Physical Findings

Stop & Think

Lab and X-Ray

Differential Diagnosis

The Disease

Treatment

Conclusions

Quiz & Evaluation

• This is important, so pay attention.
• Initial growth pattern:
• It seems that all melanomas start out with a period of radial, or horizontal, growth. (These are full fledged melanomas, not just dysplastic nevi.)
• All cytologic features of malignancy are met.
• Extends outward in the epidermis and superficial dermis.
• Lesion remains flat.
• During this radial growth phase, the cells do not have the capacity to metastasize.
• At some point (months, maybe years), the tumor progresses to a vertical growth phase.
• Malignant cells grow down into the deeper dermis.
• This represents a nodular pattern within the background of the radially expanding lesion.
• Now the malignancy has true metastatic potential.