Children younger than 10 years, African Americans, Asians, Native Americans, and dark-complected whites are at low risk.
9. What are common sites of melanoma development?
The most common sites are the posterior trunk in men and lower extremities in women. All sun-exposed areas are possible sites. Uncommon sites for melanoma formation are the soles of the feet, palms, and genitalia. Unusual noncutaneous sites for melanoma formation are the eye, anus, and gastrointestinal tract.
10. Where is melanoma most common?
Melanoma is most common in Australia, especially the northern part of the continent, where light-skinned descendants of the original settlers are exposed to tropical sun.
11. What are the warning signs of melanoma?
Skin lesions that display:
- A = Asymmetry
- B = Irregular border
- C = -Color: variable; spotted; often very black with irregular tan areas; red or pink spots; ulcerated when advanced (bleeds easily)
- D = Diameter (> 5-6 mm)
- E = Enlargement or Elevation
12. What are the types of melanoma and their incidence?
- Superficial spreading: 75% of all cases; most common
- Nodular: 15% of cases; most malignant; well circumscribed; deeply invasive
- Lentigo maligna melanoma: 5% of cases; relatively good prognosis
- Acral lentiginous: 5% of cases; most common type in people of color; appears on the soles, palms, subungual sites
13. Which moles should be considered for removal?
Growing and darkening nevi should be excised, especially in sun-sensitive patients. Itching is a sign of early malignant change. Ulceration is a late sign. Because melanoma may be familial in origin, children of patients with melanoma should be carefully screened for very dark nevi.
14. How should suspicious nevi be biopsied?
Total excision of the lesion with a narrow (1-mm) margin of normal skin plus primary repair should be done. Partial incisional biopsy is acceptable if the lesion is large or if total excision would require reconstructive surgery. Punch biopsy, incisional biopsy, or saucerization are all appropriate as long as a full-thickness specimen is obtained. Thorough pathologic study is essential.
15. Do melanomas spontaneously regress or even disappear?
Rarely melanomas can regress or even disappear. Remarkably, such patients have a poor prognosis despite the fact that the primary lesion has regressed or even sloughed off because metastatic disease to the lymph nodes and viscera may have already occurred.
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