eMedicine Specialties > Dermatology > Malignant Neoplasms

Malignant Melanoma: Multimedia

Author: Susan M Swetter, MD, Director, Pigmented Lesion and Cutaneous Melanoma Clinic, Associate Professor, Department of Dermatology, Stanford University Medical Center, Veterans Affairs Palo Alto Health Care System
Contributor Information and Disclosures

Updated: Feb 12, 2009

Multimedia

Superficial spreading melanoma, left breast, 1.3-...
(Enlarge Image)
Media file 1: Superficial spreading melanoma, left breast, 1.3-mm Breslow depth.
[ CLOSE WINDOW ]
Superficial spreading melanoma, left breast, 1.3-...

Superficial spreading melanoma, left breast, 1.3-mm Breslow depth.

Lentigo maligna melanoma, right lower cheek. Cent...
(Enlarge Image)
Media file 2: Lentigo maligna melanoma, right lower cheek. Centrally located erythematous papule represents invasive melanoma with surrounding macular lentigo maligna (melanoma in situ).
[ CLOSE WINDOW ]
Lentigo maligna melanoma, right lower cheek. Cent...

Lentigo maligna melanoma, right lower cheek. Centrally located erythematous papule represents invasive melanoma with surrounding macular lentigo maligna (melanoma in situ).

Acral lentiginous melanoma (1-mm Breslow depth), ...
(Enlarge Image)
Media file 3: Acral lentiginous melanoma (1-mm Breslow depth), left sole. Diagnostic punch biopsy site is located superiorly.
[ CLOSE WINDOW ]
Acral lentiginous melanoma (1-mm Breslow depth), ...

Acral lentiginous melanoma (1-mm Breslow depth), left sole. Diagnostic punch biopsy site is located superiorly.

Malignant melanoma. Courtesy of Hon Pak, MD.
(Enlarge Image)
Media file 4: Malignant melanoma. Courtesy of Hon Pak, MD.
[ CLOSE WINDOW ]
Malignant melanoma. Courtesy of Hon Pak, MD.

Malignant melanoma. Courtesy of Hon Pak, MD.

Cutaneous melanoma with characteristic asymmetry,...
(Enlarge Image)
Media file 5: Cutaneous melanoma with characteristic asymmetry, irregular borders, and color variation. Courtesy of Wendy Brick, MD.
[ CLOSE WINDOW ]
Cutaneous melanoma with characteristic asymmetry,...

Cutaneous melanoma with characteristic asymmetry, irregular borders, and color variation. Courtesy of Wendy Brick, MD.

More on Malignant Melanoma

Overview: Malignant Melanoma
Differential Diagnoses & Workup: Malignant Melanoma
Treatment & Medication: Malignant Melanoma
Follow-up: Malignant Melanoma
Multimedia: Malignant Melanoma
References
[ CLOSE WINDOW ]

References

  1. Demierre MF, Nathanson L. Chemoprevention of melanoma: an unexplored strategy. J Clin Oncol. Jan 1 2003;21(1):158-65. [Medline].

  2. Whiteman DC, Watt P, Purdie DM, Hughes MC, Hayward NK, Green AC. Melanocytic nevi, solar keratoses, and divergent pathways to cutaneous melanoma. J Natl Cancer Inst. Jun 4 2003;95(11):806-12. [Medline].

  3. Maldonado JL, Fridlyand J, Patel H, et al. Determinants of BRAF mutations in primary melanomas. J Natl Cancer Inst. Dec 17 2003;95(24):1878-90. [Medline].

  4. Sober AJ, Fitzpatrick TB, Mihm MC, et al. Early recognition of cutaneous melanoma. JAMA. Dec 21 1979;242(25):2795-9. [Medline].

  5. Rhodes AR, Weinstock MA, Fitzpatrick TB, Mihm MC Jr, Sober AJ. Risk factors for cutaneous melanoma. A practical method of recognizing predisposed individuals. JAMA. Dec 4 1987;258(21):3146-54. [Medline].

  6. Williams ML, Sagebiel RW. Melanoma risk factors and atypical moles. West J Med. Apr 1994;160(4):343-50. [Medline].

  7. Jemal A, Siegel R, Ward E, Hao Y, Xu J, Murray T. Cancer statistics, 2008. CA Cancer J Clin. Mar-Apr 2008;58(2):71-96. [Medline].

  8. Cockburn M, Swetter SM, Peng D, Keegan TH, Deapen D, Clarke CA. Melanoma underreporting: why does it happen, how big is the problem, and how do we fix it?. J Am Acad Dermatol. Dec 2008;59(6):1081-5. [Medline].

  9. Parkin DM, Bray F, Ferlay J, Pisani P. Global cancer statistics, 2002. CA Cancer J Clin. Mar-Apr 2005;55(2):74-108. [Medline].

  10. Geller AC, Miller DR, Annas GD, Demierre MF, Gilchrest BA, Koh HK. Melanoma incidence and mortality among US whites, 1969-1999. JAMA. Oct 9 2002;288(14):1719-20. [Medline].

  11. Swetter SM, Geller AC, Kirkwood JM. Melanoma in the older person. Oncology (Williston Park). Aug 2004;18(9):1187-96; discussion 1196-7. [Medline].

  12. Friedman RJ, Rigel DS, Kopf AW. Early detection of malignant melanoma: the role of physician examination and self-examination of the skin. CA Cancer J Clin. May-Jun 1985;35(3):130-51. [Medline].

  13. Abbasi NR, Shaw HM, Rigel DS, et al. Early diagnosis of cutaneous melanoma: revisiting the ABCD criteria. JAMA. Dec 8 2004;292(22):2771-6. [Medline].

  14. Grob JJ, Bonerandi JJ. The 'ugly duckling' sign: identification of the common characteristics of nevi in an individual as a basis for melanoma screening. Arch Dermatol. Jan 1998;134(1):103-4. [Medline].

  15. Gachon J, Beaulieu P, Sei JF, et al. First prospective study of the recognition process of melanoma in dermatological practice. Arch Dermatol. Apr 2005;141(4):434-8. [Medline].

  16. Miracco C, Santopietro R, Biagioli M, et al. Different patterns of cell proliferation and death and oncogene expression in cutaneous malignant melanoma. J Cutan Pathol. May 1998;25(5):244-51. [Medline].

  17. Bastian BC, Kashani-Sabet M, Hamm H, et al. Gene amplifications characterize acral melanoma and permit the detection of occult tumor cells in the surrounding skin. Cancer Res. Apr 1 2000;60(7):1968-73. [Medline].

  18. Sasaki Y, Niu C, Makino R, et al. BRAF point mutations in primary melanoma show different prevalences by subtype. J Invest Dermatol. Jul 2004;123(1):177-83. [Medline].

  19. Richard MA, Grob JJ, Avril MF, et al. Melanoma and tumor thickness: challenges of early diagnosis. Arch Dermatol. Mar 1999;135(3):269-74. [Medline].

  20. Demierre MF, Chung C, Miller DR, Geller AC. Early detection of thick melanomas in the United States: beware of the nodular subtype. Arch Dermatol. Jun 2005;141(6):745-50. [Medline].

  21. Swetter SM, Boldrick JC, Jung SY, Egbert BM, Harvell JD. Increasing incidence of lentigo maligna melanoma subtypes: northern California and national trends 1990-2000. J Invest Dermatol. Oct 2005;125(4):685-91. [Medline].

  22. Cress RD, Holly EA. Incidence of cutaneous melanoma among non-Hispanic whites, Hispanics, Asians, and blacks: an analysis of california cancer registry data, 1988-93. Cancer Causes Control. Mar 1997;8(2):246-52. [Medline].

  23. Byrd KM, Wilson DC, Hoyler SS, Peck GL. Advanced presentation of melanoma in African Americans. J Am Acad Dermatol. Jan 2004;50(1):21-4; discussion 142-3. [Medline].

  24. Rogers RS 3rd, Gibson LE. Mucosal, genital, and unusual clinical variants of melanoma. Mayo Clin Proc. Apr 1997;72(4):362-6. [Medline].

  25. Friedman GD, Tekawa IS. Association of basal cell skin cancers with other cancers (United States). Cancer Causes Control. Dec 2000;11(10):891-7. [Medline].

  26. Lederman JS, Lew RA, Koh HK, Sober AJ. Influence of estrogen administration on tumor characteristics and survival in women with cutaneous melanoma. J Natl Cancer Inst. May 1985;74(5):981-5. [Medline].

  27. Hannaford PC, Villard-Mackintosh L, Vessey MP, Kay CR. Oral contraceptives and malignant melanoma. Br J Cancer. Mar 1991;63(3):430-3. [Medline].

  28. Driscoll MS, Grin-Jorgensen CM, Grant-Kels JM. Does pregnancy influence the prognosis of malignant melanoma?. J Am Acad Dermatol. Oct 1993;29(4):619-30. [Medline].

  29. Smith MA, Fine JA, Barnhill RL, Berwick M. Hormonal and reproductive influences and risk of melanoma in women. Int J Epidemiol. Oct 1998;27(5):751-7. [Medline].

  30. Schwartz JL, Mozurkewich EL, Johnson TM. Current management of patients with melanoma who are pregnant, want to get pregnant, or do not want to get pregnant. Cancer. May 1 2003;97(9):2130-3. [Medline].

  31. Weiss M, Loprinzi CL, Creagan ET, Dalton RJ, Novotny P, O'Fallon JR. Utility of follow-up tests for detecting recurrent disease in patients with malignant melanomas. JAMA. Dec 6 1995;274(21):1703-5. [Medline].

  32. Johnson TM, Bradford CR, Gruber SB, Sondak VK, Schwartz JL. Staging workup, sentinel node biopsy, and follow-up tests for melanoma: update of current concepts. Arch Dermatol. Jan 2004;140(1):107-13. [Medline].

  33. Wang TS, Johnson TM, Cascade PN, Redman BG, Sondak VK, Schwartz JL. Evaluation of staging chest radiographs and serum lactate dehydrogenase for localized melanoma. J Am Acad Dermatol. Sep 2004;51(3):399-405. [Medline].

  34. Hafner J, Schmid MH, Kempf W, et al. Baseline staging in cutaneous malignant melanoma. Br J Dermatol. Apr 2004;150(4):677-86. [Medline].

  35. National Comprehensive Cancer Care Network. Clinical Practice Guidelines in Oncology - v.1.2009: Melanoma. Available at http://www.nccn.org/professionals/physician_gls/PDF/melanoma.pdf. Accessed December 9, 2008.

  36. Kaskel P, Berking C, Sander S, Volkenandt M, Peter RU, Krahn G. S-100 protein in peripheral blood: a marker for melanoma metastases: a prospective 2-center study of 570 patients with melanoma. J Am Acad Dermatol. Dec 1999;41(6):962-9. [Medline].

  37. Morris KT, Busam KJ, Bero S, Patel A, Brady MS. Primary cutaneous melanoma with regression does not require a lower threshold for sentinel lymph node biopsy. Ann Surg Oncol. Jan 2008;15(1):316-22. [Medline].

  38. Elder DE, Guerry D 4th, Epstein MN, et al. Invasive malignant melanomas lacking competence for metastasis. Am J Dermatopathol. 1984;6 Suppl:55-61. [Medline].

  39. Guerry D 4th, Synnestvedt M, Elder DE, Schultz D. Lessons from tumor progression: the invasive radial growth phase of melanoma is common, incapable of metastasis, and indolent. J Invest Dermatol. Mar 1993;100(3):342S-345S. [Medline].

  40. Clark WH Jr, Elder DE, Guerry D 4th, et al. Model predicting survival in stage I melanoma based on tumor progression. J Natl Cancer Inst. Dec 20 1989;81(24):1893-904. [Medline].

  41. Balch CM. Cutaneous melanoma: prognosis and treatment results worldwide. Semin Surg Oncol. Nov-Dec 1992;8(6):400-14. [Medline].

  42. Buzaid AC, Ross MI, Balch CM, et al. Critical analysis of the current American Joint Committee on Cancer staging system for cutaneous melanoma and proposal of a new staging system. J Clin Oncol. Mar 1997;15(3):1039-51. [Medline].

  43. Balch CM, Buzaid AC, Atkins MB, et al. A new American Joint Committee on Cancer staging system for cutaneous melanoma. Cancer. Mar 15 2000;88(6):1484-91. [Medline].

  44. Balch CM, Buzaid AC, Soong SJ, et al. Final version of the American Joint Committee on Cancer staging system for cutaneous melanoma. J Clin Oncol. Aug 15 2001;19(16):3635-48. [Medline].

  45. Balch CM, Soong SJ, Atkins MB, et al. An evidence-based staging system for cutaneous melanoma. CA Cancer J Clin. May-Jun 2004;54(3):131-49; quiz 182-4. [Medline].

  46. Agarwala SS, Glaspy J, O'Day SJ, et al. Results from a randomized phase III study comparing combined treatment with histamine dihydrochloride plus interleukin-2 versus interleukin-2 alone in patients with metastatic melanoma. J Clin Oncol. Jan 1 2002;20(1):125-33. [Medline].

  47. Veronesi U, Adamus J, Aubert C, et al. A randomized trial of adjuvant chemotherapy and immunotherapy in cutaneous melanoma. N Engl J Med. Oct 7 1982;307(15):913-6. [Medline].

  48. Kirkwood JM, Strawderman MH, Ernstoff MS, Smith TJ, Borden EC, Blum RH. Interferon alfa-2b adjuvant therapy of high-risk resected cutaneous melanoma: the Eastern Cooperative Oncology Group Trial EST 1684. J Clin Oncol. Jan 1996;14(1):7-17. [Medline].

  49. Kirkwood JM, Ibrahim JG, Sondak VK, et al. High- and low-dose interferon alfa-2b in high-risk melanoma: first analysis of intergroup trial E1690/S9111/C9190. J Clin Oncol. Jun 2000;18(12):2444-58. [Medline].

  50. Kirkwood JM, Ibrahim JG, Sosman JA, et al. High-dose interferon alfa-2b significantly prolongs relapse-free and overall survival compared with the GM2-KLH/QS-21 vaccine in patients with resected stage IIB-III melanoma: results of intergroup trial E1694/S9512/C509801. J Clin Oncol. May 1 2001;19(9):2370-80. [Medline].

  51. Kirkwood JM, Manola J, Ibrahim J, et al. A pooled analysis of eastern cooperative oncology group and intergroup trials of adjuvant high-dose interferon for melanoma. Clin Cancer Res. Mar 1 2004;10(5):1670-7. [Medline].

  52. Gogas H, Ioannovich J, Dafni U, et al. Prognostic significance of autoimmunity during treatment of melanoma with interferon. N Engl J Med. Feb 16 2006;354(7):709-18. [Medline].

  53. Demierre MF, Swetter SM, Sondak VK. Vaccine therapy of melanoma: an update. Curr Canc Ther Rev. 2005;1:115-25.

  54. National Institutes of Health. NIH Consensus conference. Diagnosis and treatment of early melanoma. JAMA. Sep 9 1992;268(10):1314-9. [Medline].

  55. Balch CM, Urist MM, Karakousis CP, et al. Efficacy of 2-cm surgical margins for intermediate-thickness melanomas (1 to 4 mm). Results of a multi-institutional randomized surgical trial. Ann Surg. Sep 1993;218(3):262-7; discussion 267-9. [Medline].

  56. Veronesi U, Cascinelli N, Adamus J, et al. Thin stage I primary cutaneous malignant melanoma. Comparison of excision with margins of 1 or 3 cm. N Engl J Med. May 5 1988;318(18):1159-62. [Medline].

  57. Thomas JM, Newton-Bishop J, A'Hern R, et al. Excision margins in high-risk malignant melanoma. N Engl J Med. Feb 19 2004;350(8):757-66. [Medline].

  58. Heaton KM, Sussman JJ, Gershenwald JE, et al. Surgical margins and prognostic factors in patients with thick (>4mm) primary melanoma. Ann Surg Oncol. Jun 1998;5(4):322-8. [Medline].

  59. Zitelli JA, Brown C, Hanusa BH. Mohs micrographic surgery for the treatment of primary cutaneous melanoma. J Am Acad Dermatol. Aug 1997;37(2 Pt 1):236-45. [Medline].

  60. Balch CM. Randomized surgical trials involving elective node dissection for melanoma. Adv Surg. 1999;32:255-70. [Medline].

  61. Balch CM, Soong SJ, Bartolucci AA, et al. Efficacy of an elective regional lymph node dissection of 1 to 4 mm thick melanomas for patients 60 years of age and younger. Ann Surg. Sep 1996;224(3):255-63; discussion 263-6. [Medline].

  62. Cascinelli N, Morabito A, Santinami M, MacKie RM, Belli F. Immediate or delayed dissection of regional nodes in patients with melanoma of the trunk: a randomised trial. WHO Melanoma Programme. Lancet. Mar 14 1998;351(9105):793-6. [Medline].

  63. Morton DL, Thompson JF, Essner R, et al. Validation of the accuracy of intraoperative lymphatic mapping and sentinel lymphadenectomy for early-stage melanoma: a multicenter trial. Multicenter Selective Lymphadenectomy Trial Group. Ann Surg. Oct 1999;230(4):453-63; discussion 463-5. [Medline].

  64. Gershenwald JE, Thompson W, Mansfield PF, et al. Multi-institutional melanoma lymphatic mapping experience: the prognostic value of sentinel lymph node status in 612 stage I or II melanoma patients. J Clin Oncol. Mar 1999;17(3):976-83. [Medline].

  65. McMasters KM, Reintgen DS, Ross MI, et al. Sentinel lymph node biopsy for melanoma: controversy despite widespread agreement. J Clin Oncol. Jun 1 2001;19(11):2851-5. [Medline].

  66. [Best Evidence] Morton DL, Thompson JF, Cochran AJ, et al. Sentinel-node biopsy or nodal observation in melanoma. N Engl J Med. Sep 28 2006;355(13):1307-17. [Medline].

  67. Hancock BW, Wheatley K, Harris S, et al. Adjuvant interferon in high-risk melanoma: the AIM HIGH Study--United Kingdom Coordinating Committee on Cancer Research randomized study of adjuvant low-dose extended-duration interferon Alfa-2a in high-risk resected malignant melanoma. J Clin Oncol. Jan 1 2004;22(1):53-61. [Medline].

  68. Levi F, Randimbison L, Te VC, La Vecchia C. High constant incidence rates of second cutaneous melanomas. Int J Cancer. Jun 14 2005;[Medline].

  69. American Joint Committee on Cancer. Manual for Staging of Cancer. 6th ed. Philadelphia, Pa: Lippincott; 2002:209-20.

  70. Balch CM, Soong SJ, Gershenwald JE, Thompson JF, Reintgen DS, Cascinelli N, et al. Prognostic factors analysis of 17,600 melanoma patients: validation of the American Joint Committee on Cancer melanoma staging system. J Clin Oncol. Aug 15 2001;19(16):3622-34. [Medline].

  71. Hillner BE, Kirkwood JM, Agarwala SS. Burden of illness associated with metastatic melanoma: an audit of 100 consecutive referral center cases. Cancer. May 1 2001;91(9):1814-21. [Medline].

  72. Kirkwood JM. Adjuvant IFN alpha2 therapy of melanoma. Lancet. Jun 27 1998;351(9120):1901-3. [Medline].

  73. Morton DL, Wen DR, Wong JH, Economou JS, Cagle LA, Storm FK, et al. Technical details of intraoperative lymphatic mapping for early stage melanoma. Arch Surg. Apr 1992;127(4):392-9. [Medline].

  74. Poo-Hwu WJ, Ariyan S, Lamb L, Papac R, Zelterman D, Hu GL, et al. Follow-up recommendations for patients with American Joint Committee on Cancer Stages I-III malignant melanoma. Cancer. Dec 1 1999;86(11):2252-8. [Medline].

[ CLOSE WINDOW ]

Further Reading

[ CLOSE WINDOW ]

Keywords

melanoma, skin cancer, cutaneous melanoma, malignancy of pigment-producing cells, malignant melanoma, malignancy of melanocytes, invasive cutaneous melanoma, melanoma in situ, metastatic melanoma, acral melanoma, changing mole, superficial spreading melanoma, nodular melanoma, lentigo maligna melanoma

[ CLOSE WINDOW ]

Contributor Information and Disclosures

Author

Susan M Swetter, MD, Director, Pigmented Lesion and Cutaneous Melanoma Clinic, Associate Professor, Department of Dermatology, Stanford University Medical Center, Veterans Affairs Palo Alto Health Care System
Susan M Swetter, MD is a member of the following medical societies: American Academy of Dermatology, American Medical Association, American Society of Clinical Oncology, Eastern Cooperative Oncology Group, Pacific Dermatologic Association, Society for Investigative Dermatology, Society for Melanoma Research, and Women's Dermatologic Society
Disclosure: Nothing to disclose.

Medical Editor

Günter Burg, MD, Professor and Chairman Emeritus, Department of Dermatology, University of Zürich School of Medicine; Delegate of The Foundation for Modern Teaching and Learning in Medicine Faculty of Medicine, University of Zürich, Switzerland
Günter Burg, MD is a member of the following medical societies: American Academy of Dermatology, American Dermatological Association, International Society for Dermatologic Surgery, North American Clinical Dermatologic Society, and Pacific Dermatologic Association
Disclosure: Nothing to disclose.

Pharmacy Editor

Michael J Wells, MD, Associate Professor, Department of Dermatology, Texas Tech University Health Sciences Center
Michael J Wells, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, and Texas Medical Association
Disclosure: Nothing to disclose.

Managing Editor

John G Albertini, MD, Consulting Staff, Dermatologic Surgery, The Skin Surgery Center
John G Albertini, MD is a member of the following medical societies: American Academy of Dermatology and American College of Mohs Micrographic Surgery and Cutaneous Oncology
Disclosure: Nothing to disclose.

CME Editor

Catherine Quirk, MD, Clinical Assistant Professor, Department of Dermatology, Brown University
Catherine Quirk, MD is a member of the following medical societies: Alpha Omega Alpha and American Academy of Dermatology
Disclosure: Nothing to disclose.

Chief Editor

Dirk M Elston, MD, Director, Department of Dermatology, Geisinger Medical Center
Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology
Disclosure: Nothing to disclose.

 
 
HONcode

We subscribe to the
HONcode principles of the
Health On the Net Foundation

All material on this website is protected by copyright, Copyright© 1994- by Medscape.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.