Melanoma Signs and Symptoms

Signs and Symptoms

Introduction

Melanoma is a form of skin cancer that arises from melanocytic cells which make the pigment melanin that colors the skin
- May also occur in mucosal surfaces or other sites where neural crest cells migrate eg oral, genital and rectal mucosa, eyes and nail beds
Most serious form of skin cancer
- Incidence increases with age
Predominantly occurs in adults, commonly on extremities in women and on trunk or head and neck in men
Metastases are via lymphatic and hematogenous routes
- Common sites of metastases are under the skin, liver, lungs, brain and bone
- In-transit metastases are skin or subcutaneous intralymphatic tumors that develop between the primary tumor and draining lymph nodes (LN)
Malignant melanoma may regress spontaneously but complete regression is <1%

Risk Factors

Risk factors include:
- Gender: Men are at increased risk
- Age: More than 50 years old
- Sun exposure, tanning bed use
- People geographically located near the equator
- Fair skin and freckling: Less commonly, dark-skinned individuals may have melanoma and the nail beds, palms, and soles are frequently affected
- Personal medical history: Sunburns, precancer or any malignancy especially actinic keratosis, keratinocyte skin cancer (basal cell carcinoma, squamous cell carcinoma), pediatric malignancy
- Family history of cutaneous melanoma, pancreatic cancer, astrocytoma, uveal melanoma, mesothelioma
  - Genetic mutations: CDKN2a, CDK4, MC1R, BAP1
- Suppressed immune system
- Environmental exposures (ultraviolet A [UVA] or psoralen plus UVA [PUVA] therapies)
- Increased numbers of nevi and pigmentation, eg familial atypical mole-melanoma syndrome, giant congenital nevi, dysplastic nevus syndrome

Malignant transformation in a nevus includes changes in size and shape including border changes, discoloration, changes in consistency, presence of inflammation, and satellites
- Deep invasion of the skin by the melanoma is shown by an increase in size, ulceration, darkening, or bleeding

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