What is malignant melanoma? Pay attention to the criteria a, b, c, d!

Malignant melanoma (MM) is the most malignant skin tumor that occurs with the malignant change of cells called melanocytes, which are localized in the epidermis, dermis or mucous epithelium, or cells in some precursor lesions such as congenital or dysplastic moles.

Today, its incidence is increasing rapidly. This tumor, which is mostly seen in adults, occurs in 2% of those younger than 20 years of age, and in 0.3-0.4% in the prepubertal period.


Ultraviolet (UV): Intermittent heavy sun exposure, significant sunburns in childhood are strong risk factors. Again, artificial UV sources, such as solariums, are also dangerous. Long-term repetitive UV is effective in the development of lentigo malignant melanoma.

Phenotype: People with fair skin, red or light colored hair and freckles are listed as risk. Skin phototypes I, II, that is, those who burn quickly but cannot tan are included in this ranking.

Melanoma or multiple nevus history: Individuals with a personal or familial history of melanoma, those with multiple nevi (me) or dysplastic nevi or large congenital melanocytic nevi (me) are at risk.

Others: A partial association with melanoma has been reported with oral contraceptive (birth control medicine) use for 10 years or more. Genetic diseases such as xeroderma pigmentosum and immunosuppressive treatments are also listed as risk factors.


Clinico-pathological subtypes of melanoma as superficial spreading melanoma (SSM), nodular melanoma (NM), lentigo malignant melanoma (LMM), and acral lentiginous melanoma (ALM) have been defined. In addition, amelanotic melanoma, which is not a histopathological entity, should be particularly emphasized because its clinical features are difficult to define.

Superficial spreading melanoma (SSM): This form, which constitutes 70% of melanomas, is the most common disease of the ages of 30-50. It is most often located on the trunk in men, and more often on the lower extremities and legs in women. It manifests itself as an unsystematic macule or plaque showing various color variations such as brown-black, pink, and violet.

Nodular melanoma (NM): This form, which constitutes 15% of melanomas, is most frequently observed in the middle of the age of 40-60 and is 2 times more common in men. It is mostly localized to the head, neck and trunk. Since there is no radial developmental phase, it has a poor prognosis. It is a rapidly developing, blue-black, dome-shaped, often ulcerated nodule.

Acral lentiginous melanoma (ALM): This clinical type, which accounts for 2-8% of melanomas in whites, is the most common form in dark-skinned and blacks (eg, it constitutes 50% of MM cases in Japanese). It is mostly observed in elderly individuals. The most common localization is the sole of the foot, followed by the palm and nail bed, respectively.

The palms of the hands and soles of the feet present with a brown-black stain with unknown edges. As it progresses, a palpable tumor develops on this spot, which is a sign of an invasive component.

Subungual melanoma manifests itself as a brownish-black discoloration starting from the lower part of the nail plate. Spattering of the brown area around the nail (Hutchinson sign) is a valuable clinical diagnostic criterion. Sometimes it can manifest itself in the form of a brown longitudinal band or with a longitudinal split and break in the nail.

Mucosal melanoma is a melanoma that develops from mucosal surfaces, histopathologically similar to ALM. Oral, genital and anal mucous membranes are the most frequently involved areas. It may start in the form of unsystematic and pigmented blotchy pigmentation and may rise after a respite spread.

Lentigo malignant melanoma (LMM): This form, which constitutes 5% of all melanomas, mostly occurs in older ages (50-70 years). 90% of this form, which is observed in sun-damaged skin, settles on the face. The remaining cases may be localized to areas other than the face, such as hands and legs.

Amelanotic melanoma:

Since this subtype of melanoma lacks pigmentation, it mimics many entities.

In summary, ABCDE criteria (asymmetry, marginal irregularity, mottled or very dark pigmentation, greater than 5 mm in diameter, and atypical evolution, that is, sudden, rapid change in colour, size or topography) are considered in the clinical diagnosis of melanoma.


1. Asymmetry: An edge of the mole is not the one-to-one (like a mirror image) of the glutton.

2. Boundaries: The endings are not obvious. It is difficult to say where the mole begins and ends?

3. Color: Presence of more than one color or black, white, red and yellow colors

4. Diameter: If greater than 0.6 cm?

Even if you can reduce your risk by avoiding the sun, there is no way to prevent melanoma. Best of luck is to detect it while it’s still treatable. If you notice a suspicious mole, see a dermatologist quickly. This could save your life. Even waiting a day can make a difference.

Even with this method, 1-25% of melanomas may not be recognized, and probably many benign MNs may be excised unnecessarily. At this point, dermoscopic examination (examination of moles with a special device) is helpful.


The key to effective treatment is early diagnosis. Melanoma should be diagnosed as early as possible and surgically removed as soon as possible.

exp. Dr. Nezih KARACA

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