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Metastatic cutaneous melanoma
Other Resources UpToDate PubMed

Metastatic cutaneous melanoma

Contributors: Susan Burgin MD, Michael W. Winter MD, Carla Casulo MD, Paritosh Prasad MD
Other Resources UpToDate PubMed

Synopsis

Melanoma is an aggressive malignancy of melanocytes. Melanoma may arise at sites of melanocytes including on the skin, on the mucous membranes, around the nail apparatus, and in the eye. Melanoma can metastasize to any organ of the body. The most frequent sites are skin / subcutaneous, lymph nodes, lungs, liver, and brain. This summary focuses on metastatic cutaneous melanoma.

The presence of nodal metastases connotes stage III disease per the American Joint Committee on Cancer (AJCC) staging system (eighth edition). Nodal disease may be occult and detectable on sentinel lymph node biopsy only, or it may be clinically detectable. Microsatellitosis (discrete nests of malignant melanocytes, 0.05 mm or more, at least 0.3 mm away from the main invasive portion of melanoma, as seen on histopathologic sections), satellitosis (clinical detectable metastases within 2 cm of the primary tumor), and in-transit metastases (intralymphatic spread of metastases more than 2 cm away from primary site) also connote stage III disease. Distant metastases, including distant skin, soft tissue, nonregional lymph node, visceral, and central nervous system (CNS) metastases, are categorized as stage IV disease.

Mutations in MAPK and downstream pathways have been found in melanoma, including in BRAF, NRAS, PTEN, KIT (mucosal melanoma), GNAQ (uveal melanoma), and CDKN2A. This has led to the development of new mutation-targeted therapies for metastatic melanoma. Historically, 5-year survival rates for advanced melanoma were less than 10%. The development of newer treatment strategies has afforded 5-year survival rates of up to 50% in some studies. In addition, complete remission has been seen in some patients.

Codes

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

SNOMEDCT:
443493003 – Metastatic malignant melanoma

Look For

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Diagnostic Pearls

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Differential Diagnosis & Pitfalls

Differential diagnosis of distant cutaneous metastases:
Additional differential diagnosis of satellitosis:
Additional differential diagnosis of in-transit metastases:
Differential diagnosis of diffuse melanosis cutis:
Metastatic melanoma can behave similarly to any other metastatic solid tumors such as lung cancer, breast cancer, colon cancer, renal cancer, etc. Brain metastases occur frequently as well, which can also be seen with metastatic lung cancer or other cancers.

Best Tests

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Management Pearls

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Therapy

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References

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Last Reviewed:03/23/2022
Last Updated:10/16/2022
Copyright © 2022 VisualDx®. All rights reserved.
Metastatic cutaneous melanoma
A medical illustration showing key findings of Metastatic cutaneous melanoma : Cough, Hepatomegaly, Jaundice, Ascites, Bone pain, Regional lymphadenopathy, Anorexia, Dyspnea
Clinical image of Metastatic cutaneous melanoma - imageId=731135. Click to open in gallery.  caption: 'A close-up of a cluster of black and deep gray papules, and background sun-damaged skin.'
A close-up of a cluster of black and deep gray papules, and background sun-damaged skin.
Copyright © 2022 VisualDx®. All rights reserved.