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DermSpaceby Mediverse

Melanoma

Also called malignant melanoma

The skin cancer that kills: malignant melanocytes. Found by pattern-breaking, asymmetry, border irregularity, colour variegation, diameter, and above all evolution. The ABCDEs are a screening aid, not a diagnostic algorithm: nodular and amelanotic melanomas break the rules.

Try the case
Asymmetric variegated melanoma with irregular border
Hover or drag to examine with the dermatoscopeUnknown authorUnknown author · Public domain

How it looks

A 9 mm asymmetric pigmented macule on the back with an irregular, notched border and variegated brown-black-blue colour, reported to have changed over months, the 'ugly duckling' unlike its neighbours.

MaculePapuleNoduleHyperpigmentationDiscreteTruncal

Rose is the lesion, grey the pattern the lesions make, green where on the body it lives.

Across skin tones

In deeply pigmented skin, melanoma disproportionately arises at acral sites, palms, soles, nail units, where nobody is looking. Acral lentiginous melanoma is why the foot exam and a new longitudinal nail band with pigment spilling onto the nail fold (Hutchinson sign) matter in every skin tone.

Don't miss

The ugly duckling sign, one lesion unlike all the patient's others, outperforms any letter of the ABCDEs. Trust the pattern-break.

Beyond the skinAfter excision: closing the defect with a local flap in SurgSpace

Symptoms & course

  • Usually asymptomatic, change IS the symptom
  • Itch, bleeding, or ulceration are late signs

Diagnostic approach

  • Dermoscopy by a trained examiner
  • Excisional biopsy with narrow margins for any suspicious lesion, never a partial shave of a suspected melanoma
  • Staging is driven by Breslow depth

Differential, and how to separate them

  • Seborrheic keratosis

    Favours it: Stuck-on, waxy, keratin-plugged surface, one of many similar

    Against it: Melanoma is flat-to-nodular with colour chaos and stands alone

  • Basal cell carcinoma

    Favours it: Pearly translucent nodule with arborising vessels

    Against it: Pigmented BCC exists, dermoscopy and biopsy decide

Management principles

  • Wide local excision with margins by depth
  • Sentinel node evaluation and systemic therapy per stage
  • Lifelong skin surveillance and photoprotection

Clinical pearl: 'Has it changed?' is the most important question about any pigmented lesion, evolution beats every static feature.

Keep going

Try the case: The spot that changedCompare with Seborrheic keratosisBack to the Atlas