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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

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