Melanoma (cutaneous)

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Melanoma

NIH - Medical Encyclopedia Melanoma

"Melanoma is the most dangerous type of skin cancer. It involves the cells that produce pigment (melanin), which is responsible for skin and hair color. Melanoma can also involve the pigmented portion of the eye. … The primary symptom of any skin cancer is usually a mole, sore, lump, or growth on the skin. Any change in appearance of a pigmented skin lesion over time is a warning sign. Also, watch for any bleeding from a skin growth. The ABCD system may help you remember features that might be a symptom of melanoma: Asymmetry: One half of the abnormal area is different from the other half. Borders: The lesion or growth has irregular edges. Color: Color is varied from one area to another, with shades of tan, brown, or black (sometimes white, red, or blue). A mixture of colors may appear within one lesion. Diameter: The trouble spot is usually (but not always) larger than 6 mm in diameter -- about the size of a pencil eraser.

If you notice any suspicious skin markings, see your health care provider as soon as possible."

Highlighted Articles

Partner Assistance Improves Skin Self-Examination for Detecting Melanoma

"Teaching people skin self-examination (SSE) with their partner rather than alone significantly improves the likelihood that the person will perform SSE and find problematic lesions, according to the results of a randomized controlled trial reported in the January issue of Archives of Dermatology. The article reviews ABCDE (asymmetry of shape, border irregularity, color variegation, diameter = 6 mm or higher, and evolution of the lesion) rules for examining moles and notes that 50% of melanomas are discovered by patients themselves."

Comparison of risk patterns in carcinoma and melanoma of the skin in men: a multi-centre case-case-control study. (Br J Cancer. 2006)

"… Subjects with fair hair had a significant risk increase for all types of tumours ... The effect of pale eyes was significant … Intermittent sun exposure measured in hours spent at beach during holidays was significant … and number of naevi …"

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Melanoma

Diagnosis, Imaging, and Screening

NEWS:

Dermatologists Detect Melanoma Earlier Than Other Clinicians "Based on the findings of the current study and others, patients with suspected melanoma should be referred to a dermatologist. But, as Dr. Chen points out, access can be a problem."

Familial Melanoma Monitoring Worthwhile

Melanoma screening is worth the money, study shows "A one-time total-body skin exam to hunt for melanoma in patients who are older than 50 is as cost effective as other widely accepted cancer screenings such as mammograms and Pap smears. For those with a family history that includes skin cancer, getting checked every two years is also cost effective, according to a paper in last month's Archives of Dermatology. … Support for this perspective, however, is far from universal. The AAD and the American Cancer Society recommend regular skin exams, but the U.S. Preventive Services Task Force finds insufficient evidence to recommend either for or against this practice. The USPSTF does advocate that physicians be alert to possible lesions while conducting physical exams for other purposes."

Most Melanomas Found by Dermatologist, Not Patient "Most melanomas would not be detected without a dermatologist's total body skin examination, according to a study presented at the American Society for Dermatologic Surgery (ASDS) 34th Annual Meeting."

Partner Assistance Improves Skin Self-Examination for Detecting Melanoma "Teaching people skin self-examination (SSE) with their partner rather than alone significantly improves the likelihood that the person will perform SSE and find problematic lesions, according to the results of a randomized controlled trial reported in the January issue of Archives of Dermatology. The article reviews ABCDE (asymmetry of shape, border irregularity, color variegation, diameter = 6 mm or higher, and evolution of the lesion) rules for examining moles and notes that 50% of melanomas are discovered by patients themselves."

ARTICLES:

Could That Mole Be Skin Cancer? (video clip)

The role of the sentinel node in surgery for melanoma

JOURNAL ARTICLES:

A relative color approach to color discrimination for malignant melanoma detection in dermoscopy images. (Skin Res Technol. 2007) "Background: Skin lesion color is an important feature for diagnosing malignant melanoma. In previous research, skin lesion color was investigated for discriminating malignant melanoma lesions from benign lesions in clinical images. … Conclusions: Experimental results appear to indicate that the melanoma color feature information is located in the interior of the lesion, excluding the 10% central-most region. The techniques presented here including the use of relative color and the determination of benign and malignant regions of the relative color histogram may be applicable to any set of images of benign and malignant lesions."

A retrospective study addressed to understanding what predicts severe histological dysplasia/early melanoma in excised atypical melanocytic lesions. (Br J Dermatol. 2007) "Conclusions These results confirm the difficulty of differentiating accurately between benign atypical naevi and borderline lesions or early melanoma in a clinical setting. It is therefore necessary to have a sufficiently low threshold for excision to avoid missing early melanomas, particularly in older patients presenting with lesions on the extremities."

A series of melanomas smaller than 4 mm and implications for the ABCDE rule. (J Eur Acad Dermatol Venereol. 2007) "Conclusions The findings of this study support those authors who have suggested elimination of the 6-mm diameter criterion in the ABCDE rule. In addition, this study provides further evidence that dark colour as a diagnostic criterion for melanoma should be given more emphasis. The substitution of 'D' to represent dark instead of diameter is worthy of consideration to enhance the value of the ABCDE mnemonic."

Clinical and Molecular Characterization of Patients at Risk for Hereditary Melanoma in Southern Brazil. (J Invest Dermatol. 2007)

Clinical pathways to diagnose melanoma: a population-based study. (Melanoma Res. 2007)

Dermoscopic features of difficult melanoma. (Dermatol Surg. 2007) "BACKGROUND The dermoscopic diagnosis of cutaneous melanoma (CM) may be difficult because some CM lack specific dermoscopic features for melanoma diagnosis…. CONCLUSION A significant number of melanomas defy even dermoscopic diagnosis. Only a meticulous comparative and interactive process based on an assessment of all the individual's other nevi ("ugly ducking" sign) and a knowledge about recent changes can lead to the recognition of DDM."

Detection of First Relapse in Cutaneous Melanoma Patients: Implications for the Formulation of Evidence-Based Follow-up Guidelines. (Ann Surg Oncol. 2007) "CONCLUSIONS: Three-quarters of FMRs were detected by patients or their partners, and it should be possible to improve this rate even further by better education. More frequent follow-up visits are thus unlikely to be valuable. Reductions in follow-up frequency may therefore be safe and economically responsible."

Diagnosis and treatment of interval sentinel lymph nodes in patients with cutaneous melanoma. (Plast Reconstr Surg. 2007) " CONCLUSIONS: Interval sentinel nodes seem as likely to contain micrometastatic disease as those in the expected sentinel lymph node basin. Half of the subjects displayed interval sentinel lymph nodes that were not in the anticipated lymphatic pathway between the primary tumor and the sentinel lymph node basin. These findings suggest that adequate preoperative lymphoscintigraphy and intraoperative recognition of interval nodes are of paramount importance in the treatment of melanoma."

Factors associated with thorough skin self-examination for the early detection of melanoma. (J Eur Acad Dermatol Venereol. 2007)

Melanoma early detection with thorough skin self-examination the "check it out" randomized trial. (Am J Prev Med. 2007)

Melanoma screening with cellular phones. (PLoS ONE. 2007)

Melanoma: prevention and early detection. (Semin Oncol. 2007)

Non-Radical Diagnostic Biopsies Do Not Negatively Influence Melanoma Patient Survival. (Ann Surg Oncol. 2007) "Both the diagnostic biopsy type and the presence of tumor cells in the re-excision specimen did not influence disease free and overall survival of melanoma patients. CONCLUSIONS: Non-radical diagnostic biopsies do not negatively influence melanoma patient survival."

Patient education and regular surveillance results in earlier diagnosis of second primary melanoma. (Int J Dermatol. 2007) "Conclusions Upon analysis of our data, subsequent primary cutaneous melanomas were found to be significantly thinner than initial primary melanomas at the time of diagnosis. This suggests that earlier diagnosis may be the result of patient education and careful follow up. Counselling on the risk of developing a second primary melanoma, education regarding clinical characteristics of melanoma, and routine lifelong follow up should be provided to all patients diagnosed with a cutaneous melanoma."

Pelvic Lymph Node Dissection Is Beneficial in Subsets of Patients with Node-positive Melanoma. (Ann Surg Oncol. 2007)

PET CT imaging in patients undergoing sentinel node biopsy for melanoma. (Eur J Surg Oncol. 2007) "CONCLUSIONS: The results of this study do not support the use of PET/CT in patients undergoing SLNB for melanoma. SLNB appears to be a more sensitive staging modality in the detection of lymphatic metastasis; however PET/CT may have a future role as a screening tool for malignancy."

Prediction of metastases in melanoma patients with positive sentinel node: Histological and molecular approach. (J Dermatol. 2007)

Prognostic value of sentinel node biopsy in 327 prospective melanoma patients from a single institution. (Eur J Surg Oncol. 2007) "CONCLUSION: SNB is a reliable procedure with high sensitivity (91.4%) and low morbidity. Breslow thickness was the only statistically significant parameter predictive of SN status. DFS was worsened in decreasing order by Breslow thickness, metastatic SN and male gender. Similarly DSS was significantly worsened by a metastatic SN, male gender, Breslow thickness and ulceration. These data reinforce the SN status as a powerful staging procedure."

Reliability of Lymphatic Mapping After Wide Local Excision of Cutaneous Melanoma. (Ann Surg Oncol. 2007)

Sentinel lymph node biopsy in cutaneous melanoma. (Acta Cir Bras. 2007) "CONCLUSION: Sentinel lymph node biopsy was demonstrated to be a safe method for selecting patients who need therapeutic lymphadenectomy."

Sentinel lymph node biopsy in cutaneous melanoma: outcome after 5-years follow-up. (Eur J Dermatol. 2007) "In our experience, sentinel lymph node technique is a safe procedure with few complications and good pronostic value. This technique allows the identification of patients with a high risk of recurrence who could benefit from early adjuvant therapeutic management. However, these results show that the survival rate of patients with positive sentinel lymph nodes remains significantly lower, even when elective lymph node dissection is performed."

Sentinel lymph node biopsy in melanoma: a micromorphometric study relating to prognosis and completion lymph node dissection. (Br J Dermatol. 2007)

Sentinel lymph node biopsy in patients with thick (= 4 mm) melanoma: a single-centre experience. (J Eur Acad Dermatol Venereol. 2007) "Conclusion Our retrospective analysis indicates that the SLN status is predictive of recurrence and survival in patients with thick melanoma, and LM/SLNB should be routinely performed in this subset of melanoma patients."

Sentinel lymph node biopsy in patients with thin melanomas. (J Dermatol. 2007) "Published data and our experience suggest that LM/SLNB is not routinely indicated for melanomas less than 0.75 mm. Our results confirmed the accuracy of the new American Joint Committee on Cancer/International Union Against Cancer criteria, in which SLNB is required for thin melanomas less than 1.0 mm when they have ulceration or Clark level IV and V invasion."

Sentinel lymph node molecular ultrastaging in patients with melanoma: a systematic review and meta-analysis of prognosis. (J Clin Oncol. 2007)

Sentinel node biopsy in cutaneous melanoma: correlations between melanoma prognostic factors and sentinel node status. (J Exp Clin Cancer Res. 2007)

Sentinel node biopsy versus elective lymph node dissection in patients with cutaneous melanoma in a Japanese population. (Int J Clin Oncol. 2007) "CONCLUSION: This interim result in a Japanese melanoma population with clinically node-negative disease demonstrated that SNB identified more nodal micrometastases than ELND. This increase in accurate staging likely resulted from the reliable identification of the lymph node field by lymphoscintigraphy, as well as the more detailed pathologic examination of the nodes removed in SNB. It is quite reasonable to perform SNB instead of ELND in this population."

Sentinel node staging of primary melanoma by the "10% rule": pathology and clinical outcomes. (Am J Surg. 2007) "BACKGROUND: Surgical staging of clinically node-negative primary melanoma involves identification and removal of "sentinel" lymph nodes (SLNs). Although some suggest removal of only the "hottest" SLN, the "10% rule" dictates that nodes are removed until the background count is 10% or less of the count of the "hottest" node. … CONCLUSIONS: Sentinel node staging of melanoma by the 10% rule provides significant prognostic information and a modest increase in tumor detection compared with removal of only the "hottest" node."

The correlation of regression in primary melanoma with sentinel lymph node status. (J Clin Pathol. 2007)

The Role of Interval Nodes in Sentinel Lymph Node Mapping and Dissection for Melanoma Patients. (J Nucl Med. 2007)

The utility of ultrasound in patients with melanoma. (Expert Rev Anticancer Ther. 2007)

Time to diagnosis of melanoma: same trend in different continents. (J Cutan Med Surg. 2007) "More females detected their lesions by themselves. The change to a darker color (21%) and enlargement of the area of the lesion (19%) were the major signs. The highest knowledge among patients that early detection may improve the outcome was found in Sweden and Australia. At each center, the media (newspaper, magazine, radio, and television) provided the best sources of information about melanoma. Twenty to 33% of all physicians initially consulted missed the melanoma diagnosis, independent of their specialty."

Trends in melanoma epidemiology suggest three different types of melanoma. (Br J Dermatol. 2007) "Conclusions Temporal trends suggest the existence of three unrelated types of melanoma: type I, thick melanomas, with stable incidence; type II, thin melanoma with a steady and important increase in incidence, mainly located on the trunk; and type III, melanoma with a slower increase in incidence, mainly located on the head and neck region."

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