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Melanoma — SCE Dermatology MCQ

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HardSkin CancerMelanomaSCE Dermatology

A 55-year-old man has a melanoma with regression on histology. The pathologist describes areas of fibrosis replacing melanocyte nests with melanophage accumulation. Why is regression clinically significant in melanoma?

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Correct answer: C — Regression may mask the original Breslow thickness, potentially leading to understaging, and has debated prognostic significance

The best answer is “Regression may mask the original Breslow thickness, potentially leading to understaging, and has debated prognostic significance”. NICE bases melanoma diagnosis, excision margins and nodal assessment on complete histology, Breslow thickness, ulceration and clinical stage, with specialist review of suspicious or changing lesions. The alternatives “It has no clinical relevance, after specialist assessment, when the full phenotype supports it”, “It indicates a good prognosis exclusively, when the full phenotype supports it, within an appropriate UK pathway”, “It is a sign of benign naevus, within an appropriate UK pathway, after clinicopathological correlation”, “It indicates complete tumour clearance, after clinicopathological correlation, after specialist assessment, when the full phenotype supports it” are clinically adjacent possibilities, but they do not fit the defining morphology, distribution, histopathology, risk signal or management sequence in this stem.

Reference: NICE NG14 melanoma recommendations: https://www.nice.org.uk/guidance/ng14/chapter/Recommendations