Summary
Definition
History and exam
Key diagnostic factors
- altered pigmented lesion (ABCDE signs)
- >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
- spontaneous bleeding or ulceration of a pigmented lesion
- constitutional symptoms
- 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
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
Treatment algorithm
Contributors
Authors
Alexander M. Menzies, MBBS, FRACP, PhD
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.
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 Amgen and 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 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
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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