'Melanoma? It can't be melanoma!': a subset of melanomas that defies clinical recognition

Article Abstract:

Early detection of malignant melanoma (skin cancer) is imperative for an optimistic prognosis. Skin lesions that show rapid growth, altered pigmentation, and have irregular contours and borders are highly suspect. Physicians finding such lesions normally have them biopsied to see if they are cancerous. Not all cancerous lesions are detected clinically. This can occur when the physician fails to include a suspect lesion on a written request for biopsy or when the lesion does not appear to be suspicious for melanoma. This study examined cases of melanoma not detected clinically because the lesions did not have the characteristic appearance of melanoma. Of 178 cases of malignant melanoma diagnosed from 53,432 specimens sent to a laboratory for examination, 13 (7.4 percent) involved cases where the clinician had not suspected melanoma. Descriptions of 10 of the lesions were available from clinical records and from the examining physician for 2 additional cases. A majority of the tumors were amelanotic (nonpigmented) and deeply invasive. All had characteristics that led to a clinical diagnosis other than melanoma, and none had characteristics indicative of melanoma. These results suggest that a subset of melanomas do not show characteristics commonly associated with this cancer and that these melanomas may go undiagnosed until they have reached a more advanced stage. (Consumer Summary produced by Reliance Medical Information, Inc.)

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Utility of follow-up tests for detecting recurrent disease in patients with malignant melanomas

Article Abstract:

Recurrent disease in patients with malignant melanomas is often detected by physical examination or by taking a history, rather than through the frequent use of expensive follow-up tests. Researchers evaluated a total of 145 patients who developed recurrent disease after surgical removal of resected malignant melanomas. The patients were scheduled for periodic visits which consisted of a physical examination, history, blood cell count, blood chemistry panel, and chest x-ray. A total of 99 patients (68%) developed symptoms that indicated the diagnosis of recurrent disease. Among patients without symptoms, physical examination determined the diagnosis in 37 patients (26%). Only 6% had abnormal chest x-rays. Chest x-rays and blood analyses had less initial diagnostic value than history and physical examination. Costs associated with follow-up care of recurrent melanomas could be reduced greatly with new guidelines regarding the use of tests.

Cancer, Cancer recurrence

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Is Physician Detection Associated With Thinner Melanomas?

Article Abstract:

Doctors are more likely to detect melanoma in its early stages when it is more easily curable. Usually, the tumor is thinner in the early stages of the disease. In a study of 102 patients with melanoma, 55% had detected the tumor themselves, and 24% had been diagnosed by a doctor. Doctors were four times more likely to detect thin tumors compared to the patients themselves. Patients whose tumors are thin have an excellent prognosis if treated promptly.

Medical examination, Mole (Dermatology), Nevus

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