Melanoma

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Última revisão: 13 Oct 2025

Última atualização: 07 Feb 2025

Melanoma is among the most common forms of cancer, and causes of cancer-related death, in young adults.

Reducing exposure to ultraviolet light is critical for primary prevention of melanoma.

Clinical features of lesion asymmetry, border irregularity, color variability, diameter >6 mm, and evolution over time should raise suspicion for melanoma and prompt further assessment with dermoscopy.

The prognosis depends on the stage at diagnosis. Over 99% of patients with in-situ melanoma will be cured with simple excision.

Targeted therapies such as immune checkpoint inhibitors and BRAF inhibitors have revolutionized the treatment of metastatic melanoma. Five-year survival rates have improved since the approval of these therapies and are now approaching 30%.

Definição

Melanoma is a malignant tumor arising from melanocytes. It is among the most common forms of cancer in young adults and typically presents as a new or changing pigmented (brown or black) skin lesion, but there are other presentations (amelanotic or desmoplastic) with a different clinical picture.[1] The incidence of melanoma peaks in adults more than 70 years of age.[1]

Lesions are often on sun-exposed anatomic locations and more often in people with Fitzpatrick type I (white) skin.

Noncutaneous melanomas may arise from melanocytes in the uvea, meninges, or mucosal membranes. Their management is beyond the scope of this topic.

História e exame físico

Principais fatores diagnósticos

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

Detalhes completos

Fatores de risco

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

Detalhes completos

Investigações diagnósticas

Primeiras investigações a serem solicitadas

dermoscopy
skin biopsy
immunohistochemistry

Detalhes completos

Investigações a serem consideradas

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)

Detalhes completos

Novos exames

CDKN2A mutational analysis

Algoritmo de tratamento

AGUDA

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

stage III melanoma with negative sentinel nodes

stage III melanoma with positive sentinel nodes

stage III melanoma with clinically positive nodes: resectable

stage III melanoma with satellite/in-transit metastases: limited resectable disease

stage III melanoma with satellite/in-transit metastases: borderline resectable or unresectable disease

stage IV metastatic melanoma

Colaboradores

Autores

Yin Wu, MRCP(UK), 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

Declarações

YW is funded by the Wellcome Trust, and consults for PersonGen Therapeutics, and Biotherapeutics.

Amanda Fitzpatrick, MRCP(UK), PhD

Medical Oncologist and Honorary Senior Lecturer

Guy's Cancer Centre

King's College

London

Declarações

AF declares she has no competing interests.

Pablo Fernandez-Peñas, MD, PhD, FACD

Professor of Dermatology

The University of Sydney

Sydney

Australia

Declarações

PF-P declares that he has no competing interests with the topic Melanoma. PF-P has advisory roles with Amgen, Boehringer Ingelheim, Bristol Meyers Squibb, Leo, Novartis, Lilly, Abbvie, Janssen, Celgene (psoriasis, atopic eczema, hidradenitis), Roche, Merck Sharp & Dohme, Sun Pharmaceuticals, Novartis, and Sanofi. He has been paid to do research for Incyte Europe Sarl, and clinical trials for Arena, Akaal Pharma, Xoma, Kyowa Hakko Kirin, AbbVie, OncoSec, Lilly, CSL Behring, Boehringer Ingelheim, Pfizer, mRage, Eisai, Jiansu Hengrui, Bristol-Myers Squibb, Sun Pharma, Novartis, Roche, Galderma, Regeneron, UCB, GlaxoSmithKline, and Amgen.

Agradecimentos

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

Declarações

PB has received honoraria from Bristol-Myers Squibb, MSD and Novartis and sponsorship from MSD and Novartis. RPMS is on the advisory board for Novartis, MSD, and Qbiotics and has previously been on the advisory board for Amgen; he has received honoraria from BMS and Novartis. SEP has received honoraria from BMS, MSD, and Novartis to attend conferences; she has participated in advisory boards for BMS, MSD, Amgen, Roche, and GSK. AMM has received honoraria from Novartis and BMS; he 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.

Revisores

David Cassarino, MD, PhD

Assistant Professor

Department of Pathology and Laboratory Medicine

University of California

Los Angeles

Declarações

DC declares that he has no competing interests.

James DeBloom, MD

Dermatologist/Dermatologic Surgeon

President of the South Carolina Skin Cancer Center

Greenville

Declarações

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

Declarações

MB declares that she has no competing interests.

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

Medical Director

CancerPartnersUK

London

Declarações

KS declares that he has no competing interests.

Créditos aos pareceristas

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Referências

Nossas equipes internas de editoria e de evidências trabalham em conjunto com colaboradores internacionais especializados e pares revisores para garantir que forneçamos acesso às informações o mais clinicamente relevantes possível.

Principais artigos

National Comprehensive Cancer Network. NCCN clinical practice guidelines in oncology: melanoma - cutaneous [internet publication].Texto completo

National Institute for Health and Care Excellence. Melanoma: assessment and management. Jul 2022 [internet publication].Texto completo

Michielin O, van Akkooi ACJ, Ascierto PA, et al. Cutaneous melanoma: ESMO clinical practice guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2019 Dec 1;30(12):1884-901.Texto completo Resumo

Seth R, Agarwala SS, Messersmith H, et al. Systemic therapy for melanoma: ASCO guideline update. J Clin Oncol. 2023 Oct 20;41(30):4794-820.Texto completo Resumo

Vogelbaum MA, Brown PD, Messersmith H, et al. Treatment for brain metastases: ASCO-SNO-ASTRO guideline. J Clin Oncol. 2022 Feb 10;40(5):492-516.Texto completo Resumo

Artigos de referência

Uma lista completa das fontes referenciadas neste tópico está disponível para os usuários com acesso total ao BMJ Best Practice.

Diagnósticos diferenciais
- Benign/dysplastic melanocytic nevi
- Seborrheic keratosis
- Pigmented basal cell carcinoma
Mais Diagnósticos diferenciais
Diretrizes
- NCCN clinical practice guidelines in oncology: melanoma - cutaneous
- NCCN clinical practice guidelines in oncology: management of immunotherapy-related toxicities
Mais Diretrizes
Folhetos informativos para os pacientes
Skin cancer (melanoma): what is it?
Skin cancer (melanoma): how is it diagnosed and treated?
Mais Folhetos informativos para os pacientes
Conectar-se ou assinar para acessar todo o BMJ Best Practice

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Melanoma

Resumo

Definição

História e exame físico

Principais fatores diagnósticos

Fatores de risco

Investigações diagnósticas

Primeiras investigações a serem solicitadas

Investigações a serem consideradas

Novos exames

Algoritmo de tratamento

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

stage III melanoma with negative sentinel nodes

stage III melanoma with positive sentinel nodes

stage III melanoma with clinically positive nodes: resectable

stage III melanoma with satellite/in-transit metastases: limited resectable disease

stage III melanoma with satellite/in-transit metastases: borderline resectable or unresectable disease

stage IV metastatic melanoma

Colaboradores

Autores

Yin Wu, MRCP(UK), PhD

Declarações

Amanda Fitzpatrick, MRCP(UK), PhD

Declarações

Pablo Fernandez-Peñas, MD, PhD, FACD

Declarações

Agradecimentos

Declarações

Revisores

David Cassarino, MD, PhD

Declarações

James DeBloom, MD

Declarações

Mai Brooks, MD, FACS

Declarações

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

Declarações

Créditos aos pareceristas

Declarações

Referências

Principais artigos

Artigos de referência

Uma lista completa das fontes referenciadas neste tópico está disponível para os usuários com acesso total ao BMJ Best Practice.

Diagnósticos diferenciais

Diretrizes

Folhetos informativos para os pacientes

Conectar-se ou assinar para acessar todo o BMJ Best Practice

Conectar-se ou assinar para acessar todo o BMJ Best Practice

Conectar-se para acessar todo o BMJ Best Practice