3.

CELLULAR ABERRATION
The Biology Cancer Part 2
DIAGNOSIS
 Imaging studies
 Excision or Fine Needle Aspiration Biopsy with
microscopic histologic examination
 Pap smear

 Blood tests – for example PSA for prostate

carcinoma, CEA or AFP for HCC or testicular,
CEA for colorectal carcinoma, CA-125 for ovarian
carcinoma, ALP for HCC or bone
 Cytologic examination of blood cells – for
leukemia
Urine with
cancer cells
(urine cytology
DIAGNOSTIC AIDS USED TO DETECT
CANCER
 Tumor markers – breast, colon, lung, ovarian,
testicular, prostate cancers
 MRI – neurologic, pelvic, abdominal, thoracic
cancers
 Fluoroscopy – neurologic, pelvic, skeletal,
abdominal, thoracic cancers
 UTZ – abdominal and pelvic cancers

 Endoscopy – bronchial, GIT cancers

 Fluoroscopy

MRI UTZ
DIAGNOSTIC AIDS USED TO DETECT
CANCER
 Nuclear medicine imaging – bone, liver, kidney,
spleen, brain, thyroid cancers
 PET – lung, colon, liver, pancreatic, head and
neck cancers; Hodgkin and Non-Hodgkin
lymphoma and melanoma
 PET fusion – see PET

 Radioimmunoconjugates – colorectal, breast,

ovarian, head and neck cancers; lymphoma and
melanoma
Nuclear Imaging
Nuclear Imaging

PET scan
 Nomenclature
Tissue of origin Benign Malignant
Ectoderm/endoderm Epithelium Papilloma Carcinoma
Gland Adenoma Adenocarcinoma
Liver cells Adenoma HCC
Neuroglia Glioma Glioma
Melanocytes Malignant
melanoma
Basal cells Basal cell
carcinoma
Germ cells Mature teratoma Seminoma
Mesoderm Connective tissue
Adipose tissue Lipoma Liposarcoma
Fibrous Fibroma Fibrosarcoma
Bone Osteoma Osteosarcoma
Cartilage Chondroma Chondrosarcoma
 Nomenclature
Tissue of origin Benign Malignant
Mesoderm Muscle
Smooth muscle Leiomyoma Leiomyosarcoma
Striated muscle Rhabdomyoma Rhabdomyosarcom
a
Neural tissue
Nerve cells Ganglioneuroma Neuroblastoma
Endothelial tissue
Blood vessels Hemagioma Angiosarcoma
Kaposi sarcoma
Meninges Meningioma Malignant
meningioma
Hematopioetic Granulocytes Leukemia
tissue
Plasma cells Multiple myeloma
plasmacytoma
Lymphocytes Lymphoma
 Site Gender Age Evaluation Frequency
Breast F 20-39 Clinical breast Every 3 years
examination
(CBE)
Self breast Every month
examination
(SBE)
>40 CBE Every year
SBE Every month
Mammogram Every year

Colon and F/M >50 Fecal occult Every 5 years

rectum blood and
flexible Every 10 years
sigmoidoscopy
or colonoscopy
or double- Every 5 years
contrast
barium enema
 Site Gender Age Evaluation Frequency
Prostate M >50 (or 40-45 if PSA and DRE Every year
at high risk)

Cervix F >21 or within 3 Pap smear Every year if

years after regular Pap;
starting to have every 2 years if
intercourse liquid Pap test

Cancer-related M/F >20-39 Pelvic Every year

check ups examination
Examination for Every 3 years
cancers of the
thyroid,
testicles,
ovaries, lymph
nodes, oral
cavity and skin
as well as
counseling about
health practices
40+ and risk factors Every year
Same as 20-39
MANAGEMENT OF CANCER
 Surgery surgical removal of the entire cancer
remains the ideal and most frequently used
treatment method
b. Diagnostic surgery – biopsy
c. As primary treatment
d. Prophylactic treatment
e. Palliative treatment
f. Reconstructive surgery
MANAGEMENT OF CANCER
 Nursing management in cancer surgery
b. The nurse completes a thorough preoperative
assessment for factors that may affect the patient
undergoing the surgical procedure
c. The patient and family require time and
assistance to deal with the possible changes and
the outcomes resulting from the surgery
d. The nurse provides education and emotional
support by assessing the needs of the patient and
family and by discussing their fear and coping
mechanisms with them
MANAGEMENT OF CANCER
 Nursing management in cancer surgery
b. After surgery, the nurse assesses the patient’s
responses to the surgery and monitors the patient for
possible complications, such as infection, bleeding,
thrombophlebitis, wound dehiscence, fluid and
electrolyte imbalance, and organ dysfunction
c. The nurse also provides for the patient’s comfort.
Postoperative teaching addresses wound care,
activity, nutrition, and medication information
d. Plans for discharge, follow-up and home care, and
treatment are initiated as early as possible to ensure
continuity of care from hospital to home or from a
cancer referral center to the patient’s local hospital
and health care provider.
MANAGEMENT OF CANCER
 Radiation therapy
b. External radiation
c. Internal radiation or brachytherapy
d. Radiation dosage – dependent on the sensitivity
of the target tissue to radiation and on the tumor
size
e. Toxicity – localized to the region being irradiated
MANAGEMENT OF CANCER
 Nursing Management in Radiation therapy
b. The nurse can explain the procedure for
delivering radiation and describe the equipment,
the duration of the procedure (often minutes
only), the possible need for immobilizing the
patient during the procedure
c. The nurse informs the family about restrictions
placed on visitors and health personnel and other
radiation precautions, for radioactive implants
MANAGEMENT OF CANCER
 Chemotherapy
b. Antineoplastic agents are used in an attempt to
destroy tumor cells by interfering with cellular
functions, including replication
c. Used primarily to treat systemic disease rather
than localized lesions that are amenable to
surgery or radiation
d. May be combined with surgery, radiation
therapy, or both, to reduce tumor size
preoperatively, to destroy any remaining tumor
cells postoperatively, or to treat some forms of
leukemia
e. Goals: cure, control and palliation
ANTINEOPLASTIC DRUGS
UNDERSIRABLE EFFECTS
 Undesirable Effects:
 Bone marrow depression
 Alopecia
 Retching-nausea/vomiting
 Fear and anxiety
 Stomatitis
GENERAL GUIDELINES FOR
ANTINEOPLASTIC DRUGS
 CBC, platelets - monitor
 Antiemetics before taking drug

 Nephrotoxicity - undesirable effect

 Counseling regarding reproduction issues

 Encourage handwashing, avoid crowds

 Recommend a wig for alopecia

PRIMARY GOALS OF CHEMOTHERAPY
 Achieve a complete cure; permanent removal of
all cancer cells from the body.
 Control or manage the disease, cancer is not
eliminated, preventing the growth and spread of
the tumor may extend the patient’s life
 Palliation - reduce the size of the tumor, easing
the severity of pain and other tumor symptoms,
thus improving the quality of life.
REASON FOR MULTIPLE DRUG USE AND
SPECIAL SCHEDULING

 Rapid cell division,

 Tumor cells express a high mutation rate
 Tumor changes its genetic make-up as it grows
 hundreds of different clones with different growth
rates and physiological properties
 Drugs affect cells in different ways and at
different times in their life cycle
Figure 27.3 Antineoplastic agents and the cell cycle
TYPES OF ANTINEOPLASTIC
DRUGS
ALKYLATING AGENTS
 Action: Causes cell death or mutation of malignant growth by
changing the structure of malignant cell growth
 Indications: Palliative treatment of chronic lymphocytic
leukemia; malignant lymphomas; Hodgkin’s disease; breast, lung
and ovarian cancers
 Adverse Effects:
 Bone marrow depression (leukopenia, thrombocytopenia)
 Anorexia/alopecia
 Distressful nausea and vomiting
 Drugs: Busulfan, carboplatin, carmustine
Figure 27.4 Mechanism of action of alkylating agents
ANTIMETABOLITES
 Action: Interferes with the building blocks of DNA
synthesis
 Indications: Myelocytic leukemia; acute lymphocytic
leukemia; Cancer of the breast, cervix, colon, liver, ovary,
pancreas, stomach and rectum
 Adverse effects: GI disturbance, oral and anal
inflammation, bone marrow depression, alopecia, renal
dysfunction, thrombocytopenia
 Drugs: Capecitabine; cytarabine
GENERAL GUIDELINES IN GIVING
ANTIMETABOLITES
 Monitor CBC and platelets weekly
 Evaluate renal function test
 Temperature assessment q4-6 hours
 Asepsis (strict)
 Bleeding, anemia, infection, and nausea - report
 Oral hygiene - brush with soft toothbrush
 Lots of fluids (2-3 L/day)
 Intake and output, nutritional intake - monitor
 The protocols for handling and administering - follow
 Emphasize protective isolation
ANTITUMOR ANTIBIOTICS
 Action: binding to DNA making it unable to
separate (2) inhibiting ribonucleic acid (RNA),
preventing enzyme synthesis.
PLANT EXTRACTS
 VINCA ALKALOIDS
 Inhibits mitotic division
 TAXANES
 Inhibits mitotic division
 TOPOISOMERASE INHIBITORS
 Breaks the DNA strands therefore altering the
integrity of the genome
Biologic Response Modifiers

 Interferons (IFNs)
 Cytokines secreted by lymphocytes and
macrophages
 Slow the spread of viral infections
 Enhance the activity of existing leukocytes.
Biologic Response Modifiers

 Interleukins
 Levamisole (Ergamisole) stimulate B cells, T cells,
and macrophages in patients with colon cancer
 Bacille Calmette-Guéin (BCG) vaccine (TICE,
TheraCys) is an attenuated strain of Mycobacterium
tuberculosis, used for the pharmacotherapy of
certain types of bladder cancer.
Table 27.6 (continued) Hormones and Hormone Antagonists
MANAGEMENT OF CANCER
 Nursing management in chemotherapy
b. Assess fluid and electrolyte imbalance
c. Modify risks for infection and bleeding
d. Administering chemotherapy
e. Protecting caregivers
Lab Values

 Patients with cancer require regular monitoring

of lab values by nurses who will anticipate their
health care needs.
 Nursing interventions can include prophylactic
measures if abnormal lab values are noted and
addressed quickly.
Leukopenia

 Chemotherapy and radiation therapy can

decrease a patient's white blood cell (WBC) count
and lead to leukopenia .
 Because neutrophils act as phagocytes, a
significant decrease in the neutrophil count
places a patient with cancer at high risk for
infection.
Neutropenia

 A measure used to assess a patient's risk for infection is

the absolute neutrophil count (ANC).
 ANC less than 500 places the patient at severe risk for
infection, and a count less than 100 constitutes extreme
risk.
 The patient may receive medications on a daily basis to
stimulate WBC production.
 The nurse should know the ANC prior to medication
administration and take appropriate measures to prevent
infection
Anemia

 Anemia occurs when the patient's red blood cells

(RBC) are lost or the production rate is decreased; low
hemoglobin and hematocrit result.
 Any abnormal values should be discussed with the
primary care provider because the patient with cancer
may require blood transfusions before reaching
critically low levels.
 Critical values for hemoglobin and hematocrit are less
than 5.0 g/dl.
Thrombocytopenia

 Thrombocytopenia occurs when platelet counts

fall below 100,000.
 Spontaneous bleeding can occur when platelet
levels fall below 20,000.
 To avoid an emergent situation, the nurse should
report platelet count at 40,000.
 The patient with elevated platelets can also
develop bleeding if the platelet function is
abnormal.
Hematopoietic Growth Factors or Colony-
stimulating factors

 Medications that help improve these hematologic

conditions are hematopoietic growth factors or
colony-stimulating factors.
 These agents stimulate red and/or white blood
cell production and maturation.
 The nurse should be aware of administration
techniques, expected therapeutic outcomes, and
potential adverse effects.
Colony Stimulating Factors

 Filigastrim (Neupogen) and sargramostim (Leukine) are

used to enhance the WBC count.
 Pegfiligastrim (Neulasta) for patients with a decreased
WBC.
 These medications may be needed if the patient is
receiving antineoplastic agents that suppress the bone
marrow.
 Epoetin alfa recombinant (Procrit) is administered to
maintain or increase the patient's RBC level.
 Positive results with this medication can decrease the
need for blood transfusions.
Colony Stimulating Factors

 Oprelvekin (Neumega), also known as interleukin 11, is a growth

factor that is used to prevent thrombocytopenia following
chemotherapy infusion.
 This medication allows hematopoietic stem cells and the
progenitor cells to proliferate, increasing platelet production.
 As the plasma volume increases, the nurse may see decreased
hemoglobin, decreased serum albumin, and decreased gamma
globulins.
 The nurse must review lab values and administration routes
associated with the use of colony-stimulating factors prior to
their administration.
Electrolyte Imbalance
 Electrolytes, essential for normal physiologic function of nerves
and muscles, are monitored closely in the patient with cancer.
 Elevated or decreased electrolyte levels can have life-threatening
effects.
 The nurse must anticipate problems such as cardiac
dysrhythmias or uncontrolled bleeding and intervene quickly.
 Intravenous fluids, oral electrolyte supplements, and/or total
parenteral nutrition (TPN) can influence electrolyte balances.
 The nurse must be able to report current lab values and all
sources of ingested or parenteral electrolytes to oncology
specialists.
Neutropenia Precautions

 Neutropenia could be related to the cancer

pathology or the result of receiving
chemotherapeutic agents.
 Individuals with an absolute neutrophil count of
less than 1,000 cells are considered neutropenic
and are at moderate risk for infection.
 ANC less than 500 creates a severe risk for the
patient, and ANC less than 100 places the
patient in an extreme risk category.
Nadir

 The term nadir represents that period of time

when blood levels are at their lowest point.
 The nadir period varies for each antineoplastic
agent.
 Most nadir periods occur approximately 10 to 14
days after the beginning of chemotherapy
treatment or several weeks following radiation
therapy, depending on the treatment agent and
life span of the particular blood cells
Reversed Isolation Precautions

 An immunocompromised state makes it difficult

for the patient with cancer to combat even minor
colds; sepsis can result.
 When assigned to care for a patient who is
neutropenic, the nurse must review guidelines
regarding care of an immunocompromised
patient.
Common Adverse Effects of Chemotherapy and Radiation

 Fatigue
 Nausea
 Pain
 Vomiting
 Oral stomatitis
 Bone/Joint Pain
 Anorexia
 Constipation
 Diarrhea
 Impaired skin integrity
 Alopecia

All patients do not experience these adverse effects; however, the nurse
should be aware of assessment criteria and early intervention strategies
Fatigue: Nursing Intervention

 Occurs greater than 70%

 It can occur when the patient reaches the nadir
period.
 Clustering patient care activities can reduce
fatigue and provide uninterrupted rest periods.
 A sign on the patient's room door can prompt
visitors to check with the nurse before entering.
 Nausea and Vomiting: Nursing Intervention

 Nausea and vomiting occur frequently with the use of

chemotherapeutic agents.
 Some chemotherapy drug regimens include antiemetics prior to
administration to promote patient tolerance of the treatment.
 Specific food choices such as gelatin, popsicles, and soft bland food
may minimize queasiness
 The patient should be encouraged to experiment with his or her diet
to increase calories.
 The patient must consume an adequate number of calories to
maintain nutrition balance and enhance quality of life.
 A dietary consult may be helpful in identifying the patient's caloric
needs and identifying which foods would be best.
 Oral Stomatitis: Nursing Intervention
 Rapidly dividing cells in the mouth are affected by chemotherapy and
radiation treatments, leading to painful mouth sores and chapped lips.
 Candida albicans (yeast) may occur on the tongue and oral mucosa. Often,
excess oral secretions make it difficult for the patient to speak clearly or to
eat a substantial amount of food.
 The patient may find relief from sucking on ice chips or popsicles.
 Several combinations of mouth rinses are available, depending on the
patient's need - excess secretions may require diphenhydramine (Benadry)
in a mouth rinse, for increased pain may need lidocaine or water and baking
soda rinses.
 Frequent oral care is vital to preserve mucosal integrity.
 Individual needs and the extent of the stomatitis should be discussed with
the primary care provider to determine the best intervention.
Bone/Joint Pain: Nursing Interventions

 Bone and joint pain increases as cancer advances

and as an adverse effect of colony-stimulating
factors.
 Analgesics and anti-inflammatory medications,
as well as alternative pain relief measures, can
be used.
 Alternative pain relief measures can include
guided imagery, music therapy, relaxation
exercises, and massage, if appropriate.
Constipation and Diarrhea: Nursing Interventions

 The disease process, lack of activity, and frequent use of opioids may
result in constipation.
 High fiber food choices, adequate fluid intake, and stool softeners are
used to promote regular elimination and help prevent bloating.
 Diarrhea can result from frequent use of antibiotics and antiemetics.
 Dehydration and the loss of electrolytes, minerals, and nutrients can
result. Stool specimens may he collected to determine if an infection has
occurred. If no infection is detected, antidiarrheal medications may be
ordered.
 It is important to replace lost fluids, maintain electrolyte levels, and
prevent sepsis.
 In either constipation or diarrhea, the nurse should anticipate the
patient's needs and initiate preventive measures.
Delirium: Nursing Intervention
 Agitated behavior requiring sedation, also described as delirium,
terminal restlessness, mental anguish and agitation, are common
problems in cancer patients.
 Factors such as cachexia, hypoalbuminemia, advanced age, and prior
dementia can contribute to this condition.
 Identification and treatment of delirium may involve such interventions
as discontinuation or dose reduction of psychoactive medications,
adjustments in fluid administration, or treatment of infections,
dehydration, or electrolyte imbalances.
 Ongoing monitoring and reassessment are critical especially when
sedatives, opioids, or other psychoactive medications are required to
control patient's symptoms.
 Changes in the patient's health and mental status, in laboratory values,
and symptoms that suggest drug toxicity should be reported promptly to
the oncology specialist.
 A psychosocial intervention for family caregivers of patients with
advanced cancer may be beneficial.
Skin Integrity: Nursing Intervention
 Maintaining skin integrity is a priority during the treatment and
healing process of cancer.
 Irradiated tissue, at risk for skin breakdown and delayed wound
healing, should be assessed at least every shift.
 Chemotherapy and radiation injure the rapidly dividing cells of the skin.
 A patient with cancer may remain in bed for long periods of time due to
fatigue and pain.
 The underlying effects to the skin may not be visible immediately, and
recovery will depend on the patient's response to treatment
 Adequate nutrition is also an important component in maintaining skin
integrity.
 Cancer-associated cachexia, related to inadequate caloric needs and
decreased protein intake, can delay wound healing
 A skin assessment instrument, such as the Braden Scale, should be used
to evaluate the patient each shift and determine specific interventions.
Anorexia: Nursing Intervention

 Chemotherapy and radiation treatments affect rapidly

dividing cells and can alter taste sensation.
 Mouth rinses with baking soda and water can be used to
soothe the mucosa prior to meals.
 Megestrol acetate (Megace) has been used for appetite
enhancement in the patient with advanced cancer.
 Liquid nutritional supplements, such as health shakes,
can also be offered.
 The use of TPN may be necessary if other means for
nutritional support are exhausted.
 Chemotherapy Precautions
 The nurse needs to be familiar with chemotherapy precautions, which are
followed for a period of 48 hours after the patient's last dose of an
antineoplastic agent.
 Antineoplastic agents are excreted from the body through fluids such as
sweat, vomitus, stool, and urine.
 The nurse should use personal protective equipment (PPE) for each patient
contact.
 PPE includes masks with face shields or goggles, chemotherapy gloves, and a
fluid-resistant gown.
 Handwashing before and after working with the patient is essential.
 The nurse should cover the commode or toilet with a disposable drape to
prevent fluids from splashing while flushing twice.
 Specified receptacles for linen and trash disposal must be used.
 Family members must be instructed on and follow the necessary precautions.
 The facility should have a policy that stipulates precautions and supplies
used to protect the staff, patient, and visitors.
MANAGEMENT OF CANCER
 Bone Marrow Transplantation
b. Allogenic (from a donor other than the patient);
either a related donor or a matched unrelated
donor
c. Autologous (from patient)
d. Syngeneic (from an identical twin)
MANAGEMENT OF CANCER
 Nursing Management in Bone Marrow
Transplantation
b. Implementing pretransplantation care
c. Providing care during treatment
d. Providing posttransplantation care
MANAGEMENT OF CANCER
 Hyperthermia
 Targeted therapies

c. BRM

d. Gene therapy

e. Growth factors
 Photodynamic therapy

 Cancer rehabilitation
SQUAMOUS CELL CARCINOMA
 SCC
 The second most common tumor arising on sun-
exposed sites in older people, exceeded only by
basal cell carcinoma
 Except for lesions on the lower legs, these tumors
have a higher incidence in men than in women
 The most important cause of cutaneous SCC is
DNA damage induced by exposure to UV light
 Is invasive, can recur and metastasize
SQUAMOUS CELL CARCINOMA
 Other Risk Factors
2. Age older than 50 years
3. Light skin; blonde or light brown hair; green,
blue, or gray eyes
4. Skin that sunburns easily (Fitzpatrick skin types
I and II)
5. Geography (closer to the equator)
([Link]
overview)
SQUAMOUS CELL CARCINOMA
 Immunosuppression may contribute to
carcinogenesis by reducing host surveillance and
increasing the susceptibility of keratinocytes to
infection and transformation by oncogenic
viruses, particularly HPV subtypes 5 and 8
 Other risk fatcors include industrial carcinogens
(tars and oils), chronic ulcers and draining
osteomyelitis, old burn scars, ingestion of
arsenicals, ionizing radiation, and (in the oral
cavity) tobacco and betel nut chewing
SQUAMOUS CELL CARCINOMA
 History
 A new and enlarging lesion that concerns the patient
 Most lesions are slow growing, while others rapidly
enlarges
 Symptoms such as bleeding, weeping, pain, or
tenderness may be noted, especially with larger
tumors
 Numbness, tingling, or muscle weakness may reflect
underlying perineural involvement, and this history
finding is important to elicit because it adversely
impacts prognosis.
 May be asymptomatic
([Link]
overview)
SQUAMOUS CELL CARCINOMA
 Imaging studies like CT scan are done for
patients with neurologic symptoms and with (+)
lymphadenopathy
 FNAB or excision biopsy of palpable lymph nodes

 Small biopsies of the lesion suspected to be SCC

([Link]
5-overview)
SQUAMOUS CELL CARCINOMA
 Nonsurgical treatment options:
2. topical chemotherapy - 5-FU

3. topical immune response modifiers – sirolimus,

prednisone, cyclosporine, azathioprine, and
mycophenolate
4. photodynamic therapy (PDT)

5. Radiotherapy

6. Systemic chemotherapy – 5-FU and cetuximab

(EGFR antagonist)
([Link]
5-overview)
SQUAMOUS CELL CARCINOMA
 Surgical treatment options:
2. Cryotherapy – for in-situ lesions; makes use of
liquid nitrogen
3. Electrodesiccation and curettage – for low-risk
carcinomas of the trunk and extremities
4. Excision with conventional margins

([Link]
5-overview)
Electrodesiccation
Excision
biopsy
BASAL CELL CARCINOMA
 BCC
 The most common invasive cancer in humans

 Slow-growing tumors that rarely metastasize

 Have a tendency to occur in sun-exposed areas

and in lightly pigmented people
 Incidence rises sharply with immunosuppression
and in people with inherited defects in DNA
repair
BASAL CELL CARCINOMA
 Tumors present clinically as pearly papules often
containing prominent dilated subepidermal blood
vessels
 Advanced lesion may ulcerate, and extensive
local invasion of bone and facial sinuses may
occur after many years of neglect (rodent ulcers)
BASAL CELL CARCINOMA
 Treatment
2. Electrodessication and curettage involves destroying
the tumor with an electrocautery device then scraping
the area with a curette
3. Surgical excision of the lesion including a margin of
normal skin. This method is preferred for larger
lesions (>2cm) on the cheek, forehead, trunk, and legs
4. Radiation therapy - may also be used where tumors
are difficult to excise or where it is important to
preserve surrounding tissue such as the lip. Its use is
declining.
5. Cryotherapy - involves destroying the tissue by
freezing it with liquid nitrogen. This may be effective
for small, well-defined superficial tumors
BASAL CELL CARCINOMA
 Prevention
2. Avoid UVB radiation from sun exposure
especially midday sun
3. Use protective clothing
4. Use sunscreen with an SPF of at least 15. This is
especially important for children.
5. Have suspicious lesions checked out - If you have
a question, get it checked out. Treating
premalignant lesions prevents their
transformation to potentially metastatic cancers.
MELANOMA
 A relatively common neoplasm that remains
deadly if not caught at its earliest stages
 Can occur in the oral and anogenital mucosal
surfaces, esophagus, meninges, and the eye
 Melanomas evolve over time from localized skin
lesions to aggressive tumors that metastatize and
are resistant to therapy
 Early recognition and complete excision are
critical
MELANOMA
 Usually asymptomatic
 Itching or pain may be an early manifestation

 Majority of lesions are greater than 10 mm in

diameter at diagnosis
 Most consistent clinical signs (in pigmented
lesions):
5. Changes in color

6. Changes in size

7. Changes in shape
MELANOMA
 Unlike benign tumors, these tumors show
variations in color (shades of black, brown, red,
dark blue, and gray)
 There may be areas of hypopigmentation

 Borders are irregular and often notched, not

smooth, round, and uniform
 Important warning signs (ABCs):

 Asymmetry

 Irregular borders

 Variegated color
MELANOMA
 Other features:
2. Diameter greater than 6 mm
3. Any change in appearance
4. New onset of itching
5. Or new onset of pain
MELANOMA
 Prognostic factors:
2. Tumor depth - <1.7mm (favorable)
3. Number of mitoses – no or few mitoses
(favorable)
4. Evidence of tumor regression – absence
(favorable)
5. The presence and number of tumor infiltrating
lymphocytes – brisk (favorable)
6. Gender – female (favorable)
7. Location – location on an extremity (favorable)
MELANOMA
 The two most important predisposing factors are
inherited genes and sun exposure
 Treatment is by stage
Stage 0 melanoma. Abnormal melanocytes are in the epidermis
(outer layer of the skin).
Stage I melanoma. In stage IA, the tumor is not more than 1 millimeter thick,
with no ulceration (break in the skin). In stage IB, the tumor is either not more
than 1 millimeter thick, with ulceration, OR more than 1 but not more than 2
millimeters thick, with no ulceration. Skin thickness is different on different parts
of the body.
Stage II melanoma. In stage IIA, the tumor is either more than 1 but not more than 2
millimeters thick, with ulceration (break in the skin), OR it is more than 2 but not more
than 4 millimeters thick, with no ulceration. In stage IIB, the tumor is either more than 2
but not more than 4 millimeters thick, with ulceration, OR it is more than 4 millimeters
thick, with no ulceration. In stage IIC, the tumor is more than 4 millimeters thick, with
ulceration. Skin thickness is different on different parts of the body.
Stage III melanoma. The
tumor may be any
thickness with or without
ulceration. It has spread
either (a) into a nearby
lymph vessel and may
have spread to nearby
lymph nodes; OR (b) to 1
or more lymph nodes,
which may be matted
(not moveable). Skin
thickness is different on
different parts of the
body.
Stage IV melanoma. The tumor has
spread to other parts of the body.
MELANOMA
 Stage 0 (Melanoma in Situ) - Treatment of stage 0 is
usually surgery to remove the area of abnormal cells
and a small amount of normal tissue around it.
 Stage I Melanoma
3. Surgery to remove the tumor and some of the normal
tissue around it.
4. A clinical trial of surgery to remove the tumor and
some of the normal tissue around it, with or without
lymph node mapping and lymphadenectomy.
5. A clinical trial of new techniques to detect cancer cells
in the lymph nodes.
6. A clinical trial of lymphadenectomy with or without
adjuvant therapy.
MELANOMA
 Stage II Melanoma
2. Surgery to remove the tumor and some of the
normal tissue around it, followed by removal of
nearby lymph nodes.
3. Lymph node mapping and
sentinel lymph node biopsy, followed by surgery
to remove the tumor and some of the normal
tissue around it. If cancer is found in the
sentinel lymph node, a second surgery may be
done to remove more nearby lymph nodes.
4. Surgery followed by high- dose biologic therapy.
5. A clinical trial of adjuvant chemotherapy and/or
biologic therapy.
6. A clinical trial of new techniques to detect cancer
cells in the lymph nodes.
 MELANOMA
 Stage III Melanoma
2. Surgery to remove the tumor and some of the normal tissue around
it.
3. Surgery to remove the tumor with skin grafting to cover the wound
caused by surgery.
4. Surgery followed by biologic therapy.
5. A clinical trial of surgery followed by chemotherapy and/or biologic
therapy.
6. A clinical trial of biologic therapy.
7. A clinical trial comparing surgery alone to surgery with biologic
therapy.
8. A clinical trial of chemoimmunotherapy or biologic therapy.
9. A clinical trial of hyperthermic isolated limb perfusion using
chemotherapy and biologic therapy.
10. A clinical trial of biologic therapy and radiation therapy.
MELANOMA
 Stage IV Melanoma
2. Surgery or radiation therapy as
palliative therapy to relieve symptoms and
improve quality of life.
3. Chemotherapy and/or biologic therapy.
4. A clinical trial of new chemotherapy, biologic
therapy, and/or targeted therapy with
monoclonal antibodies, or vaccine therapy.
5. A clinical trial of radiation therapy as palliative
therapy to relieve symptoms and improve quality
of life.
6. A clinical trial of surgery to remove all known
cancer.