Last reviewed: November 2017
Last updated: November  2017

Summary

Definition

History and exam

Key diagnostic factors

  • altered pigmented lesion (ABCDE signs)
  • spontaneous bleeding or ulceration of a pigmented lesion
  • constitutional symptoms
  • >50 benign melanocytic nevi
  • atypical nevi
  • melanocytic lesion that does not resemble surrounding melanocytic nevi ("ugly duckling")
  • pigmented lesion, asymmetric appearance, ill-defined/irregular borders, color variation
  • bluish-white veil
  • persistent single-nail melanonychia striata
  • Hutchinson sign
  • fixed lymphadenopathy
  • in-transit metastases

Risk factors

  • FHx of melanoma
  • personal hx of melanoma
  • personal hx of skin cancer (including actinic damage)
  • history of atypical nevi
  • Fitzpatrick skin type I or II (light-colored skin)
  • red or blond hair color
  • high freckle density
  • sun exposure
  • sun bed use
  • light eye color
  • increased numbers of benign-appearing melanocytic nevi
  • large congenital nevi
  • immunosuppression
  • xeroderma pigmentosum

Diagnostic investigations

1st investigations to order

  • dermatoscopy
  • skin biopsy
Full details

Investigations to consider

  • sentinel lymph node biopsy
  • serum lactate dehydrogenase (LDH)
  • CXR
  • chest/abdominal/pelvic CT scan
  • whole-body PET scan
  • brain imaging (CT or MRI)
  • BRAF mutational analysis
Full details

Emerging tests

  • CDKN2A genetic test
Full details

Treatment algorithm

Contributors

Authors VIEW ALL

Melanoma Institute Australia

The University of Sydney

Sydney

Australia

Disclosures

AMM has received honoraria from Novartis and BMS. AMM is on the advisory boards of MSD and Chugai.

Melanoma Institute Australia

The University of Sydney

Royal Prince Alfred and Mater Hospitals

Sydney

Australia

Disclosures

RPMS is on the advisory board for Amgen and has received honoraria from BMS.

Associate Professor of Dermatology

The University of Sydney

Sydney

Australia

Disclosures

PF-P declares that he has no competing interests with the topic Melanoma. PF-P has advisory roles with Leo, Novartis, Lilly, Abbvie, Janssen, Celgene (psoriasis, atopic eczema, hidradenitis). He has been paid to do research for Incyte Europe Sarl, and clinical trials for Leo, Janssen, Kyowa Hakko Kirin, Xoma, Akaal, Amgen, Merk. PF-P has also been paid for lectures by Abbvie, Amgen, Lilly, Novartis, Janssen.

Dr Alexander M. Menzies, Dr Robyn P.M. Saw, and Dr Pablo Fernandez-Peñas would like to gratefully acknowledge Dr Philip Friedlander, Dr Hobart W. Walling, and Dr Brian L. Swick, previous contributors to this monograph. PF is a consultant for Genentech. HWW and BLS declare that they have no competing interests.

Peer reviewers VIEW ALL

Assistant Professor

Department of Pathology and Laboratory Medicine

University of California

Los Angeles

CA

Disclosures

DC declares that he has no competing interests.

Dermatologist/Dermatologic Surgeon

President of the South Carolina Skin Cancer Center

Greenville

SC

Disclosures

JB declares that he has no competing interests.

Associate Director

JCCC Women's Cancers Program Area

Jonsson Comprehensive Cancer Center at UCLA

Los Angeles

CA

Disclosures

MB declares that she has no competing interests.

Medical Director

CancerPartnersUK

London

UK

Disclosures

KS declares that he has no competing interests.

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