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
Risk factors
- sun exposure
- 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 bed use
- light eye colour
- increased numbers of benign-appearing melanocytic naevi
- large congenital naevi
- immunosuppression
- xeroderma pigmentosum
Diagnostic investigations
1st investigations to order
- dermoscopy
- skin biopsy
- immunohistochemistry
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)
Emerging tests
- CDKN2A mutational analysis
Treatment algorithm
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
Contributors
Authors
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
UK
Disclosures
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
UK
利益声明
AF declares she has no competing interests.
Pablo Fernandez-Peñas, MD, PhD, FACD
Professor of Dermatology
The University of Sydney
Sydney
Australia
利益声明
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.
鸣谢
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.
利益声明
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.
同行评议者
David Cassarino, MD, PhD
Assistant Professor
Department of Pathology and Laboratory Medicine
University of California
Los Angeles
CA
利益声明
DC declares that he has no competing interests.
James DeBloom, MD
Dermatologist/Dermatologic Surgeon
President of the South Carolina Skin Cancer Center
Greenville
SC
利益声明
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
利益声明
MB declares that she has no competing interests.
Karol Sikora, MA, MBBCh, PhD, FRCR, FRCP, FFPM
Medical Director
CancerPartnersUK
London
UK
利益声明
KS declares that he has no competing interests.
Peer reviewer acknowledgements
BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.
Disclosures
Peer reviewer affiliations and disclosures pertain to the time of the review.
参考文献
关键文献
National Comprehensive Cancer Network. NCCN clinical practice guidelines in oncology: melanoma - cutaneous [internet publication].全文
National Institute for Health and Care Excellence. Melanoma: assessment and management. Jul 2022 [internet publication].全文
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.全文 摘要
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.全文 摘要
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.全文 摘要
参考文献
A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
鉴别诊断
- Benign/dysplastic melanocytic naevi
- Seborrhoeic keratosis
- Pigmented basal cell carcinoma
更多 鉴别诊断指南
- NCCN clinical practice guidelines in oncology: melanoma - cutaneous
- NCCN clinical practice guidelines in oncology: management of immunotherapy-related toxicities
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