Cancer, Malignant Melanoma


Article Author:
Jonathan Heistein


Article Editor:
Utkarsh Acharya


Editors In Chief:
Susan Johnson
Alexandra Caley


Managing Editors:
Avais Raja
Orawan Chaigasame
Carrie Smith
Abdul Waheed
Khalid Alsayouri
Frank Smeeks
Kristina Soman-Faulkner
Trevor Nezwek
Radia Jamil
Patrick Le
Sobhan Daneshfar
Anoosh Zafar Gondal
Saad Nazir
William Gossman
Pritesh Sheth
Hassam Zulfiqar
Navid Mahabadi
Steve Bhimji
John Shell
Matthew Varacallo
Heba Mahdy
Ahmad Malik
Mark Pellegrini
James Hughes
Beata Beatty
Nazia Sadiq
Hajira Basit
Phillip Hynes
Tehmina Warsi


Updated:
3/12/2019 1:15:41 PM

Introduction

A melanoma is a tumor produced by the malignant transformation of melanocytes. Melanocytes are derived from the neural crest; consequently, melanomas, although they usually occur on the skin, can arise in other locations where neural crest cells migrate, such as the gastrointestinal tract and brain.[1][2] The five-year relative survival rate for patients with stage 0 melanoma is 97%, compared with about 10% for those with stage IV disease.

Etiology

 The causes may be related to:

  • Family history - Positive family history in 5% to 10% of patients; a2.2-fold higher risk with at least one affected relative 
  • Personal characteristics - Blue eyes, fair and/or red hair, pale complexion; skin reaction to sunlight (easily sunburned); freckling; benign and/or dysplastic melanocytic nevi (number has better correlation than size); immunosuppressive states (transplantation patients, hematologic malignancies)
  • Sun exposure over a lifetime - High UVB and UVA radiation exposure (Recent evidence has shown that the risk of melanoma is higher in people who use sunscreen. Because sunscreen mostly blocks UVB, people using sunscreen may be exposed to UVA more than the general public, provided those people are exposed to the sun more than the public at large); low latitude; number of blistering sunburns; use of tanning beds
  • Atypical mole syndrome (formerly termed B-K mole syndrome, dysplastic nevus syndrome, familial atypical multiple mole melanoma) - Over ten years, 10.7% risk of melanoma (vs 0.62% of controls); higher risk of melanoma depending on number of family members affected (nearly 100% risk if two or more relatives have dysplastic nevi and melanoma)
  • Socioeconomic status - Lower socioeconomic status may be linked to more advanced disease at the time of detection. One survey of newly-diagnosed patients found that low-SES individuals have decreased melanoma risk perception and knowledge of the disease.

Epidemiology

The incidence of malignant melanoma is rapidly increasing worldwide, and this increase is occurring at a faster rate than that of any other cancer except lung cancer in women. Melanoma is more common in Whites than in Blacks and Asians. Overall, melanoma is the fifth most common malignancy in men and the seventh most common malignancy in women, accounting for 5% and 4% of all new cancer cases, respectively. The average age at diagnosis is 57 years, and up to 75% of patients are younger than 70 years.[3][4]Melanoma is notorious for affecting young and middle-aged people, unlike other solid tumors which mainly affect older adults. It is commonly found in patients younger than 55 years, and it accounts for the third highest number of lives lost across all cancers.

Pathophysiology

Melanomas may develop in or near a previously existing precursor lesion or in healthy-appearing skin. A malignant melanoma developing in healthy skin is said to arise de novo, without evidence of a precursor lesion. Solar irradiation induces many of these melanomas. Melanoma also may occur in unexposed areas of the skin, including the palms, soles, and perineum.

Certain lesions are considered to be precursor lesions of melanoma. These include the following nevi:

  • Common acquired nevus
  • Dysplastic nevus
  • Congenital nevus
  • Cellular blue nevus

Melanomas have 2 growth phases, radial and vertical. During the radial growth phase, malignant cells grow in a radial fashion in the epidermis. With time, most melanomas progress to the vertical growth phase, in which the malignant cells invade the dermis and develop the ability to metastasize.

Clinically, lesions are classified according to their depth, as follows:

  • Thin - 1 mm or less
  • Moderate - 1 mm to 4 mm
  • Thick- greater than 4 mm

The 4 major types of melanoma, classified according to growth pattern, are as follows:

  • Superficial spreading melanoma constitutes approximately 70% of melanomas; usually flat but may become irregular and elevated in later stages; the lesions average 2 cm in diameter, with variegated colors, as well as peripheral notches, indentations, or both
  • Nodular melanoma accounts for approximately 15% to 30% of melanoma diagnoses; the tumors typically are blue-black but may lack pigment in some circumstances
  • Lentigo maligna melanoma represents 4% to 10% of melanomas; the tumors are often larger than 3 cm, flat, and tan, with marked notching of the borders; they begin as small, freckle-like lesions
  • Acral lentiginous melanoma constitutes 2% to 8% of melanomas in Whites and 35% to 60% of them in dark-skinned people; may appear on the palms and soles as flat, tan, or brown stains with irregular borders; subungual lesions can be brown or black, with ulcerations in later stages.

History and Physical

Most commonly, the history includes either changing characteristics in an existing mole or the identification of a new mole.

The characteristics of melanoma are commonly known by the acronym ABCDE and include the following:

  • A - Asymmetry
  • B - Irregular border
  • C - Color variations, especially red, white, and blue tones in a brown or black lesion
  • D - Diameter greater than 6 mm
  • E - Elevated surface

Also, melanomas may itch, bleed, ulcerate, or develop satellites. Patients who present with metastatic disease or with primary sites other than the skin have signs and symptoms related to the affected organ system(s).

It is also important to examine all lymph node groups.

Evaluation

Perform excisional biopsy on suggestive lesions so that a pathologist can confirm the diagnosis. Shave biopsies and electrodesiccation are inadequate; a full thickness of skin is essential for proper histologic diagnosis and classification.[5][6][7] The most important prognostic indicator for stage I and II tumors is thickness; obtain a full-thickness biopsy specimen for adequate pathologic interpretation. Biopsy results ultimately determine the margins of resection and which patients are candidates for sentinel lymph node biopsy and other adjuvant treatment.

The following laboratory studies are indicated:

  • Complete blood count
  • Complete chemistry panel (including alkaline phosphatase, hepatic transaminases, total protein, and albumin)
  • Lactate dehydrogenase

The following imaging modalities may be considered:

  • Chest radiography
  • MRI of the brain
  • Ultrasonography (possibly the best imaging study for diagnosing lymph node involvement)
  • CT of the chest, abdomen, or pelvis
  • Positron emission tomography (PET; PET-CT may be the best imaging study for identifying other sites of metastasis)

Treatment / Management

Surgery such as wide local excision with sentinel lymph node biopsy, elective node dissection, or both is the definitive treatment for early-stage melanoma. When performing the wide local excision, first consider the surgical margins. If the primary closure is not feasible, skin grafting or tissue transfers may be needed. [8][9][10][11][8]Medical management is reserved for adjuvant therapy of patients with advanced melanoma.

Agents that may be used in adjuvant therapy include the following:

  • Interferon alfa
  • Pegylated interferon
  • Granulocyte-macrophage colony-stimulating factor (GM-CSF)
  • Ipilimumab

Agents that may be considered for treatment of advanced-stage (stage IV) melanoma include the following:

  • Dacarbazine
  • Temozolomide
  • Interleukin-2
  • Cisplatin, vinblastine, and dacarbazine (CVD)
  • Cisplatin, dacarbazine, carmustine, and tamoxifen
  • Carboplatin and paclitaxel
  • Ipilimumab
  • Pembrolizumab
  • Trametinib
  • Vemurafenib (BRAF Positive)
  • Dabrafenib (BRAF Positive)
  • Peginterferon alfa-2b
  • Nivolumab*

Prognosis

Poor prognostic factors include the following:

  • Tumor thickness (worse prognosis in thicker lesions)
  • Evidence of tumor in regional lymph nodes (stage III disease)
  • Higher number of positive lymph nodes
  • Presence of distant metastasis (stage IV disease)
  • Anatomic site (trunk and/or face lesions have worse prognoses than extremity lesions)
  • Presence of ulceration
  • Presence of regression on histologic examination (controversial)
  • Male sex

Prognosis depends on the disease stage at diagnosis, as follows:

  • Patients with stage I disease - 5-year survival rate of greater than 90%
  • Patients with stage II disease - 5-year survival rate ranging from 45% to 77%
  • Patients with stage III disease - 5-year survival rate ranging from 27% to 70%

Patients with metastatic disease have a grim prognosis, with a 5-year survival rate of less than 20%.

Enhancing Healthcare Team Outcomes

Skin cancers are frequently seen by the primary care provider, nurse practitioner, internist, and the pharmacist. While many skin lesions are benign, it is important to always consider melanoma- as it is deadly if the diagnosis is missed. If there is suspicion of melanoma, the patient should be referred to the dermatologist/oncologist and pathologist for further workup.  Surgery such as wide local excision with sentinel lymph node biopsy, elective node dissection, or both is the definitive treatment for early-stage melanoma. When performing the wide local excision, first consider the surgical margins. If the primary closure is not feasible, skin grafting or tissue transfers may be needed. Medical management is reserved for adjuvant therapy of patients with advanced melanoma. For localized lesions, the prognosis is with surgery but advanced melanoma has a grim prognosis.[12][13][14] (Level V)


  • Image 376 Not availableImage 376 Not available
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Attributed To: Contributed by DermNetNZ

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Cancer, Malignant Melanoma - Questions

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Excisional biopsy of a pigmented lesion reveals melanoma with a thickness of 1.5 mm. No ulceration or mitoses are present per the pathology report. What should be the margins or re-excision be?



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What is the greatest risk for the development of a melanoma?



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What is the most common location for superficial spreading melanoma?



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Where are melanomas most likely to be found in Asians and African Americans?



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What margin of excision is recommended in a patient with a melanoma of 3 millimeters in thickness?



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Which is false about melanoma?



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Which is true about melanoma?



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Which of the following is false about melanoma?



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An oncolytic vaccine used in the treatment of melanoma has been modified from which organism?



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What is the most common form of malignant melanoma?



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The prognosis of melanoma is based on which of the following parameters?



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Microscopic examination of a skin biopsy of malignant melanoma shows very large, visible nucleoli. This most likely signifies that the cells are making large amounts of which of the following?



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What are the ABCDEs of melanoma?

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A 65-year-old darkly pigmented male noticed a discolored lesion on the sole of his foot. He denies any pain or history of comorbidity. Upon examination, the patient has an irregular lesion of 1-cm maximum dimension that is purplish in color and located on his right heel. No other lesions are on the foot or leg. The distal pulses are normal, and there is no pedal edema. Inguinal lymph nodes are not palpable. The patient undergoes a punch biopsy from the edge of the lesion, which is diagnostic of melanoma greater than 1 millimeter in thickness. What is the best therapeutic option for this patient?



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What is the MOST common location for metastatic melanoma in the brain?



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A patient undergoes a skin biopsy of a malignant melanoma that shows large, visible nucleoli. This most likely means that the cells are making large amounts of which of the following?



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What cell type gives rise to malignant melanoma?



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What is the most important prognostic factor for melanoma?



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What is the one critical factor that determines the metastatic potential of a melanoma?



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What is the most common location in the central nervous system for malignant melanoma to metastasize?



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Which of the following types of cancer has the worst prognosis if it spreads to the brain?



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Prognosis of malignant melanoma mostly depends upon:



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Which of the following immunohistochemical stains is associated with melanoma?



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Which of the following is not an ABCD used to diagnose melanoma?

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Which of the following statements about malignant melanoma is false?



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Which of the following factors confers the highest risk for developing melanoma of the skin?



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Which of the following people is most likely to develop melanoma?



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How is the diagnosis of malignant melanoma best achieved?



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Which of the following is NOT a risk factor for malignant melanoma?



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A patient has a malignant melanoma of the skin 4 cm lateral to the umbilicus. Where might metastasis be detected in the lymph nodes?



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Which skin cancer is most likely to metastasize?



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A 50-year-old man has worked outside without his shirt for most of his life. He has a raised, irregular bordered, skin lesion with multiple colors. Pathologic analysis shows invasion into the dermis of malignant cells. Which of the following is the most likely diagnosis?



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What is the most common primary tumor of adult eye?



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A patient has a 2.0 cm wide melanoma on the right upper extremity. No lymphadenopathy is noted and the chest radiograph is normal. Histology shows malignant melanocytes with infiltration laterally and into the reticular dermis. Many lymphocytes are present surrounding the border of the malignant cells. Which of the following is most important for prognosis?



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A 40-year-old female presents with a changing mole on her back. It is 12 by 15 mm, raised, irregularly pigmented, within irregular border and smooth surface. What is the most probable diagnosis?



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Which of the following risk factors for malignant melanoma has the greatest impact?



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What is the proper method of melanoma diagnosis?



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Which of the following clinical findings is associated with melanoma?



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A 33-year-old female presents with a new skin lesion on her right arm. She noticed it about a month ago and it has since gone quite dark. She spends a lot of time in the sun and sometimes forgets to use her sunscreen. On exam, the lesion appears to be about 2 cm in diameter and has irregular borders. The color is bluish-black, but there is no pain on palpation. The lesion is excised and the pathologist reports atypical cells with hyperchromic nuclei and pagetoid growth pattern of melanocytes. Which of the following forms is the most common type of this pathological lesion?



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A 33-year-old female presents with a new skin lesion on her right arm. She noticed that it appeared about a month ago and has become quite dark. She spends a lot of time in the sun and sometimes forgets to use her sunscreen. On exam, the lesion appears to be about 2 cm in diameter and has irregular borders. The color is bluish-black, but there is no pain on palpation. The lesion is excised, and the pathologist reports atypical cells with hyperchromic nuclei and pagetoid growth pattern of melanocytes. The pathologist also reports that the tumor has extended into the papillary dermis. If this lesion was 6 mm in thickness, what are the current recommendations for surgical margins during excision?



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A 33-year-old woman presents with a new skin lesion on her right arm. She noticed it about a month ago, and it has become quite dark. She spends a lot of time in the sun and sometimes forgets to use her sunscreen. On exam, the lesion appears to be about 2 cm and has irregular borders. The color is bluish-black, but there is no pain on palpation. The lesion is excised and the pathologist reports atypical cells with hyperchromic nuclei and pagetoid growth pattern of melanocytes. The pathologist also reports that the tumor has extended into the papillary dermis. What level of Clark staging is this lesion?



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A 33-year-old female presents with a new skin lesion on her right arm. She noticed that it appeared about a month ago and has gotten quite dark. She spends a lot of time in the sun and sometimes forgets to use her sunscreen. On exam, the lesion appears to be about 2 cm and has irregular borders. The color is bluish-black, but there is no pain on palpation. The lesion is excised, and the pathologist reports atypical cells with hyperchromic nuclei and pagetoid growth pattern of melanocytes. The pathologist also reports that the tumor has extended into the papillary dermis. After excision, what adjuvant therapy is recommended for this patient?



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Cancer, Malignant Melanoma - References

References

Ott PA, Intralesional Cancer Immunotherapies. Hematology/oncology clinics of North America. 2019 Apr;     [PubMed]
Tarhini A,Atzinger C,Gupte-Singh K,Johnson C,Macahilig C,Rao S, Treatment patterns and outcomes for patients with unresectable stage III and metastatic melanoma in the USA. Journal of comparative effectiveness research. 2019 Mar 5;     [PubMed]
Ghazawi FM,Darwich R,Le M,Rahme E,Zubarev A,Moreau L,Burnier JV,Sasseville D,Burnier MN,Litvinov IV, Uveal melanoma incidence trends in Canada: a national comprehensive population-based study. The British journal of ophthalmology. 2019 Feb 28;     [PubMed]
Donley GM,Liu WT,Pfeiffer RM,McDonald EC,Peters KO,Tucker MA,Cahoon EK, Reproductive factors, exogenous hormone use and incidence of melanoma among women in the United States. British journal of cancer. 2019 Feb 28;     [PubMed]
Hayek SA,Munoz A,Dove JT,Hunsinger M,Arora T,Wild J,Shabahang M,Blansfield J, Hospital-Based Study of Compliance with NCCN Guidelines and Predictive Factors of Sentinel Lymph Node Biopsy in the Setting of Thin Melanoma Using the National Cancer Database. The American surgeon. 2018 May 1;     [PubMed]
Janz TA,Neskey DM,Nguyen SA,Lentsch EJ, Is imaging of the brain necessary at diagnosis for cutaneous head and neck melanomas? American journal of otolaryngology. 2018 Sep - Oct;     [PubMed]
Barker CA,Salama AK, New NCCN Guidelines for Uveal Melanoma and Treatment of Recurrent or Progressive Distant Metastatic Melanoma. Journal of the National Comprehensive Cancer Network : JNCCN. 2018 May;     [PubMed]
Reserva J,Janeczek M,Joyce C,Goslawski A,Hong H,Yuan FN,Balasubramanian N,Winterfield L,Swan J,Tung R, A Retrospective Analysis of Surveillance Adherence of Patients after Treatment of Primary Cutaneous Melanoma. The Journal of clinical and aesthetic dermatology. 2017 Dec;     [PubMed]
Blakely AM,Comissiong DS,Vezeridis MP,Miner TJ, Suboptimal Compliance With National Comprehensive Cancer Network Melanoma Guidelines: Who Is at Risk? American journal of clinical oncology. 2018 Aug;     [PubMed]
Coit DG,Thompson JA,Algazi A,Andtbacka R,Bichakjian CK,Carson WE 3rd,Daniels GA,DiMaio D,Fields RC,Fleming MD,Gastman B,Gonzalez R,Guild V,Johnson D,Joseph RW,Lange JR,Martini MC,Materin MA,Olszanski AJ,Ott P,Gupta AP,Ross MI,Salama AK,Skitzki J,Swetter SM,Tanabe KK,Torres-Roca JF,Trisal V,Urist MM,McMillian N,Engh A, NCCN Guidelines Insights: Melanoma, Version 3.2016. Journal of the National Comprehensive Cancer Network : JNCCN. 2016 Aug;     [PubMed]
Coit DG,Thompson JA,Algazi A,Andtbacka R,Bichakjian CK,Carson WE 3rd,Daniels GA,DiMaio D,Ernstoff M,Fields RC,Fleming MD,Gonzalez R,Guild V,Halpern AC,Hodi FS Jr,Joseph RW,Lange JR,Martini MC,Materin MA,Olszanski AJ,Ross MI,Salama AK,Skitzki J,Sosman J,Swetter SM,Tanabe KK,Torres-Roca JF,Trisal V,Urist MM,McMillian N,Engh A, Melanoma, Version 2.2016, NCCN Clinical Practice Guidelines in Oncology. Journal of the National Comprehensive Cancer Network : JNCCN. 2016 Apr;     [PubMed]
Ferguson SD,Bindal S,Bassett RL Jr,Haydu LE,McCutcheon IE,Heimberger AB,Li J,O'Brien BJ,Guha-Thakurta N,Tetzlaff MT,Tawbi H,Davies MA,Glitza IC, Predictors of survival in metastatic melanoma patients with leptomeningeal disease (LMD). Journal of neuro-oncology. 2019 Mar 7;     [PubMed]
Cho SI,Lee J,Jo G,Kim SW,Minn KW,Hong KY,Jo SJ,Cho KH,Kim BJ,Mun JH, Local recurrence and metastasis in patients with malignant melanomas after surgery: A single-center analysis of 202 patients in South Korea. PloS one. 2019;     [PubMed]
Nyakas M,Aamdal E,Jacobsen KD,Guren TK,Aamdal S,Hagene KT,Brunsvig P,Yndestad A,Halvorsen B,Tasken KA,Aukrust P,Maelandsmo GM,Ueland T, Prognostic biomarkers for immunotherapy with ipilimumab in metastatic melanoma. Clinical and experimental immunology. 2019 Mar 1;     [PubMed]

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