Melanoma is a skin cancer that starts in melanocytes, the pigment cells, and it causes most skin cancer deaths because it can spread early. Sun exposure, sunburns, fair skin, many moles and family history raise the risk, and early removal is usually curative.
Key symptoms
- New mole, or a mole that changes in size, shape or color
- A spot that looks different from the others (ugly duckling sign)
- Itching, bleeding or crusting of a mole
- Dark streak in a nail or a new spot on the palms or soles
What you find on exam
- ABCDE: asymmetry, irregular border, several colors, diameter over 6 mm, evolving
- Full skin exam including scalp, soles, between the toes and genitals
- Dermatoscope to look at pigment structure
- Feel the regional lymph nodes
Tests
- Excisional biopsy of the whole lesion with narrow margins
- Pathology: Breslow thickness, ulceration and mitotic rate guide staging
- Sentinel lymph node biopsy for thicker tumors
- CT or PET imaging and LDH for advanced stages
Treatment basics
- Wide local excision with margins based on tumor thickness
- Lymph node surgery when indicated
- Advanced or high-risk disease: immunotherapy such as pembrolizumab or nivolumab
- BRAF-mutated tumors: targeted BRAF and MEK inhibitors
- Lifelong skin checks, sun protection and skin checks for close relatives
Red flags
- Fast-growing, bleeding or ulcerated lesion
- Enlarged lymph node near a known lesion
- New headaches, weight loss or bone pain in a patient with melanoma
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Sources: NCCPA PANCE Content Blueprint; NBOME COMLEX-USA clinical presentations; AAMC Core Entrustable Professional Activities (Core EPAs). Written by Making Synapses. Making Synapses is not affiliated with these organizations.