Melanoma

Last reviewed: 2 Jun 2022
Last updated: 10 Feb 2022

Summary

Definition

History and exam

Key diagnostic factors

  • altered pigmented lesion (ABCDE signs)
  • melanocytic lesion that does not resemble surrounding melanocytic naevi ('ugly duckling')
  • spontaneous bleeding or ulceration of a pigmented lesion
  • constitutional symptoms
  • nail sign: persistent single-nail melanonychia striata
  • nail sign: Hutchinson's sign
  • atypical dermoscopy findings
  • fixed lymphadenopathy
  • in-transit metastases
More key diagnostic factors

Risk factors

  • family history of melanoma
  • personal history of melanoma
  • personal history of skin cancer (including actinic damage)
  • history of atypical naevi
  • Fitzpatrick skin type I or II (white skin)
  • red or blond hair colour
  • high freckle density
  • sun exposure
  • sun bed use
  • light eye colour
  • increased numbers of benign-appearing melanocytic naevi
  • large congenital naevi
  • immunosuppression
  • xeroderma pigmentosum
More risk factors

Diagnostic investigations

1st investigations to order

  • dermoscopy
  • skin biopsy
  • immunohistochemistry
More 1st investigations to order

Investigations to consider

  • sentinel lymph node biopsy
  • chest/abdominal/pelvic CT scan
  • whole-body PET scan
  • brain imaging (CT or MRI)
  • BRAF mutational analysis
  • NRAS mutational analysis
  • serum lactate dehydrogenase (LDH)
More investigations to consider

Emerging tests

  • CDKN2A mutational analysis

Treatment algorithm

ACUTE

early stage melanoma (melanoma in situ, stage I, stage II)

resectable advanced melanoma (stage III and stage IV)

unresectable advanced disease (stage III and stage IV)

Contributors

Authors

Sophie E. Papa, BA (Oxon) MBBS, FRCP, PhD

Clinical Reader in Immune Oncology and Honorary Consultant Medical Oncologist

School of Cancer and Pharmaceutical Sciences

King's College London

Department of Medical Oncology

Guy's and St Thomas' NHS Foundation Trust

London

UK

Disclosures

SEP has received honoraria from BMS, MSD, and Novartis to attend conferences. SEP has participated in advisory boards for BMS, MSD, Amgen, Roche, and GSK.

Prachi Bhave, BE (Hons), MBBS, FRACP

Medical Oncologist

Liverpool Hospital and Scientia Clinical Research

Sydney

Australia

Disclosures

PB has received honoraria from Novartis and sponsorship from MSD, Novartis, and BMS.

Yin Wu, MRCP, PhD

Wellcome Trust Clinical Research Career Development Fellow and Honorary Consultant Medical Oncologist

Peter Gorer Department of Immunobiology

King's College London

Department of Medical Oncology

Guy's and St Thomas' NHS Foundation Trust

London

UK

Disclosures

YW is funded by the Wellcome Trust.

Robyn P.M. Saw, MS, FRACS

Melanoma Institute Australia

The University of Sydney

Royal Prince Alfred and Mater Hospitals

Sydney

Australia

Disclosures

RPMS is on the advisory board for Novartis and MSD, and has previously been on the advisory board for Amgen. He has received honoraria from BMS.

Pablo Fernandez-Peñas, MD, PhD, FACD

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.

Acknowledgements

Dr Sophie E. Papa, Dr Prachi Bhave, Dr Yin Wu, Dr Robyn P.M. Saw, and Dr Pablo Fernandez-Peñas would like to gratefully acknowledge Dr Alexander M. Menzies, Dr Philip Friedlander, Dr Hobart W. Walling, and Dr Brian L. Swick, previous contributors to this topic.

Disclosures

AMM has received honoraria from Novartis and BMS. AMM is on the advisory boards of MSD and Chugai. PF is a consultant for Genentech. HWW and BLS declare that they have no competing interests.

Peer reviewers

David Cassarino, MD, PhD

Assistant Professor

Department of Pathology and Laboratory Medicine

University of California

Los Angeles

CA

Disclosures

DC declares that he has no competing interests.

James DeBloom, MD

Dermatologist/Dermatologic Surgeon

President of the South Carolina Skin Cancer Center

Greenville

SC

Disclosures

JB declares that he has no competing interests.

Mai Brooks, MD, FACS

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.

Karol Sikora, MA, MBBCh, PhD, FRCR, FRCP, FFPM

Medical Director

CancerPartnersUK

London

UK

Disclosures

KS declares that he has no competing interests.

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