What are the signs and symptoms of melanoma?

Updated: Jun 28, 2021
  • Author: Jonathan B Heistein, MD; Chief Editor: Gregory Gary Caputy, MD, PhD, FICS  more...
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Patients usually present with skin lesions that have changed in size, color, contour, or configuration. The acronym "ABCDE" is the hallmark of international public awareness campaigns and may be used to remember the physical characteristics suggestive of malignancy. ABCDE stands for asymmetry, irregular border, color variations (especially red, white, and blue tones in a brown or black lesion), diameter greater than 6 mm, and elevated surface. Lesions may itch, bleed, ulcerate, or develop satellites. See images below for examples.

Malignant melanoma. Courtesy of Hon Pak, MD. Malignant melanoma. Courtesy of Hon Pak, MD.
A 1.5-cm melanoma with characteristic asymmetry, i A 1.5-cm melanoma with characteristic asymmetry, irregular borders, and color variation. Courtesy of Wendy Brick, MD.

Perform excisional biopsy on these suggestive lesions so that a pathologist can confirm the diagnosis. Shave biopsies and electrodesiccation are inadequate; a full thickness of skin is essential for proper histologic diagnosis and classification. The most important prognostic indicator for stage I and II tumors is thickness; obtain a full-thickness biopsy specimen for adequate pathologic interpretation. Biopsy results ultimately determine the margins of resection and which patients are candidates for sentinel lymph node biopsy and other adjuvant treatment.

Patients who present with metastatic disease or with primary sites other than the skin have signs and symptoms related to the affected organ system(s).

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