tailieunhanh - PLASTIC SURGERY EDUCATIONAL FOUNDATION - PART 3

Sớm công nhận thay đổi màu sắc, kích thước, tính nhất quán của một-nơvi sắc tố là rất quan trọng (= ABCD của tính không đối xứng, không thường xuyên biên giới, màu sắc variegated, đường kính 6mm) Phân loại i. Ung thư: | d. Early recognition of changes in color size or consistency of a pigmented nevus is critical ABCD s asymmetry irregular borders variegated color diameter 6mm e. Classification i. Pre-malignant Lentigo maligna Hutchinson s freckle a Flat varied shades of brown pigmentation larger than most nevi irregular borders smooth b Usually slow-growing most often on face more frequently in elderly c High incidence of development of invasive melanoma d Treat by excision with graft or flap reconstruction if necessary ii. Invasive a Lentigo maligna melanoma 10 i Develops in a Hutchinson s Freckle usually as a thickened elevated nodule b Superficial spreading melanoma 70 i Flat to slightly elevated may have a great variety of colors ii Lesion initially spreads horizontally c Nodular melanoma 15 i Characteristically blue black in color ii May be unpigmented amelanotic iii Grows vertically often with early surface ulceration d Acral lentiginous melanoma 5 i On mucous membranes palms soles and subungual ii May be amelanotic in African-Americans f. Histologic staging and correlation with metastases i. Breslow s depth of invasion more reliable indicator of prognosis than Clark s level Fig. 3-1 28 a Less than mtn metastases vứtually 0 b mm metastases 50 c Greater than 4 mm metastases 66 ii. Clark s levels of cutaneous invasion Fig. 3-1 a Level I in situ above the basement membrane node metastases extremely rare b Level II in the papillary dermis metastases in 2-5 c Level III to the junction of papillary and reticular dermis metastases in up to 20 d Level IV into the reticular dermis metastases in 40 e Level V into the subcutaneous tissue metastases in 70 iii. Staging a Stage I lesions less than 2 mm thick without ulceration b Stage II 1-2 mm thick with ulceration or greater than 2 mm thick with or without ulceration c Stage III regional node metastasis d Stage IV distant metastasis g. Treatment i. Most important is the manner in which the primary lesion is removed ii. .