Melanoma overview

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

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Overview

Melanoma is a malignant tumor of melanocytes which are found predominantly in skin but also in the bowel and the eye (see uveal melanoma). It is one of the rarer types of skin cancer but causes the majority of skin cancer related deaths. Despite many years of intensive laboratory and clinical research, the sole effective cure is surgical resection of the primary tumor before it achieves a thickness greater than 1 mm.

The treatment includes surgical removal of the tumor; adjuvant treatment; chemo- and immunotherapy, or radiation therapy.

Melanomas also occur in horses, see equine melanoma.

Sometimes the skin lesion may bleed, itch, or ulcerate, although this is a very late sign. A slow-healing lesion should be watched closely, as that may be a sign of melanoma. Be aware also that in circumstances that are still poorly understood, melanomas may "regress" or spontaneously become smaller or invisible - however the malignancy is still present. Amelanotic (colorless or flesh-colored) melanomas do not have pigment and may not even be visible. Lentigo maligna, a superficial melanoma confined to the topmost layers of the skin (found primarily in older patients) is often described as a "stain" on the skin. Some patients with metastatic melanoma do not have an obvious detectable primary tumor.

Staging

Staging of melanoma is essential to determine the prognosis. Staging is based on the 2010 AJCC TNM Classification and is divided into stage 0 or melanoma in situ, stage 1 or invasive melanoma with good prognosis, stage 2 or high risk melanoma, stage 3 or melanoma with regional lymph node metastasis, and stage 4 or melanoma with distant metastasis.

Physical Examination

Physical exam findings suggestive of malignant melanoma include asymmetric lesions, dark color or variable discoloration, irregular border, large or increasing size, and ulceration.