Clinical Presentations of Melanoma

Abstract

Cutaneous melanoma is unique among cancers in that it can be readily identified through visual examination of the skin surface. In this chapter, we detail patterns of melanoma presentation as well as appropriate clinical assessment to facilitate early diagnosis. The major histogenic types of melanoma are superficial spreading melanoma, nodular melanoma, lentigo maligna melanoma, and acral lentiginous melanoma; each differs in their associations with age, sex, race, anatomic site, ultraviolet exposure, and molecular profile. The cardinal clinical feature of all types of melanoma, however, is change in size, shape, and color, eventually becoming distinctly different from the remainder of a patient’s skin lesions (i.e., the ugly duckling sign). Variant, uncommon clinical presentations of melanoma, such as amelanotic, desmoplastic, and spitzoid types, are summarized. Finally, we outline aids to the diagnosis of melanoma, including established tools, such as photography and dermoscopy, as well as emerging ones like reflectance confocal microscopy, artificial intelligence-based diagnostic systems, electrical impedance spectroscopy, and adhesive patch molecular assays.