Melanoma superficial spreading C43.L

Author: Prof. Dr. med. Peter Altmeyer

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Last updated on: 29.10.2020

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pagetoid melanoma; SSM; Superficial melanoma; Superficial spreading malignant melanoma; superficial spreading melanoma; Superficial spreading melanoma

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Most common form of malignant melanoma (about 60-70% of all malignant melanomas), which is characterized by primarily horizontal growth, in advanced stages of the disease also by vertical, invasive growth.

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The SSM group includes about 70% of all melanomas.

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Age at first diagnosis between 30 and 50 years.

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Occurs in all parts of the body.

In men mainly on the trunk; in women mainly on the lower legs.

Clinical features
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0.5 cm to 5.0 cm in size, roundish to oval, often also bizarrely configured, with tongue-shaped extensions, sharply defined, light brown to brownish, black, grey, also pink to reddish pied, initially flat plaques (no spot or patch: a spot cannot be felt with closed eyes), possibly with slightly raised edges.

Later bumpy surface, formation of infiltrated papules or nodes (vertical growth direction). Vertical growth with knot formation can start surprisingly fast within a few weeks.

Typical for the SSM are regression zones of varying size so that circinous or anular formations can develop.

Incident light microscopy: highly irregular, wide-meshed, coarse trabecular, prominent pigmentary network, peripheral breaks, pseudopodia, radial streaming, depigmentation, regression, black dots.

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Early phase: melanoma in situ. The epidermis is interspersed with large atypical melanocytes with light cytoplasm. The tumor cells are found in nests and in individual formations in all layers of the epidermis, including the stratum corneum. Later: breakthrough through the basement membrane, and wide penetration of the dermis by atypical melanocytes. Basal lymphocytic infiltrate of varying degrees. Mitoses are found in varying density in all sections of the tumor parenchyma. Differential diagnostic significance is the lack of maturation of tumor cells to depth.

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Favourable in the early phase with small herds. The tumour thickness in the nodular areas is decisive.

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  1. Debarbieux S et al (2015) Groupe imagerie cutanée non invasive de la Société française de dermatologie. Superficial spreading melanoma. Ann Dermatol Venereol 142:66-69
  2. Napolitano L et al (2014) Pigmented Mammary Paget Disease Mimicking Superficial Spreading Melanoma in an Elderly African-American Female. J Cutan Med Surg pii: 7750.2014.14098
  3. Toender A et al(2014) Increased incidence of melanoma in situ in Denmark from 1997 to 2011: results from a nationwide population-based study. Melanoma Res 24:488-495


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Last updated on: 29.10.2020