Skip to Main Content

++

Melanoma

++

Early diagnosis is vital to outcome. Thickness of a melanoma when it is removed is the major factor determining prognosis: it is vital to detect melanomas when they are in the thin stage and look like an unusual freckle. An irregular border or margin is characteristic of the tumour.

++ Clinical features
++

  • Typical age range 30–50 yrs (av. 40)

  • Can occur anywhere on the body. More common:

    • lower limb in women

    • upper back in men

  • Often asymptomatic

  • Can bleed or itch

++ Change
++

The sign of major importance is a recent change in a ‘freckle’ or mole:

++

  • change in size: at edge or thickening

  • change in shape

  • change in colour: brown, blue, black, red, white, inc. combinations

  • change in surface

  • change in the border

  • bleeding or ulceration

  • other symptoms (e.g. itching)

  • development of satellite nodules

  • lymph node involvement

++

Beware of the non-pigmented melanoma, esp. on the sole of the foot.

++ Pitfalls/traps in diagnosis
++

  • Nodular melanomas

  • Small melanoma

  • Amelanotic melanoma

  • Regressing melanoma

  • Rapidly growing melanoma

++ The early nodular melanoma problem
++

The ABCD rule often does not apply. Early nodular melanomas tend to be symmetrical, non-pigmented, even in colour, small diameter, firm and grow vertically, i.e. elevated. They are often mistaken for a haemangioma or a pyogenic granuloma. Refer if suspicious.

++ Management
++

  • Early diagnosis and referral to specialist unit is vital.

  • Surgical excision with a narrow but significant margin is the treatment.

  • Guidelines for excision margins:

    • suspicious lesion—margin 2 mm

    • melanoma in situ—margin 5 mm

    • melanoma <1 mm thick—margin 1 cm

          >4 mm thick—margin 2 cm

  • Follow-up is based on the tumour thickness:

    • ≤1 mm—6 mthly for 2 yrs

    • >1 mm—regularly for 10 yrs

    • yearly chest X-ray.

++
Table Graphic Jump Location
Table M1

Features and associations of melanoma subtypes

++

Melasma (chloasma)

++

Treat with topical 2% hydroquinone in sorbolene cream (long course). Limit sun exposure.

++

Menopause syndrome

++

The menopause is the cessation of the menses for longer than 12 months. Some women experience adverse effects.

++ Symptoms
++

  • Vasomotor, for example:

    • hot flushes (80%)

    • night sweats (70%)

    • palpitations (30%)

  • Psychogenic, for example:

    • tearfulness/depression

    • irritability

    • anxiety/tension

  • Urogenital (60%), for example:

    • atrophic vaginitis

    • vaginal dryness (45%)

    • dyspareunia

  • Musculoskeletal, e.g. non-specific muscular aches

  • Skin and other tissue changes, e.g. dry skin

  • Other, e.g.:

    • unusual ...

Want remote access to your institution's subscription?

Sign in to your MyAccess profile while you are actively authenticated on this site via your institution (you will be able to verify this by looking at the top right corner of the screen - if you see your institution's name, you are authenticated). Once logged in to your MyAccess profile, you will be able to access your institution's subscription for 90 days from any location. You must be logged in while authenticated at least once every 90 days to maintain this remote access.

Ok

About MyAccess

If your institution subscribes to this resource, and you don't have a MyAccess profile, please contact your library's reference desk for information on how to gain access to this resource from off-campus.

Subscription Options

Murtagh Collection Full Site: One-Year Subscription

Connect to a suite of general practice resources from one of the most influential authors in the field. Learn the breadth of general practice, including up-to-date information on diagnosis and treatment, as well as key clinical skills like communication.

$145 USD
Buy Now

Pay Per View: Timed Access to all of Murtagh Collection

48 Hour Subscription $34.95

Buy Now

Pop-up div Successfully Displayed

This div only appears when the trigger link is hovered over. Otherwise it is hidden from view.