++
For further information, see CMDT Part 6-08: Malignant Melanoma
+++
Essentials of Diagnosis
++
ABCDE mnemonic = Asymmetry, Border irregularity, Color variegation, Diameter > 6 mm, Evolution
May be flat or raised
Should be suspected in any pigmented skin lesion with recent change in appearance
Examination with good light may show varying colors, including red, white, black, and blue
Borders typically irregular
+++
General Considerations
++
++
One in four cases of melanoma occur before the age of 40
In 2018, approximately 96,480 new melanomas were diagnosed in the United States, approximately 60% cases in men
In 2018, melanoma caused an estimated 7230 deaths (two-thirds in men)
++
An irregular notched border where the pigment appears to be leaking into the normal surrounding skin
Topography may be irregular, ie, partly raised and partly flat
Color variegation, and colors such as pink, blue, gray, white, and black are indications for referral
A mole that stands out from the patient's other moles (the "ugly duckling sign")
A patient with a large number of moles is at increased risk for melanoma
The history of a changing mole (evolution including bleeding and ulceration) is the single most important historical reason for close evaluation and possible referral
Acral lentiginous melanomas: dark, sometimes irregularly shaped lesions on the palms and soles and new, often broad and solitary, darkly pigmented longitudinal streaks in the nails
+++
Differential Diagnosis
++
Acquired nevus (mole), eg, junctional nevus, compound nevus
Seborrheic keratosis
Lentigo, eg, solar lentigo
Dermatofibroma
Basal cell carcinoma (pigmented type)
Congenital nevus
Atypical (dysplastic) nevus
Blue nevus
Halo nevus
Pyogenic granuloma
Kaposi sarcoma
Pregnancy-associated darkening of nevi
++
++
++