1. ANNA MARIA CARROZZO

2. ll melanoma è un tumore maligno che
origina
dai melanociti della cute e delle mucose,
dai melanociti che costituiscono i nevi
e, molto più raramente,
dai melanociti posti in sedi extracutanee
(occhio, orecchio interno, meningi,
mesenchima viscerale).

3.  CRITERI CLINICI X IL RICONOSCIMENTO
A asimmetria
B bordi irregolari
C colori multipli
D dimensioni
E evoluzione intesa come cambiamento

4.  LENTIGO MALIGNA-MELANOMA: 10%
 SUPERFICIAL SPREADING MELANOMA: 70%
 MELANOMA NODULARE (NODULARE-ACROMICO): 15%
 ACRAL LENTIGINOUS MELANOMA:5%
Varianti istologiche
Animal Melanoma
Melanoma desmoplastico

5. LENTIGO MALIGNA o MELANOSI DI DUBREUILH
LENTIGO MALIGNA-MELANOMA

6. SSM

7. SEDI PARTICOLARI
MELANOSI DELLE MUCOSE

9. MELANOMA NODULARE
MELANOMA NODULARE ACROMICO

10. ALM

11. FATTORI PROGNOSTICI
Breslow-Clark
n° Mitosi x campo
Ulcerazione

12. CLARK
Livello I: Melanoma in situ: il tumore è
nell'epidermide al di sopra di una lamina basale
intatta;
Livello II: il tumore invade il derma papillare;
Livello III: il tumore arriva fino all'interfaccia tra
derma papillare e derma reticolare, senza
infiltrare quest'ultimo;
Livello IV: il tumore invade il derma reticolare;
Livello V: il tumore invade il tessuto
sottocutaneo.

13. Breslow Sopravvivenza a 10 anni
_
< 1mm 91%
1,01-2,0mm 78%
2,01-4,0mm 62%
> 4mm 38%

14. Eleven Independent Clinicopathologic Prognostic
Markers for Cutaneous Melanoma
 Age at Diagnosis
 Gender
 Growth phase (radial vs vertical)
 Thickness
 Level of invasion
 Presence of ulceration
 Presence and density of tumor infiltrating lymphocytes
 Regression
 Presence of microsatellites
 Presence of vascular and lymphatic invasion
 Presence and quantity of mitotic figures

15. PRECURSORI MELANOMA
 Cute normale
 Nevi acquisiti
 Nevi congeniti
 Nevi displastici

16. La dermoscopia (o microscopia a
epiluminiscenza) é una tecnica
diagnostica per esaminare in vivo lesioni
cutanee, ingrandite di 10-20 volte. Si
tratta di un'apparecchiatura che utilizza:
olio che, applicato sulla lesione rende il
derma più trasparente; un obiettivo, che
posto a diretto contatto con la lesione
tramite l'olio potenzia l'esame in vivo
delle strutture della giunzione dermo-
epidermica; una sorgente di luce e una
lente d'ingrandimento.

17. Melanoma in situ

18. Melanoma in situ

19. Più recentemente, sono stati
studiati sistemi digitali di
diagnostica per immagini:
epiluminiscenza.

21. 22-10-2007 dm. 4,00x2,4mm dm 4,1x2,5mm
01-04-2008
50X
50X
06-10-2008 dm. 4,2x2,5mm
22-06-2009
50X 50X
dm.4,1x2,4mm

22. Proliferazione
melanocitaria atipica
Intraepidermica
suggestiva per forma
iniziale di melanoma in
situ
associata ad intenso
infiltrato infiammatorio
del derma papillare-
reticolare
Margini di escissione
chirurgica indenni

24. B
A

25. ATYPICAL MOLE SYNDROME AND DYSPLASTIC NEVI:
IDENTIFICATION OF POPULATIONS AT RISK FOR
DEVELOPING MELANOMA
J.H. Silva, B.C.Soares de Sa et Al. CLINICS 2011 March
In 1820, Norris described what is currently considered in a family
predisposed to melanoma.
In 1978 Clark reported an increase incidence of cutaneous melanoma
in families with multiple melanocytic lesions, introducing the
melanoma tumor progression model from melanocytic nevi, and
used the term B_Kmole syndrome, from the initials of the patients
surnames. Now the terms AMS,Dysplastic Nevus Syndrome and
Familial Atypical Multiple-Mole Syndrome (FAMMS) have been
employed.
In 1985, Elder extended the theory of nevus-melanoma for sporadic
dysplastic nevi as a possible precursor of sporadic melanoma

26. 1984-2008 A.B.Ackerman
"The perplexing story of the dysplastic nevus and the dysplastic nevus
syndrome can be comprehended only in the context of understanding
the consistent lack of a repeatable definition of dysplasia and the
persistent failure to provide reliable criteria for clinical and
histopathologic diagnosis of dysplastic nevus. As a consequence of
these rickety underpinnings, it was inevitable that the edifice would
collapse, and it did in less than 15 years. The epitaph for dysplastic
nevus was written in 1992, and that was published in the Journal of
the American Medical Association in 1992. In that report, the panel
stated that the term dysplastic nevus had outlived its usefulness and
should be abandoned. We concur and advise further that the
concepts of dysplasia, dysplastic melanocytes, dysplastic nevus, and
the dysplastic nevus syndrome not only be abandoned now, but that
they also not be supplanted by equally opaque notions, such as
cytologic and architectural atypia, nevus with histologic dysplasia,
clinically atypical mole, and atypical mole syndrome.
Resolving Quandaries in Dermatology, Pathology and Dermatopathology. pp 88. Promethean
Medical Press/Waverly, 1995.

28. Several studies have shown that the
presence of dysplastic nevi considerably
increases the risk of developing
melanoma, which demonstrates that these
lesions, aside from being precursors to
disease are also important risk markers

29.  Atypical moles differ from common acquired melanocytic
nevi in several respects, including diameter and lack of
pigment uniformity. Confusion exists because some atypical
moles cannot be clinically distinguished from melanoma. The
clinical and histologic appearances of atypical moles occurring
in a familial setting appear to overlap with sporadically
occurring atypical moles.
 The US National Institutes of Health Consensus Conference
on the diagnosis and treatment of early melanoma defined a
syndrome of familial atypical mole and melanoma (FAMM).
The criteria for FAMM syndrome are as follows:
 The occurrence of malignant melanoma in 1 or more first- or
second-degree relatives
 The presence of numerous (often >50) melanocytic nevi, some
of which are clinically atypical
 Many of the associated nevi showing certain histologic
features (see Histologic Findings)

30. Dysplastic nevus (atypical nevus)
Gisele Gargantini Rezze, Alexandre Leon, Joao Duprat
Abstract: Atypical nevum (dysplastic) is considered an
important factor associated with increased risk of
developing cutaneous melanoma. It is believed that
atypical nevi are precursor lesions ofcutaneous
melanoma.They may be present in patients with multiple
melanocytic nevi (atypical nevus syndrome) or isolated
and in small numbers in a non-familial context. The disease
usually begins at puberty and predominates
in young people. It has a predilection for sun-exposed
areas, especially the trunk. The major challenge
in relation to atypical nevi lies in the controversy of defining
its nomenclature, clinical diagnosis, dermoscopic
criteria, histopathological diagnosis and molecular aspects.
This review aims at bringing knowledge,
facilitating comprehension and clarifying doubts about
atypical nevus. An Bras Dermatol. 2010;85(6):863-71.

31. Ing.30X dm.5,7x4,8 Ing.30X dm.8,4x6,4
09-03-2010, reg. 09-03-2010, reg. scapolare
sternale, nevo dx, nevo displastico
displatico

32. dm.4,8x4,00mm dm.5,00x4,3mm
Ing.30X Ing.30X
Gomito sx
03-05-2010 22-11-2010
SSM a cellule fusate ed epitelioidi,in
fase di crescita radiale infiltrante il
derma papillare II
Clark, Breslw.0,22mm

33. dm. 11,2x8,2mm
15-02-2011,
Interscapolare
paravert. Dx,
Melanoma in situ, IClark
15-02-2011
sottoscapolaresx
20X
Nevo
displastico con
focali aree di
trasformazione
melanomatosa 20X
in situ, IClark dm. 8,00x6,5mm

34. Ing.30X
09-02-2010 Melanoma a diffusione superficiale
della pianta piede sx, Clark:II, Breslow:0,3 mm.
Ing.30X
30X dm.3,8x3,1mm
ANAMNESI:dal febbraio 2004 ad oggi:
1)Nevo melanocitico giunzionale displastico
2)Melanoma della gamba dx insorto su nevo
dm 4,8x4,00 23-11-2010
Clark:III; Breslow 0,5mm
3) vari nevi composti
26-11-2009
Ing.30X
dm:4,4x4,2
10-04-2012: Nevo Composto
dm 4,7x4,4

35. Ing. 15X
Melanoma infiltrante il
28-11-2008 derma papillare, II
Clark, Breslow 0,45mm
Ing.20X
dm. 10,9x6,6mm
24-04-2009 dm. 7,3x6,2mm
Nevo melanocitico giunzionale
con aspetti displastici

36. dm. 3,1x2,9mm Ing.30X dm. 3,2x3,0mm Ing.30X
12-01-2009 05-05-2009
dm. 3,4x3,2 mm Ing.30X
reg. tibiale
ant.dx. SSM
infiltrante il
derma
papillare,
II
Clark, Breslo 28-01-2010
w 0,15mm

37. dm. 3,7x3,3mm 19-07-2007 , ginocchio
interno sx ,
Ing. 30X
22-05-2008
SSM, in fase di crescita radiale II
Clark, 0,25 Breslow
Ing. 30X dm.4,00x3,3mm

38. dm.2,2x2,00mm
24-09-2010
caviglia sx
dm.2,7x2,6mm
Ing. 50X
SSM in fase di crescita
radiale a cellule
epitelioidi, infiltrante il
derma papillare
II Clark, Breslow : 0,4mm
28-01-2011
Ing. 50X

39. VivaScope® Technology
(Reflectance Model)
Detector
Pinhole
Focusing Lens
Laser Beamsplitter
Scanning Optics
Quarter Wave Plate
Objective Lens
Windo
w
Tissue Sample

40. VivaCamTM Macroscopic Camera Option
Clinical Photograph
of a Lesion
3mm x 3mm
VivaBlockTM
10mm x 10mm
VivaCamTM
Image

41. K. Busam, C. Charles, A. Marghoob, MSKCC
Image taken at the papillary dermis of the biopsy-proven nevus component (A) of previous
nevus shown in the previous slide. Notice the organized nests of nevomelanocytes within the
superficial dermis, consistent with a benign lesion. 500 µm field of view.

42. GRAZIE

43. ANIMAL MELANOMA: di recente codifica. E’ un
Melanoma che sintetizza pigmento. E’ una variante
istopatologica rara, così chiamato per la prominente
produzione di melanina, che appare simile ad una
variante di melanoma osservata nei cavalli grigi
MELANOMA DESMOPLASTICO: forma rara di
Melanoma, caratterizzato dalla tendenza ad infiltrare i
vasi sanguigni, a diffondersi per invasione
perineurale e per l’alta frequenza con la quale
recidiva localmente.