melanotic carcinoma


melanoma

A tumour that comprises 1–3% of all new cancers (18,000/year) and causes 6500 deaths/year (US), most age 30–50; melanoma is increasing at ± 7%/year, and now affects 9/105 (primarily the head and neck) in men and 12/105 (primarily legs) in women; it is rare but more aggressive in children.
 
Risk factors
Giant congential melanocytic nevus, dysplastic nevus, xeroderma pigmentosum, immunodeficiency, moles with persistent pigment changes (especially > age 15), large or irregularly pigmented lesions, familial moles, congenital moles, Caucasian (12-fold greater risk than Black), previous melanoma, melanoma in 1st-degree relative, immunosuppression, photosensitivity, increased sun exposure.
 
Site of metastasis
Liver, lung, intestine, pancreas, adrenal, heart, kidney, brain, spleen, thyroid.
Management
Wide excision; chemo- and radiation are essentially useless.
 
Prognosis
Local recurrence common; many metastasise; 5-year survival reflects stage when diagnosed. 
Poor prognostic factors
Large size, paranasal/nasopharyngeal location, vascular invasion, high mitotic activity, marked cellular pleomorphism, distant metastases.
Stages of melanoma
▪ Stage I—Confined to epidermis and/or upper dermis, and measures ≤ 1.5-mm thick.
▪ Stage II—1.5-mm to 4-mm thick; spread to lower dermis but not beyond or to adjacent lymph nodes.
▪ Stage III—Any of the following:
– > 4-mm thick;
– Spread beyond the skin;
– Satellite lesions within 2 cms of the original tumour; or
– Spread to nearby lymph nodes or satellite lesions between original and regional lymph nodes.
▪ Stage IV—Metastases to other organs or to lymph nodes far from the original lesion.
Types of melanoma
Acral lentiginous melanoma
A rare, flat, palmoplantar or subungual lesion more common in non-whites; average 5-year survival < 50%; unrelated to actinic exposure, but possibly related to ectopic pigmentation.
 
Amelanotic melanoma
Rare, poorly differentiated, and occurs in those with a previous pigmented melanoma; since the Fontana-Masson stain is rarely positive in amelanotic melanoma, special studies are necessary, including immunoperoxidase staining with antibodies to the S-100 antigen and ultrastructural examination for presence of premelanosomes.
 
Lentigo maligna
Comprises 10% of melanomas; affects those > age 60; appears as flat, indolent lesions on face, arising from a premalignant freckle with greater than 90% 5-year survival; aetiologically linked to prolonged actinic exposure.
 
Nodular melanoma
15% of cases; similar clinically to superficial spreading melanoma; 50% average 5-year survival.
 
Premalignant melanoma
1/3 of lentigo maligna (Hutchinson’s freckle) progress to malignant melanoma after 10–15 years.
 
Superficial spreading melanoma
70% of cases; affects ages 30 to 60, especially female in lower legs or trunk, as a flat lesion (radial growth phase) that may be present for months to years; average 5-year survival 75%; aetiologically linked to recreational actinic exposure.
 
Thin melanoma (Stage-I cutaneous melanoma)
A lesion measuring < 1 cm in diameter; virtually 100% survival.

mel·a·not·ic car·ci·no·ma

(mel'ă-not'ik kahr'si-nō'mă) Obsolete term for melanoma

carcinoma

(kar?sin-o'ma ) [ carcin- + -oma] A malignant tumor that occurs in epithelial tissue and may infiltrate local tissues or produce metastases. It may affect almost any organ or part of the body and spread by direct extension, through lymphatics, or through the bloodstream. The causes vary with tumor type.

Patient care

Optimal patient care includes: identifying and explaining to patient and family the type of cancer and its typical natural history; options for treatment, side effects of treatments, expected response of the cancer to the treatment, best predictions for recovery and life expectancy, availability of clinical trials, alternative and complementary therapies, and the potential benefit of referral to specialty cancer centers.

acinar cell carcinoma of the pancreas

A rare carcinoma that arises from pancreatic cells that manufacture digestive proteins, such as lipase, chymotrypsin, or alpha-1-antitrypsin.

alveolar cell carcinoma

A type of lung carcinoma.BASAL CELL CARCINOMABASAL CELL CARCINOMA

basal cell carcinoma

Abbreviation: BCC
The most common human cancer, typically found on skin exposed to sun or other forms of ultraviolet light. Although it is sometimes locally invasive, it rarely metastasizes to other organs. Typically it begins as a small, shiny papule. The lesion enlarges to form a whitish border around a central depression or ulcer that may bleed. When the lesion reaches this stage, it is often called a rodent ulcer. After biopsy, the removal method used is determined by the size, location, and appearance of the lesion. Synonym: basal cell epithelioma; epithelial cancer See: illustrationillustration

bronchioloalveolar carcinoma

A relatively rare form of non-small cell lung cancer consisting of columnar cells, and in which the tumor arises in the periphery of the lung within the septal borders of the alveoli, which the tumor tends to preserve. The tumor cells frequently produce mucin.

bronchogenic carcinoma

Lung cancer.

chorionic carcinoma

Choriocarcinoma.

choroid plexus carcinoma

A cancer that arises from the cells that line the fluid-filled cavities (ventricles) of the brain.

carcinoma of the colon

See: colorectal cancer

colorectal carcinoma

Colorectal cancer.

carcinoma cuniculatum

Any slowly growing squamous cell carcinoma of the skin, typically presenting as a gradually enlarging warty tumor.

ductal carcinoma in situ of breast

See: ductal carcinoma in situ of breast

embryonal carcinoma

An aggressive germ cell tumor that may metastasize widely. It can occur in young adults of either sex.

epidermoid carcinoma

Squamous cell carcinoma.

carcinoma erysipelatoides

Metastatic spreading of cancer, usually from an internal organ to the skin, to which the spreading tumor gives a red, inflammatory appearance.

giant cell carcinoma

Carcinoma marked by the presence of unusually large cells.

glandular carcinoma

Adenocarcinoma.

keratinocyte carcinoma

A cancer arising from cells in the epidermis. It includes basal cell carcinomas, keratoacanthomas, and squamous cell carcinomas of the skin. Most keratinocyte carcinomas arise in sun-exposed areas of the body, such as the ears, the temples, the forehead or the nose.

carcinoma in situ

Abbreviation: CIS
Malignant cell changes in the epithelial tissue that do not extend beyond the basement membrane.

medullary carcinoma

Carcinoma in which there is a predominance of cells and little fibrous tissue.

melanotic carcinoma

Carcinoma containing melanin.

mucinous carcinoma

Carcinoma in which the glandular tissue secretes mucin.

neuroendocrine carcinoma

Any of a diverse group of malignancies, such as carcinoid, islet cell tumors, neuroblastoma, and small-cell carcinomas of the lung. All have dense core granules and produce polypeptides that can be identified by immunochemical methods.

oat cell carcinoma

A poorly differentiated carcinoma of the bronchus that contains small oat-shaped cells. Synonym: small cell carcinoma

carcinoma of pancreas

Pancreatic cancer.

pancreatic carcinoma

Pancreatic cancer.

papillary carcinoma of the thyroid

See: papillary carcinoma of the thyroid

renal cell carcinoma

A carcinoma that arises from the proximal tubular cells of the kidney. In 2008 the American Cancer Society estimated there would be about 56,700 new patients diagnosed with renal cell carcinoma and about 13,700 deaths from it. Synonym: hypernephroma; kidney cancer

Symptoms

Because of its location in the retroperitoneum, renal cell carcinoma may grow to a relatively large size before it manifests obvious symptoms. The most common findings are blood in the urine (hematuria), flank pain, or a flank mass. Some patients develop fevers, weight loss, or symptoms caused by hormones excreted by the tumor. These hormones (parathyroid-like hormone or erythropoietin) occasionally cause hypercalcemia or abnormal increases in the red blood cell count (erythrocytosis).

Treatment

Surgical removal of the affected kidney may be curative for those patients whose tumor has not spread outside the perirenal fascia. Treatment options are less successful for patients with metastatic disease because renal cell carcinomas are relatively resistant to chemotherapy.

sarcomatoid carcinoma

A carcinoma that contains both epithelial and mesenchymal components. This cancer may arise from cells in the kidney, urinary bladder, or lung.

scirrhous carcinoma

Hard cancer.

small cell carcinoma

Oat cell carcinoma.SQUAMOUS CELL CARCINOMA

squamous cell carcinoma

Carcinoma that develops primarily from squamous cells, e.g., of the skin or in the mouth, lungs, bronchi, esophagus, or cervix. Synonym: epidermoid carcinoma See: illustrationillustrationillustration

thymic carcinoma

A carcinoma found in the anterior mediastinum, usually a squamous cell carcinoma, spindle cell carcinoma, or lymphoepithelioma. Many of these tumors release chemically active substances that cause paraneoplastic syndromes.

transitional cell carcinoma

A carcinoma that originates in cells that line the urinary tract, e.g., in cells that line the inner kidney, the ureters, or the urinary bladder. Synonym: urothelial carcinoma

urothelial carcinoma

Transitional cell carcinoma.