Internal Medicine

0521779407-14 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 21:16

964 Melanoma

MELANOMA

TIMOTHY S. BROWN, MD

history & physical

History

■High risk (>50-fold increased risk)

➣Changing mole

➣Atypical moles in a patient with a family history of melanoma

➣>50 nevi≥2mm

■Intermediate risk (10 fold)

➣Family history of melanoma

➣Sporadic atypical moles

➣Congenital nevi

➣Personal history of prior melanoma

■Low risk (2–4 fold)

➣Immunosuppression

➣Sun sensitivity or excess sun exposure

➣Light skin color with inability to tan

➣Upper socioeconomic status

Signs & Symptoms

■Clinical presentation (symptoms)

➣Most often asymptomatic

➣Burning, itching, and bleeding have been described

➣Asymmetry

➣Border irregularity

➣Color variability

➣Diameter >6 mm

■Practical tips to assist with diagnosis

➣Perform full body skin exam.

➣Conduct exam with optimal lighting.

➣Magnifying lens/dermoscopy to facilitate exam

➣Wood’s lamp accentuates epidermal pigmentation.

■Classification of melanoma types

➣Superficial spreading melanoma 70%

➣Nodular melanoma 15%

➣Lentigo maligna melanoma 5%

➣Acral lentiginous melanoma 5–10%

■Precursor lesions

➣Clark’s (dysplastic) melanocytic nevus