Resumo
Definição
História e exame físico
Principais fatores diagnósticos
- 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
Fatores de risco
- 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
- exposição ao sol
- uso de câmaras de bronzeamento
- olhos claros
- números elevados de nevos melanocíticos com aparência benigna
- nevos congênitos grandes
- imunossupressão
- xeroderma pigmentoso
Investigações diagnósticas
Primeiras investigações a serem solicitadas
- dermatoscopia
- biópsia de pele
- imuno-histoquímica
Investigações a serem consideradas
- 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
Novos exames
- Análise mutacional de CDKN2A
Algoritmo de tratamento
melanoma em estádio inicial (melanoma in situ, estádio I, estádio II)
melanoma avançado ressecável (estádio III e estádio IV)
doença avançada irressecável (estádio III e estádio IV)
Colaboradores
Autores
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
Declarações
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
Declarações
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
Declarações
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
Declarações
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
Declarações
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.
Agradecimentos
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.
Declarações
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.
Revisores
David Cassarino, MD, PhD
Assistant Professor
Department of Pathology and Laboratory Medicine
University of California
Los Angeles
CA
Declarações
DC declares that he has no competing interests.
James DeBloom, MD
Dermatologist/Dermatologic Surgeon
President of the South Carolina Skin Cancer Center
Greenville
SC
Declarações
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
Declarações
MB declares that she has no competing interests.
Karol Sikora, MA, MBBCh, PhD, FRCR, FRCP, FFPM
Medical Director
CancerPartnersUK
London
UK
Declarações
KS declares that he has no competing interests.
Diagnósticos diferenciais
- Nevos melanocíticos benignos/displásicos
- Ceratose seborreica
- Carcinoma basocelular pigmentado
Mais Diagnósticos diferenciaisDiretrizes
- NCCN clinical practice guidelines in oncology: cutaneous melanoma
- Clinical practice guidelines for the diagnosis and management of melanoma
Mais DiretrizesFolhetos informativos para os pacientes
Câncer de pele (melanoma): o que é?
Câncer de pele (melanoma): como é diagnosticado e tratado?
Mais Folhetos informativos para os pacientes
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