Clinical Presentation and Staging of Melanoma

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William H. Ward
Fernando Lambreton
Neha Goel
Jian Q. Yu
Jeffrey M. Farma


Cutaneous melanoma is responsible for the vast majority of skin cancer-related deaths in the United States. Known risk factors include genetic defects, environmental exposures, and a combination of both. Among environ­mental risks, exposure to ultraviolet rays is the most important and the most modifiable risk factor. Several genetic syndromes involve increased risk of melanoma, including xeroderma pigmentosum, familial atypical multiple moles and melanoma syndrome, BRCA2 mutation, and congenital melanocytic nevi. Although the necessity of implementation remains controversial, the most effec­tive melanoma screening technique is the whole-body skin examination. Typically, melanoma lesions are incidentally discovered during routine skin examination using the “ABCDE” mnemonic. Once suspected, questions pertaining to the sites of potential metastasis should be asked and excisional or partial biopsy should be considered. The primary histologic subtypes of melanoma include superficial spreading, lentigo maligna, nodular, acral lentiginous, desmoplastic, and amela­notic. Melanoma staging is completed via clinical and histologic assessment using the American Joint Committee on Cancer TNM system. Delayed or deficient ele­ments of initial melanoma evaluation can limit patient outcomes and increase disease-related mortality. Clinicians involved in the diagnosis or treatment of cutaneous melanoma must be familiar with the available screening options, key steps of diagnosis, and the staging ramifications of disease discovery.


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Chapter 6