
Intermedio -1 - 4 mm ------ 2 cm
Grueso - ms de 4 mm ----- 2cm

Tratamiento Local
Cierre
a) Primario
b) Injerto
c) Colgajos locales
d) Colgajos a distancia

Tratamiento Local
Localizaciones Especiales
a) Dedos de las manos o de los pies
b) Planta del pie
c) Cara
d) Mama

Tratamiento Local
Situaciones clnicas especiales
Nevus congnito gigantes
Melanoma de las mucosas
Melanoma desmoplasico
Embarazo

Tratamiento Del Fallo Local y De La

Enfermedad Metastsica Subclnica
Tratamiento de la enfermedad regional
Diseccin electiva de los ganglios linfticos
Cartografa (mapeo de los ganglios linftico
y biopsia del ganglio centinela
Valor pronstico de ganglio centinela
Evaluacin de ganglio centinela
Directrices prcticas

Terapia Adyuvante
Terapia biolgica
Radioterapia
Quimioterapia

Tratamiento de la Enfermedad
Metastasica

Ciruga
Radioterapia
Quimioterapia
Terapia Biolgica