Malignant melanoma (pigm./amelanot.)

Last Updated: 2023-07-07

Author(s): Anzengruber F., Navarini A.

ICD11: 2C30.Z

Black skin cancer, melanoma, malignant melanoma.

Malignant, epithelial tumour of the melanocytes.

  • Incidence (Central Europe): 3-5/100'000/year
  • Incidence (Scandinavia): 12-15/100,000/year
  • Incidence (Australia): 40/100,000/year
  • Lifetime risk (2010) 1:75
  • The closer the place of residence to the equator, the higher the incidence (for Caucasians)
  • African Americans have a 20-fold lower risk.
  • Approximately 1.3% of all cancer deaths are due to malignant melanoma.
  • Women > men.

  • Superficial spreading malignant melanoma (SSM)
  • Nodular malignant melanoma (NM)
  • Acrolentiginous malignant melanoma (ALM)
  • Lentigo-maligna melanoma (LMM)
  • Mucinous melanoma
  • Amelanotic malignant melanoma. CAVE: Any type of melanoma can appear amelanotic
  • Desmoplastic malignant melanoma
  • Malignant melanoma with unknown primary tumour
  • Occult primary site (uvea, meninges, GI tract, lymph nodes)

  • Risk factors
  • Melanoma in self-history
  • UV radiation (cumulative sun exposure and sunburns)
  • Light skin type (mild redness, severe tanning)
  • Red hair (4.7 times increased risk vs. black haired)
  • Positive family history
  • > 100 melanocytic nevi
  • ≥5 atypical nevus cell nevi if ≥2 1st degree relatives have melanoma
  • Dysplastic nevus syndrome (>5 atypical nevus cell nevi and > 50 inconspicuous nevus cell nevi
  • MDM2-SNP309 polymorphism
  • BK mole syndrome
  • Xeroderma pigmentosum
  • An association with Parkinson's disease is discussed
  • About 1/3 of all melanomas arise on existing nevus cell nevi. The majority of all melanomas arise de novo

  • Predilection sites
    • Women: Face, lower legs
    • Men: upper torso
  • Partly reddish, partly bluish, sometimes brown-blackish or not pigmented at all, inhomogeneous, usually progressive in size, irregularly bounded nodules or plaques
  • Metastasis: In 2/3 of all cases, first lymphogenic and then haematogenic. However, haematogenous initial metastases are also possible
  • Satellite metastases: reddish to skin-coloured nodes, which are grouped up to 2 cm around the primary tumour
  • In-transit metastases: Cutaneous or subcutaneous metastases that lie between the primary tumour and the locoregional lymph nodes.
  • Hematogenous metastases can occur in all organs, especially lungs, liver, heart, brain, skin or bone

  • Anamnesis (self-history, family history, sunburns?)
  • Whole body inspection incl. mucous membranes, lymph node status!
  • Macroscopy and dermoscopy (Two-Step Algorithm, ABCDE, ugly duckling concept)
  • If melanoma is suspected, we recommend immediate referral to our centre in Basel ( with keyword melanoma excision), we take over the excision within 48h.
  • If this is not desired, primary complete excision without safety margin is recommended.
  • Take biopsies only in exceptional cases, these do not allow determination of Breslow thickness and may contribute to misdiagnosis.

  • Immunohistology
    • Routine diagnostics: S100, MART1 and IMP3
    • Most important marker: MART1 (Melan A)
    • Proliferation marker: MIB1
    • Ev. CD10 overexpression is an indication of poorer prognosis

  • Post-excision in practice without sentinel lymph node biopsy is the most common mistake as it alters the lymph node drains.
  • Metastasis
  • Delay of diagnosis not uncommon especially in acral melanoma

  • Sun protection (behavioural, topical, textile)
  • Regular full body examination

  1. Dummer R, Hauschild A, Lindenblatt N, Pentheroudakis G, Keilholz U, Committee EG. Cutaneous melanoma: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol 2015;26 Suppl 5:v126-32.
  2. Larson AR, Rothschild B, Walls AC, et al. Impact of the 2009 AJCC staging guidelines for melanoma on the number of mitotic figures reported by dermatopathologists at one institution. J Cutan Pathol 2015;42:536-41.
  3. Nathan P, Cohen V, Coupland S, et al. Uveal Melanoma UK National Guidelines. Eur J Cancer 2015;51:2404-12.
  4. Watts CG, Dieng M, Morton RL, Mann GJ, Menzies SW, Cust AE. Clinical practice guidelines for identification, screening and follow-up of individuals at high risk of primary cutaneous melanoma: a systematic review. Br J Dermatol 2015;172:33-47.
  5. Pflugfelder et al. Malignant melanoma S3-guideline "diagnosis, therapy and follow-up of melanoma". J Dtsch Dermatol Ges. 2013 Aug;11 Suppl 6:1-116, 1-126.