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{{Melanoma}}
{{Melanoma}}
{{CMG}}
{{CMG}} {{AE}} {{YD}}; {{SSK}}
==Overview==
==Overview==
==Types of primary melanoma==
[[Melanoma]] may be classified into either [[Skin|cutaneous]] or [[Skin|non-cutaneous]] [[Melanoma|melanomas]]. The most common 4 sub-types of [[Skin|cutaneous]] [[melanoma]] include [[Superficial (human anatomy)|superficial]] spreading [[melanoma]], [[Nodule (medicine)|nodular]] [[melanoma]], [[acral lentiginous melanoma]], and [[lentigo maligna melanoma]]. Less common sub-types of [[melanoma]] include [[Desmoplasia|desmoplastic]]/[[spindle cell]] [[melanoma]], [[nevoid melanoma]], [[Spitzoid melanoma|spitzoid melanocytic melanoma]], [[angiotropic melanoma]], [[blue nevus]]-like [[melanoma]], and [[composite melanoma]].
[[Image:Superficial spreading melanoma 1 060619.jpg|thumb|right|220px|Superficial spreading melanoma on the right leg of a 63-year-old man. This is an asymmetric black and 2 cm nodule with variable color, texture and well demarcated border.]]


The most common types of Melanoma in the skin:
==Classification of Melanoma==
* [[superficial spreading melanoma]] (SSM)
Shown below is a table that demonstrates the various sub-classes of [[melanoma]]:<ref name="book1">{{cite book|last=Schanderdorf D, Kochs C, Livingstone E |date=2013 |title=Handbook of Cutaneous Melanoma: A Guide to Diagnosis and Treatment |publisher=Springer }}</ref><ref name="book2">{{cite book|last=Mooi W, Krausz T|date=2007 |title=Pathology of Melanocytic Disorders 2nd Ed. |publisher=CRC Press}}</ref>
* [[nodular melanoma]]
{| {{table}} cellpadding="4" cellspacing="0" style="border:#c9c9c9 1px solid; margin: 1em 1em 1em 0; border-collapse: collapse;"
* [[acral lentiginous melanoma]]
| align="center" style="background: #4479BA;" | {{fontcolor|#FFF|'''Subtype'''}}
* [[lentigo maligna melanoma|lentigo maligna (melanoma)]]
| align="center" style="background: #4479BA;" | {{fontcolor|#FFF|'''Frequency'''}}
Any of the above types may produce melanin (and be dark in colour) or not (and be amelanotic - not dark).  Similarly any subtype may show desmoplasia (dense fibrous reaction with neurotropism) which is a marker of aggressive behaviour and a tendency to local recurrence.
| align="center" style="background: #4479BA;" | {{fontcolor|#FFF|'''Clinical Features'''}}
|-
| colspan="3" |'''''Common Subtypes'''''
|-
|[[Superficial (human anatomy)|Superficial]] spreading [[melanoma]]||70%||
*Most common sub-type
*Usually affects sun exposed sites among both men and women aged 50-70 years
*Characterized by the ''presence'' of abundant junctional [[Epidermis (skin)|intra-epidermal]] spread of [[malignant]] [[Melanocyte|melanocytes]]
|-
|[[Nodular melanoma]]||15-25%||
*Second most common subtype
*Usually affects sun exposed sites among both men and women aged 50-70 years
*Characterized by the ''absence'' of junctional [[Epidermis (skin)|intra-epidermal]] spread of [[malignant]] [[Melanocyte|melanocytes]]
|-
|[[Acral lentiginous melanoma]]||5%||
*Not associated with [[Chronic (medical)|chronic]] [[ultraviolet]] exposure
*Affects the [[Limb (anatomy)|extremities]] of individuals of all [[Race|races]]
*Common among the elderly Caucasian and non-Caucasian individuals
|-
|[[Lentigo maligna melanoma]]||1-5%||
*Preceded by [[lentigo maligna]]
*Common among the elderly Caucasian [[Patient|patients]]
*Usually appears as a flat, non-palpable [[lesion]] that affects sun exposed sites, especially the [[head]] and [[neck]] ([[Lesion|lesions]] on [[Limb (anatomy)|extremities]] are less common)
|-
| [[Skin|Non-cutaneous]] [[melanoma]]||5%||
*[[Melanoma]] that does not affect the [[skin]]
*Usually affects the [[eye]] ([[ocular]] [[melanoma]]) or the [[Mucous membrane|mucus membranes]] ([[Mucous membrane|mucosal]] [[melanoma]])
|-
| colspan="3" | '''''Less Common Subtypes'''''
|-
| [[Desmoplasia|Desmoplastic]]/[[Spindle cell]] [[melanoma]]||Rare||
*[[Lesion]] typically amelanotic and has a [[morphology]] similar to a [[scar tissue]]
*Appears indolent but is highly [[Infiltration (medical)|infiltrative]]
*Characterized by local recurrence and [[Perineurium|perineural]] spread
*Usually affects males aged 60-70 years in sun exposed sites
*May be [[de novo]] or can be associated with a pre-existing [[melanoma]]
*Has several subtypes:
::*Pure: paucicellular
::*[[Desmoplasia|Desmoplastic]]-neurotropic [[melanoma]]: characterized by neurotropism
::*Pure neurotropic [[melanoma]]: no [[desmoplasia]] with [[spindle cell]] [[melanoma]] of neurotropic [[phenotype]]
::*Mixed/Combined: [[Epithelium|epithelial]] and [[spindle cells]]
|-
| [[Nevoid melanoma]]||Rare||
*[[Lesion]] has features of both [[melanoma]] and [[melanocytic nevus]] on [[Histopathology|histopathological]] [[analysis]]
*Clinical features resemble those of a typical [[melanoma]]
|-
| [[Spitzoid melanoma|Spitzoid melanocytic neoplasm]]||Rare||
*[[Lesion]] has features of both [[melanoma]] and Spitz ([[epithelioid]]) [[tumor]]
*Typically affects sun exposed sites among children and young adults, but adults with Spitz [[Tumor|tumors]] are more often [[Diagnosis|diagnosed]] with [[Spitzoid melanoma]]
*Compared to [[benign]] Spitz [[Tumor|tumors]], [[Spitzoid melanoma|Spitzoid melanomas]] are usually large (>5 mm)
|-
| [[Angiotropic melanoma]]||Rare||
*[[Lesion]] characterized by angiotropism, whereby the [[melanoma]] grows in proximity (within 1-2 mm) to [[blood]] and/or [[Lymphatic system|lymphatic tissue]] but no [[tumor]] within the [[vascular]] [[lamina]] itself
*The [[tumor]] may originally be another sub-type of [[melanoma]]
*Clinical features similar to typical [[melanoma]]
|-
| [[Blue nevus]]-like [[melanoma]]||Rare||
*[[Melanoma]] that develops from a pre-existing [[blue nevus]]
*One of the rarest forms of [[melanoma]]
*Appears as a [[blue nevus]] that has recently been rapidly expanding with irregular contours
*Typically affects middle-aged men
|-
| [[Composite melanoma]]||Rare||
*[[Melanoma]] that develops in the proximity of other pre-existing [[Epithelium|epithelial]] [[Cancer|malignancies]] (e.g. [[Basal cell carcinoma|basal]]/[[squamous cell carcinoma]])
*May be characterized by one of the following:
::*Collision [[tumor]]: Collision of [[melanoma]] and another nearby [[malignant]] [[tumor]]
::*Colonization: Colonization of [[Melanocyte|melanocytes]] in a [[tumor]]
::*Combined: Two distinct [[Tumor|tumors]] appear to have mixed features of the [[melanoma]] and the other [[tumor]]
::*[[Biphenotypic melanoma|Biphenotypic]]: One [[tumor]] that has features of [[melanoma]] and another [[Epithelium|epithelial]] [[Cancer|malignancy]]
|}


Elsewhere:
* [[clear cell tumor|clear cell sarcoma]] (Melanoma of Soft Parts)
* mucosal melanoma
* [[uveal melanoma]]
==References==
==References==
{{reflist|2}}
{{reflist|2}}
{{WH}}
{{WH}}
{{WS}}
{{WS}}
[[Category:Up-To-Date]]
[[Category:Oncology]]
[[Category:Medicine]]
[[Category:Dermatology]]
[[Category:Surgery]]

Latest revision as of 01:44, 2 January 2019

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Yazan Daaboul, M.D.; Serge Korjian M.D.

Overview

Melanoma may be classified into either cutaneous or non-cutaneous melanomas. The most common 4 sub-types of cutaneous melanoma include superficial spreading melanoma, nodular melanoma, acral lentiginous melanoma, and lentigo maligna melanoma. Less common sub-types of melanoma include desmoplastic/spindle cell melanoma, nevoid melanoma, spitzoid melanocytic melanoma, angiotropic melanoma, blue nevus-like melanoma, and composite melanoma.

Classification of Melanoma

Shown below is a table that demonstrates the various sub-classes of melanoma:[1][2]

Subtype Frequency Clinical Features
Common Subtypes
Superficial spreading melanoma 70%
  • Most common sub-type
  • Usually affects sun exposed sites among both men and women aged 50-70 years
  • Characterized by the presence of abundant junctional intra-epidermal spread of malignant melanocytes
Nodular melanoma 15-25%
  • Second most common subtype
  • Usually affects sun exposed sites among both men and women aged 50-70 years
  • Characterized by the absence of junctional intra-epidermal spread of malignant melanocytes
Acral lentiginous melanoma 5%
Lentigo maligna melanoma 1-5%
Non-cutaneous melanoma 5%
Less Common Subtypes
Desmoplastic/Spindle cell melanoma Rare
  • Lesion typically amelanotic and has a morphology similar to a scar tissue
  • Appears indolent but is highly infiltrative
  • Characterized by local recurrence and perineural spread
  • Usually affects males aged 60-70 years in sun exposed sites
  • May be de novo or can be associated with a pre-existing melanoma
  • Has several subtypes:
Nevoid melanoma Rare
Spitzoid melanocytic neoplasm Rare
Angiotropic melanoma Rare
Blue nevus-like melanoma Rare
  • Melanoma that develops from a pre-existing blue nevus
  • One of the rarest forms of melanoma
  • Appears as a blue nevus that has recently been rapidly expanding with irregular contours
  • Typically affects middle-aged men
Composite melanoma Rare

References

  1. ↑ Schanderdorf D, Kochs C, Livingstone E (2013). Handbook of Cutaneous Melanoma: A Guide to Diagnosis and Treatment. Springer.
  2. ↑ Mooi W, Krausz T (2007). Pathology of Melanocytic Disorders 2nd Ed. CRC Press.

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