 Hello everyone welcome back to another session in dentistry and more today we have a malignant condition Which is known as malignant melanoma, which is a neoplasm of epidermal melanocytes so epidermal melanocytes Which is one of the most biologically unpredictable and deadly of all human neoplasm? Okay, this is a very deadly neoplasm and which is very unpredictable This malignant melanoma, which is the most or the third most common cancer of skin of skin After basal cell cosonoma and scoma cell cosonoma of K. This is about skin So earlier it was believed that melanomas develop in knee-y especially the junctional knee-y But now it is thought that the lesions which were Interpreted as junctional knee-y where in fact the pre malignant melanocytic Displacias, okay, so melanocytic Displacia so before it was Thought to be a junctional knee-y, but now it is understood that it is a pre malignant melanocytic dysplasia so certain lesions considered to be pre malignant melanomas are the Accurate knee-y, dysplastic knee-y, congenital knee-y and cellular blue knee-y so Coming to the etiological factors the environmental factors are sun exposure artificial UV sources socioeconomic status, fair skin, red hair and Number of melanocytic knee-y all could be the etiological factors in genetical factors the familial melanoma familial melanoma and Zero derma pigment osm, okay There is factors of oral melanomas are unknown basically They have no apparent relationship to chemical thermal or physical events to which the oral mucosa is continuously Exposed so there are two phases in the growth of a melanoma that is a radial growth phase Okay, first one is radial Growth phase Radial growth phase is the initial phase which may last for many years and the neoplastic process is confined to the epithelium, okay radial Growth the neoplastic activity is confined to epithelium only and the second phase is a vertical growth phase, okay vertical Growth phase which begins when the neoplastic cells populate the underlying Connected tissue and in this phase so connected tissue what happens there will be metastasis So that is a two types of growth seen in Malignant melanoma that is the radial growth and vertical growth, okay So we have four types of melanoma that is the first one is superficial Spreading type superficial spreading melanoma second one is neodular melanoma third one is lentigo Malignant melanoma and the last one is The acryl lentiginous melanoma So the clinical features of superficial spreading or SSM is which exists in a radial growth phase called pre malignant melanosis and It present as a tan brown black or add mixed relations of sun exposed skin especially the backside and Vertical vertical growth phase is characterized by increase in size change in color Neodularity and also ulceration in nodular melanoma Which is nm no clinically recognizable radial growth phase and Existing solely in a vertical growth phase only the vertical growth, okay and It present as a sharply delineated nodule with a decrease of pigmentation maybe pink or black which is known as Amelanotic melanoma Amelanotic melanoma so amelanotic melanoma is nodular melanoma Due to the it's pigmentation it appear as a pink or black which is known as amelanotic melanoma and Prediction for occurrence on the back and head and neck skin off The third one lendigo Maligna melanoma or LMM which exists in a radial growth phase Which is known as lendigo maligna or melanotic freckle of Hutchinson, okay? melanotic freckle Hutchinson and Occurs characteristically as a macular lesion on the malar skin of the Middle East and elderly Caucasian more common in women. Okay, so this is more common in Caucasian Ethnicity and women Okay in Malar region so the last one or the acral lendigo Melanoma which is developing on the palms and soles as well as on the toes and fingers Which is characterized by macular lendigas pigmented area around a nodule They are extremely aggressive with rapid progression from the radial to vertical growth phase So the following criteria which helps in clinical diagnosis, okay clinical diagnosis We can Go for a a b c d e rule So a is the a symmetry B is border irregularity Border irregularity C is color irregularity color irregularity Okay, D is diameter and E is elevation So this is a a b c d e rule in clinical diagnosis of malignant melanoma in border irregularity with blurred nost or ragged edges and Color irregularity pigmentation is not uniform black brown red Tan white and blue can all appear together Diameter greater than six mm growth in itself is a sign okay, so That is a a b c d e rule asymmetry border irregularity color irregularity diameter and elevation Whereas the oral manifestation it is twice as common in men than in women most commonly it is seen in 40 to 70 group age group predilection for the palate and maxillary gingiva palate and maxillary gingiva and It appears as a deeply pigmented area at times also rated and hemorrhagic Which tends to increase progressively in size and oral melanomas exist in superficial spreading acroillendigas and nodular types in Histologic features we have Malignant cells often as a nest or cluster in groups in an organoid fashion and They have large nuclei prominent nuclei and show a nuclear pseudo inclusion and Radial growth phase of superficial spreading melanoma is characterized by presence of large epithelioid melanocytes distributed in a so-called Pachytoid manner, which is known as Buckshot scatter, okay Buckshot Scatter Buckshot scatter, which is nothing but the presence of large epithelioid melanocytes distributed in a Pachytoid manner So when melanocytes penetrate the basement membrane a host cell response develops which would destroy the tumor cell And vertical growth phases characterized by proliferation of malignant cells in the dermis, okay, and The nodular type is characterized by large epithelioid melanocytes within the connective tissue and Tumor cells may invade and ulcerate the overlying epithelium and penetrate the deep soft tissues Whereas a lentigo malignant, which is characterized by increased number of atypial melanocytes Moving on to the treatment and Prognosis the surgical excision for cutaneous lesion should be performed when lymph nodes are involved regional lymph node Dissection if tumors are greater than 0.75 millimetre in thickness and located in the so-called band sites that is back arm neck and Scalp this is band site So it have a greater tendency to metastasis so surgical excision for oral melanoma jaw resection and lymph node resection should be Performed women have a much meta-servable rate up to 50 years and then the rate declines Nodular and superficial spreading melanoma have a much poorer prognosis than the LMM tumors which is less than 0.75 millimetre rarely metastasis or it could be rarely cause a reason for death and The oral melanoma have much poorer prognosis than the cutaneous ones So that is all about malignant melanoma. So we have discussed the various details and ABCD rule Various types its historical features clinical features and finally the treatment and Bands criteria buckshot scatter appearance. So it is a commonly asked as a question So I'll come with a new topic in the industry and more. Thank you