What you need to know about Melanoma for USMLE, ABIM, ABFM, PANCE
One of the key roles of an internist is to prevent deadly disease before it happens. One of the deadliest diseases is melanoma and given its malignancy, identifying it in the earliest stages is essential.
Below is what you need to know about melanoma to correctly answer just about any question you encounter on your medical boards regarding this skin cancer.
Minimal UV exposure = Prevention
For any question on your boards asking for the first-line prevention against melanoma, the answer is sun avoidance, sun-protective clothing, and sunscreen.
Know your ABCDEs for diagnosis
There are 5 classic characteristics that allow us to identify melanoma. Conveniently there is a mnemonic: ABCDE
- Border (irregular)
- Colors (multiple;)
- Diameter >6mm
From our Medical Mnemonics package (you can sign up here) 4 types of melanoma
The ABIM, PANCE, ABFM, and USMLE don’t expect you to have the knowledge of a dermatologist when it comes to melanoma. However, knowing the 4 major subtypes of melanoma can help you on the exam and also be clinically useful.
- Lentigo malignana
- Superficial spreading melanoma
- Nodular melanoma
- Acral lentiginous melanoma
- First, biopsy by complete excision.
- If the melanoma is >1mm thick, a sentinel lymph node biopsy should also be performed.
- If the melanoma is >4mm thick or the sentinel lymph node biopsy is positive, patients should receive adjuvant immunotherapy with interferon alfa.
- If metastatic disease to up to few sites is present, immunotherapy with interleukin-1 and ipilimumab is recommended.
- If V600E BRAF mutation is present, look for vemurafenib as the correct answer.
Uniform, light brown patch on upper body or face (initially)–>Expanding, multiple colors.
Well-defined asymmetric patch/plaque with irregular border, color variation, and enlarging diameter. Detected usually on back in men and on legs in women (areas with intermittent skin exposure, as opposed to hands and face).
Most aggressive! Most likely to lead to death. See mnemonic above for nodular-melanoma specific features.
Darker skin individuals. On hands and feet.
How do you treat Melanoma?
Now you know the salient points to master for answer any melanoma related question on your USMLE, ABIM, ABFM, and PANCE.
Sun Image: http://thehazelkey.com/
Lentigo Maligna Image: https://en.wikipedia.org/wiki/File:Lentigo_maligna.JPG
Superficial Spreading Melanoma Image: By Unknown – National Cancer Institute (AV Number: AV-8500-3850; Date Created: 1985; Date Entered: 1/1/2001), http://visualsonline.cancer.gov/details.cfm?imageid=2184, Public Domain, https://commons.wikimedia.org/w/index.php?curid=859342
Nodular melanoma Image: https://commons.wikimedia.org/wiki/File:NodularMelanomaEvolution.jpg