Clinical features

Most melanomas are asymptomatic (1).

• often there is a history of increased sun exposure
• F>M by ratio of 2:1
• they can occur anywhere in the body but the most common sites include
  • the face and neck - people with chronic sun exposure throughout life
  • the lower extremities including the soles of the feet – in 50% of women, 18% of men.
  • on the trunk - 35% of men, 14% of women (1)
  • sometimes in the nailbeds
• they may arise from moles or lentigo maligna, or de novo. If a malignant melanoma arises from a mole or lentigo maligna, then often the area of the lesion increases and may darken or bleed. It may also become ulcerated, inflamed, become irregular in edge or depth, or itchy

More than 50% of melanomas are detected by patients themselves and may consult the physician due to appearance of a new lesion and/or change in an existing lesion (2).

• change in size –
  • size may change over years but any change over weeks or months is suspicious
• change in colour
  • melanomas often show irregular pigment in a lesion, with shades of black, brown, grey, and pink (3)
  • lesions are generally black in nodular melanoma; there may be irregularity of colour
  • non-pigmented red nodule (amelanocytic melanoma) can be the presenting lesion on rare occasions; these are more likely on hands and feet (3).
• change in outline
  • often show a geographical outline with a sharp cut-off from normal skin
• itching
  • often unreliable since benign naevi intermittently itch (3)
• they may bleed or ulcerate
  • is a late sign, often seen in advanced melanomas (3)
• symptoms and signs of metastasis e.g. weight loss, dyspnoea and jaundice

Reference:

• (1) Bishop JN et al. The prevention, diagnosis, referral and management of melanoma of the skin: concise guidelines. Clin Med. 2007;7(3):283-90
• (2) Cancer Council Australia/Australian Cancer Network/Ministry of Health, New Zealand (2008). Clinical Practice Guidelines for the Management of Melanoma In Australia and New Zealand
• (3) Bataille V, de Vries E. Melanoma--Part 1: epidemiology, risk factors, and prevention. BMJ. 2008;337:a2249.