> ## Content Index
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> Use this file to discover other available public pages before exploring further.

# Pigmented Lesions in 2024: Spitz, Melanoma, Breslow (& Tips for a Skin MDT)
- URL: https://www.theplasticsfella.com/december-1st/
- Published: 2024-11-29T19:00:50.000Z
- Updated: 2024-11-29T19:04:49.000Z
- Description: Also: Winner of the Sunday quiz, technique tips on Mohs surgery vs standard excision, & giant CMN identification.
- Author: PlasticsFella
- Tags: thePlasticsPaper

#### In this week's edition

1. ****✍️** [****Letter from P'Fella**](https://www.theplasticsfella.com/december-1st/#a-letter-from-pfella)  
Can a skin MDT truly achieve perfection?
2. ****🤓** [****The Sunday Quiz**](https://www.theplasticsfella.com/december-1st/#the-sunday-quiz)  
Four winners achieve a perfect score!
3. [🖼️](https://emojipedia.org/framed-picture?ref=theplasticsfella.com) [****Image of the Week**](https://www.theplasticsfella.com/december-1st/#image-of-the-week)  
Identifying giant CMN.
4. ****🚑** [****Technique Tip**](https://www.theplasticsfella.com/december-1st/#technique-tip)  
Comparison of Mohs surgery and standard excision.
5. ❤️‍🩹 [****Case of the Week**](https://www.theplasticsfella.com/december-1st/#case-of-the-week)  
Clinical diagnosis and management of Spitz naevus.
6. 📖 [****What Does the Evidence Say**](https://www.theplasticsfella.com/december-1st/#what-does-the-evidence-say)  
Evidence on techniques for SLNB.
7. ****🔥** [****Articles of the Week**](https://www.theplasticsfella.com/december-1st/#articles-of-the-week)  
Pediatric spitz lesions, Breslow's original publication, & margins for primary cutaneous melanoma: with 1 sentence summaries.
8. 💕 [****Feedback**](https://www.theplasticsfella.com/december-1st/#feedback)  
Suggest ideas & give feedback!

## A Letter from P'Fella

**Skin MDT - Can It Ever Be Perfect?*

👋

****Hey team!**  
  
Over the years, the messages I've been getting from people — especially junior staff managing logistics — highlight the same issues with the ****Skin MDT**. We all agree that the Skin MDT is crucial for patient care, but does it really work as well as we want it to? The challenges seem to be universal, and I don’t have all the answers — which is why I’m turning to you for insights.

**The Problems**

If we are totally honest about it, we can probably all relate to the usual struggles:

- People running late or away.
- Slides missing some nuanced details.
- Disorganized mix of tools resulting in duplication of work.
- Communication gaps leading to confusion.

**A Better Way?**

What if we made the Skin MDT **asynchronous**? Instead of cramming everyone into a room (or on Zoom), make it a **peer-reviewed process** throughout the week.

**How an Asynchronous MDT Could Work**

1. **Log In and Review:** Everyone logs in during the week to review cases and provide feedback.
2. **Discuss Complex Cases:** Only cases with disagreement or complexity are discussed in real-time.
3. **Save Time:** This approach saves time, focuses on challenging cases, and ensures every case gets reviewed.

This would mean **less waiting around**, **more efficiency**, and potentially **better outcomes** for patients. Every case gets the attention it needs, but we aren’t drowning in logistics.

**What Do You Think?**

Looking forward to your thoughts,  
P'Fella ❤️

## The Sunday Quiz

**Results from the Last Round: Winners Announced!*

****Congratulations to the winners** of the weekly quiz!  
  
After six challenging rounds of plastic surgery questions, the top scorers are ****Toby**, ****Paul**, ****Nathan**, and ****Alexander L**. We'll be in touch with you soon.   
  
Each of them achieved a perfect score — an impressive feat!  
  
A big thank you to everyone who took part. Stay tuned for more engaging quizzes in upcoming editions!

![](https://storage.ghost.io/c/a0/9f/a09fd7b4-d396-4b28-aed3-b87e20483292/content/images/2024/11/Leaderboard-Team-Post-Template--3-.png)

Check out the leaderboard below!

## Image of the Week

Signs of Giant CMN

🖼️

****Image of the Week**   
  
In this section, we feature an anatomical illustration. This edition features an anatomical illustration focusing on Giant Congenital Melanocytic Nevi (CMN).  
  
Read more [here](https://www.theplasticsfella.com/congenital-melanocytic-naevus/). 

![Giant congenital melanocytic naevus](https://storage.ghost.io/c/a0/9f/a09fd7b4-d396-4b28-aed3-b87e20483292/content/images/2024/11/image-10.png)

Giant congenital melanocytic naevus

## Technique Tip

**Mohs vs. Standard Excision*

🚑

****Technique Tip of the Week**   
  
This week’s edition dives into the nuances of Mohs surgery vs standard excision highlighting their practical considerations.   
  
You can read more about the technique [here](https://www.theplasticsfella.com/mohs-micrographic-surgery/#mohs-vs-standard-excision). 

![Standard Excision vs Moh's Surgery](https://storage.ghost.io/c/a0/9f/a09fd7b4-d396-4b28-aed3-b87e20483292/content/images/2024/11/image-11.png)

Standard Excision vs Moh's Surgery

## Case of the Week

**Spitz Naevus in a Clinical Setting*

🏥

Here's an overview of our ****Spitz Naevus Clinical Scenario**.  
  
Spitz naevus is a benign melanocytic lesion often seen in children and young adults. While generally non-threatening, it can mimic melanoma in appearance, posing a diagnostic challenge for clinicians.

![](https://storage.ghost.io/c/a0/9f/a09fd7b4-d396-4b28-aed3-b87e20483292/content/images/2024/11/AI-generated-image--17--1.png) 

#### Spitz Naevus - Clinical Scenario

1. ****Describe the clinical and dermoscopy findings of Spitz Naevus.**
2. ****Describe the histopathological findings of Spitz Naevus.**
3. ****Appreciate the different types of Spitz naevi and their potential for malignant behaviour.**
4. ****Knowledge of the management of Spitz naevus in different age groups.**

[Read the Article](https://www.theplasticsfella.com/spitz-naevus-clinical-scenario/) 

## What Does the Evidence Say?

**Evidence on Techniques for SLNB*

In this section, we dive deep into the latest research and evidence on medical practices and surgical techniques. 

Sentinel lymph node biopsy (SLNB) is the standard procedure for staging ****melanoma**. The gold standard technique combines ****radioisotope** and ****blue dye** (Morton et al., 2014; Ferrucci et al., 2018).   
  
However, new methods have emerged, including indocyanine green (ICG) fluorescence, superparamagnetic iron oxide nanoparticles, and contrast-enhanced ultrasound (Ferrucci et al., 2018). ICG fluorescence has shown higher sensitivity and detection rates compared to traditional methods (Korn et al., 2014; Fujisawa et al., 2012).   
  
A meta-analysis revealed that radioisotope alone or combined with blue dye yielded the highest identification rates in melanoma (Niebling et al., 2016). SLNB has been shown to improve ****disease-free survival** in patients with ****intermediate**\-thickness and ****thick** ****melanomas** (Morton et al., 2014), highlighting its importance in cancer staging and management.

## Articles of the Week

**3 Interesting Articles with 1 Sentence Summaries*

✅

****Clinical Insights into Pediatric Spitz Lesions: Features, Management, and Outcomes** ([Patel](https://www.jprasurg.com/article/S1748-6815%2824%2900404-2/fulltext?ref=theplasticsfella.com), 2024)  
  
Paediatric Spitz-type lesions are mostly benign, with no recurrence or mortality observed. Conservative management is sufficient for benign cases, with minimal excisions recommended for suspicious lesions.

✅

****Breslow's Depth: A Critical Factor in Melanoma Prognosis and Survival** ([Breslow](https://journals.lww.com/annalsofsurgery/citation/1970/11000/thickness,%5Fcross%5Fsectional%5Fareas%5Fand%5Fdepth%5Fof.17.aspx?ref=theplasticsfella.com), 1970)  
  
Tumor thickness, cross-sectional area, and invasion depth predict melanoma survival more effectively than lesion diameter alone.

✅

****1 Versus 2-cm Excision Margins for pT2-pT4 Primary Cutaneous Melanoma** ([Moncrieff](https://pubmed.ncbi.nlm.nih.gov/29850955/?ref=theplasticsfella.com), 2018)  
  
1-cm margins reduced reconstruction (13.6% vs. 34.9%) and wound necrosis (0.5% vs. 3.6%) compared to 2-cm margins, with no QoL differences at 12 months.

## Feedback

### I hope you enjoyed it 😄

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