Malignant Melanoma 

The malignant melanoma is composed of melanocytes, which are the pigment-producing cells in skin. It usually occurs in sun-exposed skin, though rare forms do occur in skin which does not often see sunlight. The first sign is generally a change in an existing mole or the appearance of a new pigmented (or sometimes skin-coloured) spot. 

Red flags for spotting malignant melanoma (ABCDE method)  

  • A for Asymmetry or the development of an asymmetry of features in a spot 
  • B for the development of irregular Borders or heights in a spot 
  • C for a change in Colour or shades of colours in a spot or even new murkiness or blotchiness 
  • D for a change in the Diameter or a growing size of a spot  
  • E for Evolving, or growing and changing of any spot, including new itching or bleeding. 

Other rare signs can include new dark areas under nails or inside of the mouth, vagina or anus

New moles and spots in childhood, adolescence or pregnancy are normal but you should consult a skin cancer doctor with any concerning features or with new moles or spots in adults.
 

Screening for malignant melanoma
Individuals at risk of melanoma should familiarise themselves with the above red flags, check their skin regularly and have annual skin checks with a skin cancer doctor such as myself. 

Risks for development of malignant melanoma

  • unprotected UV exposure 
  • frequent burning 
  • high number of unusual moles 
  • a depressed immune system 
  • a family history of malignant melanomas in first degree relatives 
  • Types I-III skin, which is fair skin with a tendency to burn rather than tan, freckles, light eye colour and blonde or red hair

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Treatment for malignant melanoma
The most important prognostic feature of a malignant melanoma is the thickness of the malignant melanoma:

  • Stage 1    Less than 2mm thick
  • Stage 2    Greater than 2mm thick
  • Stage 3    Spread to lymph nodes
  • Stage 4    Distant, metastatic spread

Surgery can be curative for thin melanomas and normally require at least 1-2cm of normal tissue to be removed around it.

For more advanced melanomas, lymph node biopsy is now a consideration and you will normally be referred to a plastic surgeon with an interest in skin cancer medicine for a discussion about this.

For thick melanomas, patients will require a multi-disciplinary approach involving both oncologists and surgeons. There are now a range of treatments offered, including interferon treatment, clinical trials of vaccines, chemotherapy and gene therapy. Radiotherapy may also be of benefit in treating some forms of melanoma and can also be used to palliate local symptoms.