Malignant melanoma

Definition and Epidemiology

• Malignant melanoma is a form of skin cancer that arises from melanocytes.
• It is the fifth most common cancer in the UK.
• Highest incidence in Caucasians; however, can occur in any skin type.

Aetiology

• UV radiation exposure (sunlight, tanning beds)
• Genetic predisposition (family history, specific gene mutations)
• Moles (dysplastic naevi)
• Immunosuppression

Clinical Presentation

• ABCDE rule: Asymmetry, Border irregularity, Colour variation, Diameter >6mm, Evolving
• Itchiness, bleeding, or pain in an existing mole
• New mole or skin lesion
• Metastatic symptoms: fatigue, weight loss, bone pain

Diagnosis

• Dermoscopic examination
• Excisional biopsy for histopathological examination
• Imaging: Ultrasound, MRI, PET scan for staging
• Sentinel lymph node biopsy for staging
• (Refer to the NICE guidelines 2015 for diagnostic criteria)

Treatment

• Surgical excision with clear margins
• Sentinel lymph node biopsy for staging
• Adjuvant therapies: Immunotherapy (e.g., pembrolizumab), targeted therapies (e.g., BRAF inhibitors)
• Palliative care for metastatic disease

Prognosis

• Staging is essential: early stages have a good prognosis.
• 5-year survival rate varies widely (98% for stage I, <20% for stage IV)

Prevention

• Sunscreen usage
• Avoidance of tanning beds
• Regular skin checks for high-risk individuals