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
- 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
Diagnostic tests
1st tests to order
- dermoscopy
- skin biopsy
- immunohistochemistry
Tests 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
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, E15 VC and Prokarium.
Amanda Fitzpatrick, MRCP(UK), PhD
Medical Oncologist and Honorary Senior Lecturer
Guy's Cancer Centre
King's College
London
UK
Disclosures
AF declares she has no competing interests.
Pablo Fernandez-Peñas, MD, PhD, FACD
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 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.
Acknowledgements
Dr Yin Wu, Dr Amanda Fitzparick, 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.
Disclosures
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.
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
- Systemic therapy for melanoma
- Cutaneous melanoma
More GuidelinesPatient information
Skin cancer (melanoma): what is it?
Skin cancer (melanoma): how is it diagnosed and treated?
More Patient information
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