Malignant melanoma is a neoplasm arising from the melanocytes in the epidermis. It is strongly associated with fair-skinned people with excessive sunlight exposure, particularly episodes of sunburn during childhood. It is commonest in areas with high sun exposure and a predominantly Caucasian population - eg. Australia, South Africa, the "Sunbelt" region of the United States.
- Superficial spreading melanoma
- Nodular melanoma
- Lentigo maligna melanoma
- Acral lentiginous melanoma
- Amelanotic melanoma
The AJCC / UICC TNM system is the current staging system. T stage is assessed on total thickness of the melanoma, and further categorised by the presence or absence of ulceration.
For full current details, the cancer.gov Physician's Data Query is recommended:
A general strategy can be summarised as:
- Confirming the diagnosis
- Staging the disease
- Deciding on best stage-appropriate treatment according to current evidence, local resources and patient physiology
This is achieved by:
- Excisional biopsy with a close border
- Further staging, if justified by clinical findings or by thickness >= 1 mm
- Definitive excision and closure
- Consideration of (staging) sentinel lymph node biopsy or (therapeutic) lymphadenectomy
- Consideration of adjuvant therapies (interferon) or clinical trials
- Consideration of treatment of any metastatic disease.
This field of surgery is developing rapidly, with major trials recently published or in progress.