Melanoma is a potentially fatal cutaneous tumor derived from epidermal melanocytes. Any age can be affected; peak incidence is in 20- to 45-year-old patients (much younger than BCC or SCC). The most significant risk factor is a primary relative with melanoma. Evaluation of any pigmented lesion should include the ABCDE rule (A for asymmetry, B for irregular borders, C for color variegation, D for diameter > 6 mm, and E for elevation and evolving). Any lesion with these characteristics is considered suspicious for melanoma.
Melanoma. This lesion demonstrates asymmetry, color variegation, and a diameter greater than 6 mm. (Photo contributor: J. Matthew Hardin, MD.)
Nodular Melanoma. This has progressed to an exophytic tumor, which was deeply invasive histopathologically. (Photo contributor: Department of Dermatology, Wilford Hall USAF Medical Center and Brooke Army Medical Center, San Antonio, TX.)
Management and Disposition
Prompt outpatient dermatologic referral is indicated. Simply acknowledging suspicious lesions seen during emergency care may encourage earlier follow-up.
The palms, soles, and nail areas are the most common sites in dark-skinned individuals.
Melanoma can occur in sites not exposed to the sun (genitalia/buttocks/scalp).
Any growing pigmented or nonpigmented lesion should be referred to dermatology.
Most patients will not have new moles after 35 years old. A new mole in this setting should be referred.
Melanoma. Slow-growing, pigmented plaque on the arch of the foot. (Photo contributor: J. Matthew Hardin, MD.)