Malignant Melanoma

There is a lot of new information about the link between various malignancies and inflammatory bowel disease. Here: answers to 3 key questions.

As the incidence of malignant melanoma continues to rise, so does primary care physicians’ need to identify pigmented lesions for early detection. Take a look at these presentations to test your knowledge.

A 48-year-old Hispanic man had a tender, bleeding growth within a darkly pigmented plaque on the right flank. The pigmented lesion had been present since birth; it was previously asymptomatic. The tumor arose out of the mainly flat patch 6 months earlier and had slowly enlarged. The patient worked indoors, wore sunscreen daily, and generally avoided outdoor activities. He had no family history of skin cancer.

An 83-year-old man with a history of hypertension, hyperlipidemia, and diverticulosis was hospitalized because of painless hematochezia of 1 day's duration. Two years earlier, he had undergone surgical excision of a superficial spreading melanoma on his right thigh.

ABSTRACT: Prevention of skin cancer requires photoprotection (eg, the use of a sunscreen with both UVB and UVA protection) and regular monitoring of the skin for suspicious lesions. Encourage patients to examine all areas of their skin, including the interdigital and genital regions, for unusual macules, papules, and nodules. Teach patients the "ABCDE" warning signs of melanoma (asymmetry, border irregularity, color variegation, diameter greater than 0.5 cm, evolving lesion). Office skin examinations are recommended for patients with risk factors for skin cancer and for those with obvious sun damage. Correct lighting, preferably daylight, and cross-illumination are crucial. Palpation may be helpful in detecting lesions such as actinic keratoses, which have a gritty, sandpaper-like surface.

A 32-year-old woman, who recently gave birth, seeks evaluation of 2 lesions onher neck. A linear, medium brown, warty, 4-cm lesion has been present sinceshe was born; there has been no disproportionate growth or change in color.The crusted 0.5-cm nodule at the most cephalad aspect of the linear lesiondeveloped in early pregnancy and has gradually enlarged.