Summer 2018 | Live Blog | Early and Thin Melanoma
Dr. Abel Jarrell, a dermatologist and dermatopathologist, shed light on the management of early and thin melanomas on Day 3 of the SDPA Annual Summer Conference. Dr. Jarrell began his lecture with the statement “some of the most valuable time you can spend in your education is focusing on pigmented lesions”. He presented the best approach to pigmented lesions with the advice “don’t do a partial biopsy of a much larger lesion”. The patient who presents with numerous pigmented lesions can be a challenge and is best approached with use of dermoscopy and photography. Dr. Jarrell also addressed the need for margin control management of dysplastic nevi is still evolving and controversial.
Next, Dr. Jarrell reviewed the known risk factors for the development of melanoma including skin type, genetics, family history of melanoma, intermittent intense UV exposure and many atypical nevi. Tanning bed use is a significant risk factor in the development of melanomas. Dr. Jarrell also reviewed a case presentation of a young woman with a history of heavy tanning bed use who presented with two melanomas as a representative example of the correlation of indoor tanning and development of melanoma.
Finally, Dr. Jarrell reviewed the newest standards for the classification and management of melanoma that was instituted this year by the AJCC. While the mitotic rate is no longer used in staging melanomas, it should still be assessed and reported for all melanomas. He further elaborated on nodal status and ulceration. For the management of melanoma in situ, there is controversy of adequate margins which lies between 0.5 and 1 cm margins for most cases.