Melanoma is a cancer that develops from melanocytes, the pigment-producing cells of the skin. It can arise on different skin sites and can spread to lymph nodes or distant organs if not detected and treated early.
Melanoma is a malignant tumor of melanocytes. Most melanomas arise in the skin, although melanomas can also arise at other sites containing melanocytes. Early melanoma may be highly treatable, while deeper or metastatic disease requires more extensive evaluation and systemic therapy.
Melanocytes are pigment-producing cells located primarily in the basal layer of the epidermis. Melanoma can invade the dermis and deeper tissues and can spread through lymphatic channels or blood vessels.
Melanoma begins when melanocytes develop genetic changes that disrupt normal control of cell growth and survival. The abnormal cells multiply and may progressively invade surrounding skin and deeper tissues.
A melanocyte acquires genetic changes that allow abnormal growth and survival. The tumor may invade deeper layers of skin and can spread through lymphatic or blood vessels to lymph nodes and distant organs.
Melanoma is classified by anatomical site, microscopic features, tumor thickness, ulceration, lymph-node involvement and distant metastasis. Common cutaneous patterns include superficial spreading, nodular, lentigo maligna and acral lentiginous melanoma.
Major cutaneous melanoma patterns include superficial spreading melanoma, nodular melanoma, lentigo maligna melanoma and acral lentiginous melanoma. Less common melanomas can arise at mucosal or ocular sites and have different clinical characteristics.
A new pigmented skin lesion
A mole that changes in size, shape or color
Asymmetry of a mole or pigmented lesion
Irregular or poorly defined border
Multiple or uneven colors within a lesion
Increasing diameter of a lesion
Evolution or continued change over time
Persistent itching
Bleeding or oozing from a lesion
Crusting or ulceration
New pigmented lesions near an existing melanoma
Enlarged lymph nodes in more advanced disease
Melanoma results from accumulated genetic changes in melanocytes. Ultraviolet radiation is an important environmental risk factor, but melanoma can also occur in areas with limited sun exposure and in people with different skin types.
High cumulative ultraviolet exposure
Repeated sunburns, especially earlier in life
Indoor tanning
Fair skin that burns easily
Large number of ordinary moles
Atypical or dysplastic nevi
Personal history of melanoma
Family history of melanoma
Inherited melanoma-predisposition variants
Weakened immune system
Increasing age, while melanoma can occur at any age
Diagnosis begins with a clinical skin examination followed by biopsy of a suspicious lesion. Pathology determines whether melanoma is present and reports important features such as Breslow thickness and ulceration. Additional imaging and lymph-node evaluation are used when indicated for staging.
Asymmetric pigmented lesion
Irregular border
Uneven or multiple colors
Increasing lesion diameter
Visible evolution over time
Bleeding, crusting or ulceration
New satellite or nearby pigmented lesions
Enlarged regional lymph nodes
Other suspicious pigmented skin lesions
Signs of distant disease when clinically advanced
Histopathology of the skin biopsy
Breslow tumor thickness measurement
Assessment of ulceration
Pathologic assessment of margins
LDH blood test in selected advanced disease
Routine blood chemistry for treatment and organ-function assessment
Molecular testing for actionable variants when indicated
BRAF mutation testing in appropriate advanced melanoma
Other molecular profiling when clinically indicated
Ultrasound of regional lymph nodes
PET-CT for selected higher-risk or advanced disease
CT imaging for staging selected patients
MRI of the brain for selected advanced or high-risk disease
Other targeted imaging based on symptoms or suspected metastasis
Dermoscopic examination
Excisional or appropriate skin biopsy
Sentinel lymph-node biopsy when indicated
Expert dermatopathology review
Molecular testing for BRAF and other actionable alterations when appropriate
Additional pathology or molecular testing for advanced disease
Common benign nevus
Dysplastic or atypical nevus
Seborrheic keratosis
Solar lentigo
Pigmented basal cell carcinoma
Pigmented actinic keratosis
Hemangioma or other benign pigmented lesion
Pigmented dermatologic infection or inflammatory lesion
Melanoma is commonly staged from 0 through IV using TNM-based criteria. Stage is influenced by tumor thickness and ulceration, regional lymph-node involvement and distant metastasis.
Staging or grading systems differ between diseases. The information here is educational and should be interpreted by a qualified healthcare professional in the context of the individual case.
Localized melanoma is primarily treated with surgical excision. Depending on stage and risk, treatment may also include sentinel lymph-node evaluation, adjuvant immunotherapy, targeted therapy for appropriate molecular findings, radiation in selected situations and systemic immunotherapy or targeted therapy for advanced disease.
Pembrolizumab for selected melanoma settings
Nivolumab for selected melanoma settings
Ipilimumab for selected advanced melanoma settings
Nivolumab plus ipilimumab in selected advanced disease
BRAF and MEK inhibitor combinations for appropriate BRAF-mutant melanoma
Other targeted or immunotherapy options selected by melanoma subtype and stage
Supportive medicines for treatment-related adverse effects
Medicines listed here are for educational information only. Do not start, stop, or change a medicine without professional medical advice.
Complications may result from local tumor growth, lymph-node or distant metastasis, surgery or systemic treatment. Possible problems include wound complications, lymphedema, immune-related adverse effects, organ metastases and recurrence.
Severe shortness of breath or chest pain in advanced disease
New seizure, confusion, severe headache or sudden neurologic symptoms
Rapidly worsening weakness or loss of consciousness
Heavy or uncontrolled bleeding from a tumor or surgical site
Severe allergic or treatment-related reaction
High fever or rapidly worsening illness during cancer treatment
If symptoms are severe, rapidly worsening, or life-threatening, seek emergency medical care immediately.
Prognosis is strongly influenced by tumor thickness, ulceration, lymph-node status, distant metastasis and response to therapy. Early localized melanoma generally has a much more favorable outlook than metastatic disease.
Survival statistics describe outcomes in groups of people and cannot predict exactly what will happen to one individual. Prognosis depends on factors such as cancer stage, tumor biology, treatment response, overall health, and follow-up.
Melanoma can occur at any age and in people of all skin types. Risk patterns vary by age, genetic susceptibility, ultraviolet exposure and geographic setting. Melanoma is less common than basal or squamous cell skin cancer but accounts for a disproportionate share of skin-cancer deaths.
Avoid excessive ultraviolet exposure and indoor tanning. Use shade, protective clothing and suitable sunscreen, and monitor the skin for new or changing lesions. Prompt clinical evaluation of suspicious changes improves the chance of early diagnosis.
What is the exact melanoma subtype and pathology diagnosis?
What is the Breslow thickness and is ulceration present?
What stage is the melanoma?
Is sentinel lymph-node biopsy recommended?
Are there regional lymph-node or distant metastases?
Should BRAF or other molecular testing be performed?
What surgery and margins are recommended?
Is adjuvant immunotherapy or targeted therapy appropriate?
What symptoms should prompt urgent medical attention?
What follow-up skin examinations and imaging are needed?
BimariDur provides educational health information to help people understand diseases, symptoms, tests, and treatment concepts. It does not replace examination, diagnosis, or treatment by a qualified healthcare professional.
Do not delay professional medical care because of information read on BimariDur.