Malignant melanoma: a pictorial review.

Abstract

Malignant melanoma (MM) is a malignancy of pigment-producing cells (melanocytes), which are located primarily in the skin, but also found in the ears, gastrointestinal tract, eyes, oral and genital mucosa and leptomeninges. For the purpose of this review the focus will be on malignant melanoma (hereby referred to as melanoma) affecting the skin i.e. cutaneous melanoma. Despite the fact that melanoma is the least common form of skin cancer (accounting for approximately 4% of all new cancer cases in UK), it has the highest mortality rate with more than 2000 deaths UK wide in 2011. (1) In Northern Ireland (NI) numbers of melanoma have increased from 103 cases per year in 1984-1992, to 258 per year in 2004-2009. (2) In addition, the risk of a second cancer has shown to be increased in patients in NI following the diagnosis of melanoma. (3) The incidence continues to rise worldwide and whilst some of the increase may be due to increased surveillance and earlier detection, most are considered to be linked to changes in sun-related behaviour e.g. increase in frequency of holidays abroad over time and the use of sunbeds. (4-7) The diagnosis of MM can have devastating consequences for a patient and their relatives. Early detection of MM has been shown to significantly improve survival. (8) In this review we will discuss pathophysiology and risk factors with a focus on history, examination and differential diagnosis. Assessment tools to aid early detection are reviewed and referral pathways based on how and when to refer to secondary care will be discussed briefly.