Summary
Definition
History and exam
Key diagnostic factors
- lesão pigmentada alterada (sinais do ABCDE)
- lesão melanocítica que não se assemelha a nevos melanocíticos circundantes ("patinho feio")
- sangramento espontâneo ou ulceração de uma lesão pigmentada
- sintomas constitucionais
- sinal ungueal: melanoníquia estriada persistente em uma única unha
- sinal ungueal: sinal de Hutchinson
- achados dermatoscópicos atípicos
- linfadenopatia fixa
- metástases em trânsito
Risk factors
- exposição ao sol
- história familiar de melanoma
- história pessoal de melanoma
- história pessoal de câncer de pele (inclusive danos actínicos)
- história de nevos atípicos
- Tipo de pele I ou II (pele branca) de Fitzpatrick
- cabelo ruivo ou louro
- alta densidade de sardas
- uso de câmaras de bronzeamento
- olhos claros
- números elevados de nevos melanocíticos com aparência benigna
- nevos congênitos grandes
- imunossupressão
- xeroderma pigmentoso
Diagnostic tests
1st tests to order
- dermatoscopia
- biópsia de pele
- imuno-histoquímica
Tests to consider
- biópsia do linfonodo sentinela
- tomografia computadorizada (TC) do tórax/abdome/pelve
- PET do corpo inteiro
- imagens do cérebro (tomografia computadorizada [TC] ou ressonância nuclear magnética [RNM])
- análise mutacional em BRAF
- Análise mutacional de NRAS
- lactato desidrogenase (LDH) sérica
Emerging tests
- Análise mutacional de CDKN2A
Treatment algorithm
melanoma em estádio inicial (melanoma in situ, estádio I, estádio II)
melanoma em estádio III com linfonodos sentinelas negativos
melanoma em estádio III com linfonodos sentinelas positivos
melanoma em estágio III com linfonodos clinicamente positivos: ressecável
melanoma em estádio III com metástases satélite/em trânsito: doença limitada ressecável
melanoma em estádio III com metástases satélite/em trânsito: doença limítrofe ressecável ou irressecável
melanoma metastático em estádio 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, and Biotherapeutics.
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 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.
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.
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.
References
Key articles
National Comprehensive Cancer Network. NCCN clinical practice guidelines in oncology: melanoma - cutaneous [internet publication].Full text
National Institute for Health and Care Excellence. Melanoma: assessment and management. Jul 2022 [internet publication].Full text
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.Full text Abstract
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.Full text Abstract
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.Full text Abstract
Reference articles
A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
Differentials
- Nevos melanocíticos benignos/displásicos
- Ceratose seborreica
- Carcinoma basocelular pigmentado
More DifferentialsGuidelines
- NCCN clinical practice guidelines in oncology: melanoma - cutaneous
- NCCN clinical practice guidelines in oncology: management of immunotherapy-related toxicities
More GuidelinesFolhetos informativos para os pacientes
Como tomar sol de forma segura
Câncer de pele (melanoma): o que é?
Mais Folhetos informativos para os pacientes
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