Melanoma: Early Detection Saves Lives

Melanoma is an aggressive malignancy of pigment-producing cells known as melanocytes. Melanoma can arise on the skin, on mucous membranes, in or around the nail apparatus, and in the eye. The etiology of melanoma is incompletely understood, but ultraviolet radiation and genetics are believed to play a role. Subtypes include superficial spreading melanoma (the most common type), nodular melanoma, lentigo maligna melanoma (usually occurring on chronically sun-exposed skin), and acral lentiginous melanoma (presents on distal extremities).

Early melanoma is highly curable. More advanced cases require multidisciplinary input and surgical and medical therapeutic approaches. Frontline clinicians and other health care professionals can play a vital role in prevention and early detection. If you suspect melanoma, prompt referral to a dermatologist is warranted.

Evaluating Lesions

Careful skin examination is important; you can observe the skin while performing the physical examination. Ask patients if they have noticed any changing moles. Apply the ABCDEs of melanoma and the “ugly duckling” rule to evaluate individual pigmented lesions. If you notice any of the criteria, refer to a dermatologist.

The ABCDEs of melanoma:

A – Asymmetry: One half of the lesion does not mirror the other half.

B – Border: The borders are irregular or indistinct.

C – Color: The color is variegated; the pigment is not uniform, and there may be varying shades and/or hues.

D – Diameter: Classically, any pigmented lesion greater than 5-6 mm in diameter is concerning, although melanomas may also be smaller.

E – Evolving: Notable change in a lesion over time raises suspicion for malignancy. Ulceration and bleeding should prompt biopsy.

The ugly duckling rule: If a patient has multiple pigmented lesions, look for any lesion that stands out from the rest or is unlike the others.

Amelanotic melanomas have little to no pigment on visual inspection. The diagnosis of amelanotic melanoma should be in the differential diagnosis of any new or evolving pink papule, plaque, or nodule.

Prevention

• Counsel patients on sun protection.
• Teach patients to check their own skin for suspicious moles that fulfill the ABCDE or ugly duckling criteria, including less visible areas of the body such as the back, legs, and soles of feet.

Resources

VisualDx