Summary
Definition
History and exam
Key diagnostic factors
- 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
Risk factors
- 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 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
- 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)
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.
Differentials
- Benign/dysplastic melanocytic nevi
- Seborrheic keratosis
- Pigmented basal cell carcinoma
More DifferentialsGuidelines
- Suspected cancer: recognition and referral
- Clinical practice guidelines for the diagnosis and management of melanoma
More GuidelinesPatient leaflets
Skin cancer (melanoma): what is it?
Skin cancer (melanoma): how is it diagnosed and treated?
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