Melanoma physical examination: Difference between revisions

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{{CMG}}
__NOTOC__
 
{{CMG}}; {{AE}}: {{YD}}, {{SSK}}, {{JH}}.
{{Melanoma}}
{{Melanoma}}


==Overview==
==Overview==
Physical examination findings suggestive of [[malignant]] melanoma include ABCDE: <u>A</u>symmetry of the [[lesion]], <u>B</u>order irregularity, <u>C</u>olor change, large [[Diameter|<u>D</u>iameter]], and <u>E</u>volution over time.


==Physical Examination==
==Physical Examination==
Moles that are irregular in color or shape are suspicious of a malignant or a premalignant melanoma. Following a visual examination and a [[Dermatoscopy|dermatoscopic exam]] (an instrument that illuminates a mole, revealing its underlying pigment and vascular network structure), the doctor may biopsy the suspicious mole.  If it is malignant, the mole and an area around it needs excision. This will require a referral to a surgeon or dermatologist.
===Skin===
*Although melanoma can occur anywhere, melanoma among women occurs more commonly on the [[Limb (anatomy)|extremities]], and among men it occurs more commonly on the [[trunk]] or [[head]] and [[neck]].
*[[Patient|Patients]] with suspected melanoma should have a full-[[Human body|body]] examination for other [[Lesion|lesions]].
 
*On [[physical examination]], the ABCDE for distinguishing [[benign]] [[Nevus|nevi]] from [[malignant]] melanoma are:
:*'''A''' - ''Asymmetry'' (suggestive of melanoma)<ref name="pmid28036304">{{cite journal |vauthors=Lee H, Kwon K |title=A mathematical analysis of the ABCD criteria for diagnosing malignant melanoma |journal=Phys Med Biol |volume=62 |issue=5 |pages=1865–1884 |date=March 2017 |pmid=28036304 |doi=10.1088/1361-6560/aa562f |url=}}</ref><ref name="pmid25698455">{{cite journal |vauthors=Tsao H, Olazagasti JM, Cordoro KM, Brewer JD, Taylor SC, Bordeaux JS, Chren MM, Sober AJ, Tegeler C, Bhushan R, Begolka WS |title=Early detection of melanoma: reviewing the ABCDEs |journal=J. Am. Acad. Dermatol. |volume=72 |issue=4 |pages=717–23 |date=April 2015 |pmid=25698455 |doi=10.1016/j.jaad.2015.01.025 |url=}}</ref>
:*'''B''' - ''Border irregularity'' (suggestive of melanoma)
:*'''C''' - ''Color'' (irregular color or discoloration, very dark color suggestive of melanoma)
:*'''D''' - ''[[Diameter]]'' (large size or increase in size suggestive of melanoma)
:*'''E''' - ''Evolution over time''
 
*Other signs in a nevus that would suggest a [[malignant]] change include the following:
:*Development of [[Satellite (biology)|satellites]]
:*[[Ulcer|Ulceration]] or [[bleeding]] (late signs)<ref name="pmid25389339">{{cite journal |vauthors=Bønnelykke-Behrndtz ML, Schmidt H, Christensen IJ, Damsgaard TE, Møller HJ, Bastholt L, Nørgaard PH, Steiniche T |title=Prognostic stratification of ulcerated melanoma: not only the extent matters |journal=Am. J. Clin. Pathol. |volume=142 |issue=6 |pages=845–56 |date=December 2014 |pmid=25389339 |doi=10.1309/AJCPW56PHGLFTKZC |url=}}</ref><ref name="pmid21954690">{{cite journal |vauthors=Callender GG, McMasters KM |title=What does ulceration of a melanoma mean for prognosis? |journal=Adv Surg |volume=45 |issue= |pages=225–36 |date=2011 |pmid=21954690 |doi= |url=}}</ref><ref name="pmid30192302">{{cite journal |vauthors=Tromme I, Sacré L, Hammouch F, Richez P, Degryse JM, Speybroeck N |title=Melanoma diagnosis: predictive value of macroscopic changes observed by the patient |journal=Melanoma Res. |volume=28 |issue=6 |pages=611–617 |date=December 2018 |pmid=30192302 |doi=10.1097/CMR.0000000000000496 |url=}}</ref>
 
* Any suggestive findings detected on [[Physical examination|physical exam]] warrant a complete [[Biopsy|excisional biopsy]]. To view the complete approach for a suspected melanoma, click [[Melanoma biopsy#Approach to Patients with Suspected Melanoma|'''here''']].
 
===Gallery===
====HEENT====
 
<gallery>
 
Image: Melanoma_04.jpg| Melanoma. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/disease.jsf?diseaseId=12  With permission from Dermatology Atlas.]''<ref name="www.atlasdermatologico.com.br">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/disease.jsf?diseaseId=283>
 
Image: Melanoma_06.jpg | Melanoma. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/disease.jsf?diseaseId=12  With permission from Dermatology Atlas.]''<ref name="www.atlasdermatologico.com.br">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/disease.jsf?diseaseId=283>
 
Image: Melanoma_07.jpg | Melanoma. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/disease.jsf?diseaseId=12  With permission from Dermatology Atlas.]''<ref name="www.atlasdermatologico.com.br">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/disease.jsf?diseaseId=283>
 
Image: Melanoma_08.jpg | Melanoma. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/disease.jsf?diseaseId=12  With permission from Dermatology Atlas.]''<ref name="www.atlasdermatologico.com.br">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/disease.jsf?diseaseId=283>
 
Image: Melanoma_10.jpg | Melanoma. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/disease.jsf?diseaseId=12  With permission from Dermatology Atlas.]''<ref name="www.atlasdermatologico.com.br">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/disease.jsf?diseaseId=283>
 
Image: Melanoma_12.jpg | Melanoma. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/disease.jsf?diseaseId=12  With permission from Dermatology Atlas.]''<ref name="www.atlasdermatologico.com.br">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/disease.jsf?diseaseId=283>
 
Image: Melanoma_13.jpg | Melanoma. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/disease.jsf?diseaseId=12  With permission from Dermatology Atlas.]''<ref name="www.atlasdermatologico.com.br">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/disease.jsf?diseaseId=283>
 
Image: Melanoma_14.jpg | Melanoma. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/disease.jsf?diseaseId=12  With permission from Dermatology Atlas.]''<ref name="www.atlasdermatologico.com.br">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/disease.jsf?diseaseId=283>
 
Image: Melanoma_16.jpg | Melanoma. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/disease.jsf?diseaseId=12  With permission from Dermatology Atlas.]''<ref name="www.atlasdermatologico.com.br">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/disease.jsf?diseaseId=283>
 
Image: Melanoma_17.jpg | Melanoma. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/disease.jsf?diseaseId=12  With permission from Dermatology Atlas.]''<ref name="www.atlasdermatologico.com.br">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/disease.jsf?diseaseId=283>
 
Image: Melanoma_18.jpg | Melanoma. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/disease.jsf?diseaseId=12  With permission from Dermatology Atlas.]''<ref name="www.atlasdermatologico.com.br">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/disease.jsf?diseaseId=283>
 
Image: Melanoma_19.jpg | Melanoma. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/disease.jsf?diseaseId=12  With permission from Dermatology Atlas.]''<ref name="www.atlasdermatologico.com.br">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/disease.jsf?diseaseId=283>
 
Image: Melanoma_21.jpg | Melanoma. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/disease.jsf?diseaseId=12  With permission from Dermatology Atlas.]''<ref name="www.atlasdermatologico.com.br">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/disease.jsf?diseaseId=283>
 
Image: Melanoma_23.jpg | Melanoma. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/disease.jsf?diseaseId=12  With permission from Dermatology Atlas.]''<ref name="www.atlasdermatologico.com.br">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/disease.jsf?diseaseId=283>
 
Image: Melanoma_26.jpg | Melanoma. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/disease.jsf?diseaseId=12  With permission from Dermatology Atlas.]''<ref name="www.atlasdermatologico.com.br">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/disease.jsf?diseaseId=283>
 
Image: Melanoma_02.jpg | Melanoma. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/disease.jsf?diseaseId=12  With permission from Dermatology Atlas.]''<ref name="www.atlasdermatologico.com.br">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/disease.jsf?diseaseId=283>
 
Image: Melanoma_11.jpg | Melanoma. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/disease.jsf?diseaseId=12  With permission from Dermatology Atlas.]''<ref name="www.atlasdermatologico.com.br">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/disease.jsf?diseaseId=283>
 
Image:Amelanotic_lentigo_maligna_01.jpeg|Lentigo maligna melanoma. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/disease.jsf?diseaseId=12  With permission from Dermatology Atlas.]''<ref name="www.atlasdermatologico.com.br">{{Cite web | title = Dermatology Atlas | url = http://atlasdermatologico.com.br/disease.jsf?diseaseId=26>
 
Image:Amelanotic_lentigo_maligna_02.png|Lentigo maligna melanoma. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/disease.jsf?diseaseId=12  With permission from Dermatology Atlas.]''<ref name="www.atlasdermatologico.com.br">{{Cite web | title = Dermatology Atlas | url = http://atlasdermatologico.com.br/disease.jsf?diseaseId=26>
 
Image:Amelanotic_lentigo_maligna_03.jpeg|Lentigo maligna melanoma. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/disease.jsf?diseaseId=12  With permission from Dermatology Atlas.]''<ref name="www.atlasdermatologico.com.br">{{Cite web | title = Dermatology Atlas | url = http://atlasdermatologico.com.br/disease.jsf?diseaseId=26>
 
Image:Amelanotic_lentigo_maligna_04.jpeg|Lentigo maligna melanoma. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/disease.jsf?diseaseId=12  With permission from Dermatology Atlas.]''<ref name="www.atlasdermatologico.com.br">{{Cite web | title = Dermatology Atlas | url = http://atlasdermatologico.com.br/disease.jsf?diseaseId=26>
 
 
Image:NodularMelanomaEvolution.jpg|Evolution of nodular melanoma. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/disease.jsf?diseaseId=12  With permission from Dermatology Atlas.]''<ref name="www.atlasdermatologico.com.br">{{Cite web | title = Dermatology Atlas | url = http://atlasdermatologico.com.br/disease.jsf?diseaseId=26>
 
</gallery>
 
====Extremities====
 
<gallery>
 
Image: Melanoma_01.jpg | Melanoma. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/disease.jsf?diseaseId=12  With permission from Dermatology Atlas.]''<ref name="www.atlasdermatologico.com.br">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/disease.jsf?diseaseId=283>
 
Image: Melanoma_03.jpg | Melanoma. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/disease.jsf?diseaseId=12  With permission from Dermatology Atlas.]''<ref name="www.atlasdermatologico.com.br">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/disease.jsf?diseaseId=283>
 
Image: Melanoma_09.jpg | Melanoma. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/disease.jsf?diseaseId=12  With permission from Dermatology Atlas.]''<ref name="www.atlasdermatologico.com.br">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/disease.jsf?diseaseId=283>
 
Image: Melanoma_20.jpg | Melanoma. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/disease.jsf?diseaseId=12  With permission from Dermatology Atlas.]''<ref name="www.atlasdermatologico.com.br">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/disease.jsf?diseaseId=283>
 
Image: Melanoma_22.jpg | Melanoma. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/disease.jsf?diseaseId=12 With permission from Dermatology Atlas.]''<ref name="www.atlasdermatologico.com.br">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/disease.jsf?diseaseId=283>
 
</gallery>
 
====Genitales====
 
<gallery>


The diagnosis of melanoma requires experience, as early stages may look identical to harmless [[Mole (skin marking)|moles]] or not have any color at all. Where any doubt exists, the patient will be referred to a specialist dermatologist. Beyond this expert knowledge a [[biopsy]] performed under [[local anesthesia]] is often required to assist in making or confirming the [[diagnosis]] and in defining the severity of the melanoma.
Image: Melanoma_05.jpg | Melanoma. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/disease.jsf?diseaseId=12  With permission from Dermatology Atlas.]''<ref name="www.atlasdermatologico.com.br">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/disease.jsf?diseaseId=283>


==Images==
</gallery>
{|
|-
| Skin|| Ear Nose Throat
|-
! [[Image:melanoma.jpg|thumb|200px|left|Skin Melanoma<ref>http://picasaweb.google.com/mcmumbi/USMLEIIImages/photo#5089143285975657906</ref>]]
! [[Image:AuricleMelanoma SqCC.jpg|thumb|left|ENT - This patient had two adjacent cancers.  The flat black lesion below the antitragus is a malignant melanoma.  The white elevated keratotic lesion is a squamous cell carcinoma <ref>http://www.ghorayeb.com</ref>.]]
|}


==References==
==References==
{{Reflist|2}}
{{Reflist|2}}
[[Category:Up-To-Date]]
[[Category:Oncology]]
[[Category:Medicine]]
[[Category:Dermatology]]
[[Category:Surgery]]

Latest revision as of 20:30, 3 January 2019


Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: : Yazan Daaboul, M.D., Serge Korjian M.D., Jesus Rosario Hernandez, M.D. [2].

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Overview

Physical examination findings suggestive of malignant melanoma include ABCDE: Asymmetry of the lesion, Border irregularity, Color change, large Diameter, and Evolution over time.

Physical Examination

Skin

  • Although melanoma can occur anywhere, melanoma among women occurs more commonly on the extremities, and among men it occurs more commonly on the trunk or head and neck.
  • Patients with suspected melanoma should have a full-body examination for other lesions.
  • A - Asymmetry (suggestive of melanoma)[1][2]
  • B - Border irregularity (suggestive of melanoma)
  • C - Color (irregular color or discoloration, very dark color suggestive of melanoma)
  • D - Diameter (large size or increase in size suggestive of melanoma)
  • E - Evolution over time
  • Other signs in a nevus that would suggest a malignant change include the following:

Gallery

HEENT

Extremities

Genitales

References

  1. ↑ Lee H, Kwon K (March 2017). "A mathematical analysis of the ABCD criteria for diagnosing malignant melanoma". Phys Med Biol. 62 (5): 1865–1884. doi:10.1088/1361-6560/aa562f. PMID 28036304.
  2. ↑ Tsao H, Olazagasti JM, Cordoro KM, Brewer JD, Taylor SC, Bordeaux JS, Chren MM, Sober AJ, Tegeler C, Bhushan R, Begolka WS (April 2015). "Early detection of melanoma: reviewing the ABCDEs". J. Am. Acad. Dermatol. 72 (4): 717–23. doi:10.1016/j.jaad.2015.01.025. PMID 25698455.
  3. ↑ Bønnelykke-Behrndtz ML, Schmidt H, Christensen IJ, Damsgaard TE, Møller HJ, Bastholt L, Nørgaard PH, Steiniche T (December 2014). "Prognostic stratification of ulcerated melanoma: not only the extent matters". Am. J. Clin. Pathol. 142 (6): 845–56. doi:10.1309/AJCPW56PHGLFTKZC. PMID 25389339.
  4. ↑ Callender GG, McMasters KM (2011). "What does ulceration of a melanoma mean for prognosis?". Adv Surg. 45: 225–36. PMID 21954690.
  5. ↑ Tromme I, Sacré L, Hammouch F, Richez P, Degryse JM, Speybroeck N (December 2018). "Melanoma diagnosis: predictive value of macroscopic changes observed by the patient". Melanoma Res. 28 (6): 611–617. doi:10.1097/CMR.0000000000000496. PMID 30192302.
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