Malignant Melanoma

James C. Shaw

(ICD-9 172.3 Face; 172.4 Scalp, Neck; 172.5 Trunk; 172.6 Upper Extremity; 172.7 Lower Extremity)

Symptoms and Signs

Malignant melanoma (MM) is usually asymptomatic. Sometimes it can cause pruritus. Pruritus in a “mole” is a cardinal symptom that cannot be ignored. Bleeding is also an important complaint. MM usually develops as a patch, papule, or nodule. It is almost always pigmented, although nonpigmented (amelanotic MM) forms can arise. MM develops in preexisting nevi or de novo on normal skin. Current estimates are that 1 in 75 Americans will develop MM during their lifetime. The ABCDE of diagnosis are crucial to both physicians and patients (Figs. 39-1, 39-2, 39-3 and 39-4):

Asymmetry
Border irregularities
Color variegation, including blue, gray, red, and black
Diameter usually greater than 6 mm
Enlargement, either of an existing nevus or of a new lesion, over a 1- or 2-month period