Malignant Melanoma: Examination

A comprehensive clinical examination is the basis for selecting further diagnostic steps:

• General physical examination – including blood pressure, pulse, body weight, height; further:
  • Inspection (viewing).
    • Skin and mucous membranes including use of a dermatoscope (reflected light microscope) [Leading symptoms: pigment moles that change (ABCD(E) rule according to Stolz):
      • Asymmetry
      • Boundary: irregular boundary
      • Color (color): irregular color
      • Diameter > 5 mm
      • Sublimity > 1 mm]

      [Associated symptoms:

      • Bleeding
      • Ulceration (ulceration)
      • Incrustations]

      In Europeans, the changes occur preferentially on the chest, back or extremities.

  • Inspection and palpation (palpation) of the lymph node stations (cervical, axillary, supraclavicular, inguinal).
  • Inspection of the genital and anal region.
• Health check (as an additional follow-up measure).

Square brackets [ ] indicate possible pathological (pathological) physical findings.

Dermoscopy (reflected light microscopy): five criteria for the diagnosis of melanoma in situ (MIS)

• 1. irregular hyperpigmented areas:
  • Dark brown or black small areas in central parts of the lesion with an irregular shape that cannot be assigned to known features (dots, globules, blotches)
• 2. regression zones
• 3. prominent skin markings (PSM).
  • Continuous furrows that are lighter pigmented than the surrounding area.
  • Are typically found on the extremities
• 4. atypical pigment network
• 5. angled lines

Interpretation

• 1 + 2 in more than 50% of lesion surface area → probability of MIS was increased by 5.4- and 4.7-fold, respectively.
• 1 + 3 → probability for a MIS was increased by 4.3 or 2.7 times, respectively
• DD MIS versus invasive melanoma:
  • Extensive regression was the only indicator of MIS.
  • A blue-white haze is more indicative of invasive melanoma

Note: The criteria still need to be validated.