Malignant Melanoma - picture, treatment, symptom of Malignant Melanoma

Malignant melanoma is the leading cause of death due to skin disease. There were 53,000 cases of melanoma in the United States in 2002, with 7800 deaths. One in four cases of melanoma occur before the age of 40. Melanoma is the most common cancer of women between the ages of 25 and 29 and the second most common cause in women ages 30–34. Overall survival for melanomas in whites rose from 60% in 1960–1963 to 85% in 1983–1990, due primarily to earlier detection of lesions.

Tumor thickness is the single most important prognostic factor. Ten-year survival rates—related to thickness in millimeters—are as follows: < 0.76 mm, 96%; 0.76–1.69 mm, 81%; 1.7–3.6 mm, 57%; and > 3.6 mm, 31%. With lymph node involvement, the 5-year survival rate is 30%; with distant metastases, it is less than 10%. More accurate prognoses can be made on the basis of thickness, site, histologic features.

Clinical Findings of Malignant Melanoma

Primary malignant melanomas may be classified into various clinicohistologic types, including lentigo maligna melanoma (arising on sun-exposed skin of older individuals); superficial spreading malignant melanoma (the most common type, occurring in two-thirds of individuals developing melanoma); nodular malignant melanoma, acral-lentiginous melanomas (arising on palms, soles, and nail beds); malignant melanomas on mucous membranes; and miscellaneous forms such as amelanotic (nonpigmented) melanoma and melanomas arising from blue nevi (rare) and congenital nevi.

Malignant Melanoma Symptom

While superficial spreading melanoma is largely a disease of whites, persons of other races are at risk for other types of melanoma, particularly acral lentiginous melanoma. These occur as dark, sometimes irregularly shaped lesions on the palms and soles and as new, often broad and solitary, darkly pigmented longitudinal streaks in the nails. Acral lentiginous melanoma may be a difficult diagnosis because benign pigmented lesions of the hands, feet, and nails occur commonly in more darkly pigmented persons and clinicians may hesitate to biopsy the palms and especially the soles and nail beds. As a result, the diagnosis is often delayed until the tumor has become clinically obvious and histologically thick. Clinicians should give special attention to new or changing lesions in these areas.

Malignant Melanoma Skin Cancer & Metastatic Malignant Melanoma

Melanomas vary from macules to nodules. Variegation of color from flesh tints to pitch black and a frequent admixture of white, blue, purple, and red may occur. The border tends to be irregular, and growth may be rapid or indolent. Melanomas are often larger than 6 mm (see photograph). Again, one should refer lesions based on a suspicion of melanoma rather than delay until the diagnosis is certain. Dermoscopy—use of a special magnifying device to evaluate pigmented lesions—helps select suspicious lesions that require biopsy. In experienced hands, the specificity is 85% and the sensitivity 95%.

Treatment & prognosis of Malignant Melanoma

Treatment of melanoma consists of excision. After histologic diagnosis, the area is usually reexcised with margins dictated by the thickness of the tumor. Thin low-risk and intermediate-risk tumors require only conservative margins of 1–3 cm. More specifically, surgical margins of 0.5 cm for melanoma in situ and 1 cm for lesions less than 1 mm in thickness are recommended.

Sentinel lymph node biopsy (selective lymphadenectomy) using preoperative lymphoscintigraphy and intraoperative lymphatic mapping is effective for staging melanoma patients with intermediate risk without clinical adenopathy and is recommended for all patients with lesions over 1 mm in thickness or with high-risk histologic features. -Interferon and vaccine therapy may reduce recurrences in patients with high-risk melanomas. Referral of intermediate-risk and high-risk patients to centers with expertise in melanoma is strongly recommended.

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