Melanoma

What it is

Malignant melanoma is the most dangerous skin cancer and needs urgent excision. Where basal cell carcinoma is slow, locally invasive and rarely metastasizes, and squamous cell carcinoma is more aggressive than BCC and can metastasize, melanoma is highly metastatic, to lymph nodes, brain, lungs and liver. Its histology is atypical melanocytes at all levels of the epidermis.

One site has its own line. Subungual melanoma is best recognized early, otherwise the patient will present with the symptoms of metastases.

Who gets it

The risk factors taken in the history are exposure to sunlight and UV, a family history of melanoma, dysplastic nevus syndrome, xeroderma pigmentosum, and a history of non-melanoma skin cancer.

Two further settings name it:

• Skin cancer, whether SCC, BCC or malignant melanoma, is one of the malignancies that complicate immunosuppression
• A family history suggestive of hereditary breast and ovarian cancer syndrome includes melanoma alongside breast, ovarian and pancreatic cancer, and a person with a pathogenic BRCA1 or BRCA2 variant, man or woman, is offered full-body skin examinations for melanoma as part of their surveillance

A history of melanoma is also listed among the absolute contraindications to the use of CHC, beside venous thrombosis, pulmonary embolism, coronary vascular disease, cerebrovascular accident, uncontrolled hypertension, age over 35 with cigarette smoking, endometrial cancer, hepatic tumor or abnormal LFT, breast cancer within the last 5 years, current pregnancy and breast feeding under 6 weeks.