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Melanoma in Adult

See also in: External and Internal Eye,Anogenital,Hair and Scalp,Oral Mucosal Lesion
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Contributors: Jeffrey M. Cohen MD, William M. Lin MD, Sarah Hocker DO, Susan Burgin MD
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Synopsis

Melanoma is an aggressive malignancy of pigment-producing cells known as melanocytes. Melanoma may arise at sites of melanocytes including on the skin, mucous membranes, around the nail apparatus (see nail melanoma), and in the eye. There are 4 main subtypes of melanoma: superficial spreading melanoma (the most common type), nodular melanoma, lentigo maligna melanoma, and acral lentiginous melanoma (the least common type).

The etiology of melanoma is incompletely understood, although ultraviolet radiation is believed to play a role in some melanomas and knowledge of the melanoma genome continues to advance. Melanoma has been shown to have one of highest mutation rates of any cancer type, reflective of its clinical and pathologic diversity and resistance to treatment in advanced stages.

Risk factors for melanoma include a family history or prior personal history of melanoma, a history of severe or blistering sunburns, a changing mole, a giant congenital nevus (greater than 20 cm), older age, lighter skin phototype, and multiple atypical nevi. In a case control study of over 1000 patients, 3 or more iris pigmented lesions conferred an increased risk for cutaneous melanoma. Men are more prone to developing melanoma on the head, neck, and trunk, whereas women tend to develop melanoma on the arms and legs. The median age at diagnosis is in the 60s. The number of new cases of melanoma in the United States has been steadily rising since 1975, with an estimated 76 380 new cases of melanoma in the United States in 2016. The lifetime risk of being diagnosed with melanoma in the United States is estimated to be 2.1%.

The primary prognostic feature of melanoma is the depth of invasion, which is measured histologically in millimeters and referred to as the Breslow thickness. Early diagnosis and treatment of thin melanomas can lead to a generally favorable prognosis (97% and 93% for 5- and 10-year survival for a T1aN0M0 melanoma; see staging below), while advanced forms carry a dismal prognosis (33% for 1-year survival for an M1c melanoma). Mortality rates are higher among men than among women. The most frequent sites of melanoma metastasis are skin / subcutaneous, lymph nodes, lungs, liver, and brain; however, melanoma can metastasize to any organ of the body.

The management of advanced melanoma has changed dramatically over the last several years and continues to rapidly evolve with the introduction of therapies targeted to specific genetic mutations and immunotherapies that activate an individual's immune system against melanoma. Clinical trials have shown these agents to be effective in extending life expectancy in metastatic melanoma for several months.

Related topic: Amelanotic melanoma

Codes

ICD10CM:
C43.9 – Malignant melanoma of skin, unspecified

SNOMEDCT:
372244006 – Malignant melanoma

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Diagnostic Pearls

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Differential Diagnosis & Pitfalls

Best Tests

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Management Pearls

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Therapy

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Drug Reaction Data

Below is a list of drugs with literature evidence indicating an adverse association with this diagnosis. The list is continually updated through ongoing research and new medication approvals. Click on Citations to sort by number of citations or click on Medication to sort the medications alphabetically.

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References

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Last Updated: 11/06/2018
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Melanoma in Adult
See also in: External and Internal Eye,Anogenital,Hair and Scalp,Oral Mucosal Lesion
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Melanoma : Black color, Pigmented papule
Clinical image of Melanoma
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