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Malignant melanoma
1.
2. Pigmentation is a hallmark of melanoma
Features suggestive of melanoma include
recent onset of a pigmented lesion, change
in an existing pigmented lesion, irregular
margins, asymmetrical shape, colour change
or presence of multiple colours, and
diameter greater than 6 mm in diameter.
4. pre-existing naevus (junctional or compound)
Primary melanoma (de novo)
PAM with atypia
Amelanotic tumours are pink and have a
characteristic smooth ‘fish-flesh’ appearance
- Difficult to diagnose.
5.
6. Ocular manifestations:
Dark brown elevated lesion –perilimbal
region –interpalpebral.
S/L : Reddish,brown stippled/homogeneous
dark brown ,intralesional
microcysts,prominent blood vessels
- focal nodular epibulbar mass.
13. Symptoms :
- Blurred vision
- Visual field defect
- Flashes
- Floaters
- no symptom
14. CHOROIDAL
Dark brown to golden solid tumour
Biconvex ,lenticular on cross section
Mushroom configuration[break tru bruch
membrane]
Non rhegmatogenous RD –Clear serous sub
retinal fluid/bloody.
Prominent clumps of orange lipofuscin
pigment.
15. CILIARY BODY
Elevated ,nodular dark brown –peripheral
fundus.
Pathology :
Anaplastic melanocytic cells – high N/C ratio
prominent nucleoli
mitotic figures
Spindle cells, mixed cells, Epitheloid cells,
Vascular loops & networks.
16. B –SCAN: Solid acoustically dark [sonolucent]
biconvex or mushroom configuration
Acoustic brightness on cap
A scan: Low amplitude internal reflectivity
stepwise decremental reduction in
echo spike amplitude
high amplitude at cap
17. Fluorescein Angiography :
Dome shaped-
early phase – filling of retinal,intratumoural vessels
Late phase – Non uniform hyperfluorescent staining
Mushroom shaped-
Early phase – filling of intratumoural vessels
Late phase – Generalized staining of apical nodule ,
sub retinal fluid.
18. MRI :
Hyperintense relative to dark vitreous on T1
Hypointense relative to bright vitreous on T2
25. (melanoma in situ, intraepidermal melanoma /Hutchinson freckle)
Uncommon condition that develops in sun-damaged skin in elderly
individuals. Malignant change may occur, with infiltration of the
dermis.
Histology - intraepidermal proliferation of spindle-shaped atypical
melanocytes that replace the basal layer of the epidermis
Signs
A slowly expanding pigmented macule with an irregular border
Nodular thickening and areas of irregular pigmentation are highly
suggestive of malignant transformation
Treatment is usually by excision.
26.
27. Histology shows large atypical melanocytes within the dermis
Signs
Superficial spreading melanoma is characterized by a
plaque with an irregular outline and variable pigmentation
Nodular melanoma is typically a blue-black nodule
surrounded by normal skin
3 Treatment is usually by wide excision and may include
local lymph node removal.