Melanoma — Clinical Case (Wikimedia Commons)

Diagnosis: Melanoma

Spalaco-dermie frontale, heteromorphic dermatosis. Rare Books Keywords: Disease; Dermatology; Jean Louis-Marie Alibert. Clinical photograph sourced from Wikimedia Commons (CC BY 4.0).

Clinical Presentation

ABCDE criteria: Asymmetry, Border irregularity, Color variation (brown, black, red, white, blue), Diameter >6mm, Evolution (change over time). Ugly duckling sign: lesion that looks different from patient's other moles. Amelanotic variants may be pink/red.

Clinical History

Risk factors: UV exposure (especially intermittent/blistering sunburns), fair skin, >50 nevi, atypical mole syndrome, family history, CDKN2A mutations, prior melanoma, immunosuppression. Acral lentiginous melanoma: palms, soles, nail beds — most common in darker skin types.

Treatment

Surgery: wide local excision (margins based on Breslow thickness: 1cm for ≤1mm, 2cm for >2mm). Sentinel lymph node biopsy for ≥0.8mm. Adjuvant: immunotherapy (nivolumab, pembrolizumab), targeted therapy (dabrafenib + trametinib for BRAF-mutant). Advanced: combination immunotherapy.

Differential Diagnosis

Dysplastic nevus, Seborrheic keratosis, Pigmented BCC, Blue nevus, Dermatofibroma, Pyogenic granuloma (amelanotic melanoma), Subungual hematoma

Key Learnings

Breslow thickness is the single most important prognostic factor. BRAF V600E mutation present in ~50% of melanomas — test all stage III/IV. Immunotherapy has dramatically improved survival in advanced melanoma. Total body photography and sequential dermoscopy aid surveillance.

Tags: melanoma, skin cancer, malignant, melanocyte, oncology