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
- 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
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
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
Declarações
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
Declarações
AF declares she has no competing interests.
Pablo Fernandez-Peñas, MD, PhD, FACD
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 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.
Agradecimentos
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.
Declarações
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.
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: management of immunotherapy-related toxicities
- Systemic therapy for melanoma
Mais DiretrizesFolhetos informativos para os pacientes
Skin cancer (melanoma): what is it?
Skin cancer (melanoma): how is it diagnosed and treated?
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