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

Malignant melanoma (MM) is the worst 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 generally seen in adults, occurs at a rate of 2% in those younger than 20 years of age and in the prepubertal period at a rate of 0.3-0.4%.


Ultraviolet (UV): Intermittent intense sun exposure and severe sunburns in childhood are strong risk factors. Artificial UV sources such as solariums are also dangerous. Long-term repetitive UV is effective in the development of lentigo malignant melanoma.

Phenotype: Fair-skinned people, red or light-colored hair and freckles are listed as risks. Skin phototypes I, II, that is, those who can burn immediately but cannot tan are included in this ranking.

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

Others: A partial association of oral contraceptive (birth control drug) use for 10 years or more with melanoma has been reported. 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 makes up 70% of melanomas, is most often a disease of the ages of 30-50. It is usually located on the trunk in men, and more often on the lower extremities and legs in women. It manifests as an irregularly shaped macule or plaque showing various color variations such as brown-black, pink, violet.

Nodular melanoma (NM): This form, which accounts for 15% of melanomas, is most common between the ages of 40-60 and is 2 times more common in men. It is mostly localized to the head, neck and trunk. It has a poor prognosis since there is no radial developmental phase. 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 accounts for 50% of MM cases in Japanese). It is usually observed in elderly people. 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 are characterized by a brown-black stain with indistinct borders. As it progresses, a palpable tumor develops on this spot, a sign of an invasive component.

subungual melanoma On the other hand, it 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 as a brown longitudinal band or a longitudinal split and break in the nail.

Mucosal melanoma It is a melanoma that develops from mucosal surfaces and is histopathologically similar to ALM. Oral, genital and anal mucous membranes are the most frequently involved areas. It may start as an irregularly shaped and pigmented spot pigmentation and may increase after spreading for a while.

Lentigo malignant melanoma (LMM): This form, which accounts for 5% of all melanomas, usually occurs at a later age (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, the ABCDE criteria (asymmetry, marginal irregularity, mottled or very dark pigmentation, greater than 5 mm in diameter, and atypical evolution, i.e. sudden, rapid change in color, size, or topography) are considered in the clinical diagnosis of melanoma.


1. Asymmetry: One side of the mole is not the same (like a mirror image) of the other.

2. Boundaries: Boundaries are not clear. 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

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. The best chance is to detect it while it’s still treatable. If you notice a suspicious mole, see a dermatologist immediately. 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, perhaps a large number of benign MNs may be excised unnecessarily. At this point too dermoscopic examination (examination of moles with a special device) it is helpful.


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