Abstract
The malignant cell in melanoma is the melanocyte. Because melanocytes are located in the basal layer of the epidermis, melanoma is most commonly seen on the skin. However, melanoma can also arise on mucosal surfaces such as the oral cavity, the upper gastrointestinal mucosa, the genital mucosa, as well as the uveal tract of the eye and leptomeninges. Melanomas tend to be pigmented but can also present as pink or red lesions. They can mimic benign or other malignant skin lesions. This chapter presents the spectrum of typical and less typical presentations of melanoma, as well as patterns of spread. It is divided into (1) cutaneous lesions; (2) patterns of regional spread, (3) non-cutaneous lesions; and (4) distant metastases.
This is a preview of subscription content, log in via an institution.
Buying options
Tax calculation will be finalised at checkout
Purchases are for personal use only
Learn about institutional subscriptionsReferences
Clemente C, Cook M, Ruiter D, Mihm M (2001) Histopathologic diagnosis of melanoma. World Health Organization melanoma programme publications, Milan, Trezzano SN
Bolognia JB, Jorizzo JL, Schaffer JV (2012) Dermatology. Saunders, Philadelphia
Ackerman A, Cerroni L, Kerl H (1994) Pitfalls in histopathologic diagnosis of malignant melanoma. Lea & Febiger, Philadelphia
Lipsker D, Engel F, Cribier B et al (2007) Trends in melanoma epidemiology suggest three different types of melanoma. Br J Dermatol 157(2):338–343
Swerdlow AJ, English J, Mackie RM et al (1986) Benign melanocytic naevi as a risk factor for malignant melanoma. Br Med J (Clin Res Ed) 292:1555–1559
Weiss J, Bertz J, Jung EG (1991) Malignant melanoma in southern Germany: different predictive value of risk factors for melanoma subtypes. Dermatologica 183:109–113
Argenziano G, Soyer HP, Chimenti S et al (2003) Dermoscopy of pigmented skin lesions: results of a consensus meeting via the internet. J Am Acad Dermatol 48:679–693
Demierre MF et al (2005) Early detection of thick melanomas in the United States: beware of the nodular subtype. Arch Dermatol 141(6):745–750
Koch SE, Lange JR (2000) Amelanotic melanoma: the great masquerader. J Am Acad Dermatol 42:731–734
Weinstock MA, Sober AJ (1987) The risk of progression of lentigo maligna to lentigo maligna melanoma. Br J Dermatol 116:303–310
Stolz W, Schiffner R, Burgdorf WH (2002) Dermatoscopy for facial pigmented skin lesions. Clin Dermatol 20:276–278
Shaw JH, Koea JB (1988) Acral (volar-subungual) melanoma in Auckland New Zealand. Br J Surg 75:69–72
Phan A, Touzet S, Dalle S et al (2007) Acral lentiginous melanoma: histopathological prognostic features of 121 cases. Br J Dermatol 157(2):311–318
Skender-Kalnenas TM, English DR, Heenan PJ (1995) Benign melanocytic lesions: risk markers or precursors of cutaneous melanoma? J Am Acad Dermatol 33:1000–1007
Bauer J, Garbe C (2004) Risk estimation for malignant transformation of melanocytic nevi. Arch Dermatol 140:127
Tsao H, Bevona C, Goggins W, Quinn T (2003) The transformation rate of moles (melanocytic nevi) into cutaneous melanoma. A population based estimate. Arch Dermatol 139:282–288
Garbe C, Buttner P, Weiss J et al (1994) Risk factors for developing cutaneous melanoma and criteria for identifying persons at risk: multicenter case-control study of the central malignant melanoma registry of the German Dermatological Society. J Invest Dermatol 102:695–699
Caballos P, Barnhill R (1993) Spontaneous regression of cutaneous tumors. Adv Dermatol 8:229–261
Nestle FO, Burg G, Dummer R (1999) New perspectives on immunobiology and immunotherapy of melanoma. Immunol Today 20:5–7
Marincola FM, Jaffee EM, Hicklin DJ, Ferrone S (2000) Escape of human solid tumors from T-cell recognition: molecular mechanisms and functional significance. Adv Immunol 74:181–273
Barr RJ (1994) The many faces of completely regressed malignant melanoma. Pathology (Phila) 2(2):359–370
Hayes PJ, Malone JC, Brown TC (2014) New blue-black nodule in a patient with a history of melanoma. JAMA Dermatol 150:767–768
McGovern VJ, Shaw HM, Milton GW (1983) Prognosis in patients with thin malignant melanoma: influence of regression. Histopathology 7:673–680
Abramova L, Slingluff CLJR, Patterson JW (2002) Problems in the interpretation of apparent ‘‘radial growth phase’’ malignant melanomas that metastasize. J Cutan Pathol 29:407–414
Ceballos PI, Barnhill RL (1993) Spontaneous regression of cutaneous tumors. Adv Dermatol 8:229–261
Boon T, Cerottini JC, Van den Eynde B et al (1994) Tumor antigens recognized by T lymphocytes. Annu Rev Immunol 12:337–365
Menzies SW, McCarthy WH (1997) Complete regression of primary cutaneous malignant melanoma. Arch Surg 132:553–556
Guitart J, Lowe L, Piepkorn M et al (2002) Histological characteristics of metastasizing thin melanomas. Arch Dermatol 138:603–608
Clark WH, Elder DE, Guerry D et al (1989) Model predicting survival in stage I melanoma based on tumor progression. J Natl Cancer Inst 81:1893–1904
Ronan SG, Eng AM, Briele HA et al (1987) Thin malignant melanomas with regression and metastases. Arch Dermatol 123:1326–1330
Fontaine D, Parkhill W, Greer W et al (2003) Partial regression of primary cutaneous melanoma. Am J Dermatopathol 25:371–373
Shaw HM, McCarthy WH, McCarthy SW et al (1987) Thin malignant melanomas and recurrence potential. Arch Surg 122:1147–1150
Lee CC, Faries MB, Wanek LA, Morton DL (2008) Improved survival after lymphadenectomy for nodal metastasis from an unknown primary melanoma. J Clin Oncol 26:535–541
Prens SP, van der Ploeg AP, van Akkooi AC, van Montfort CA, van Geel AN et al (2011) Outcome after therapeutic lymph node dissection in patients with unknown primary melanoma site. Ann Surg Oncol 13:3586–3592
High WA, Steward D, Wilbers CRH et al (2005) Completely regressed primary cutaneous malignant melanoma with nodal and/or visceral metastases: a report of 5 cases and assessment of the literature and diagnostic criteria. J Am Acad Dermatol 53(1):89–100
McClain SE, Mayo KB, Shada AL et al (2012) Amelanotic melanomas presenting as red skin lesions: a diagnostic challenge with potentially lethal consequences. Int J Dermatol 51(4):420–426
Bastian BC (2002) Molecular cytogenetics as a diagnostic tool for typing melanocytic tumors. Recent Results Cancer Res 160:92–99
Bauer J, Bastian BC (2006) Distinguishing melanocytic nevi from melanoma by DNA copy number changes: comparative genomic hybridization as a research and diagnostic tool. Dermatol Ther 19:40–49
Sangüeza M, Zelger B (2007) Melanoma simulating atypical fibroxanthoma. Am J Dermatopathol 29(6):551–554
Diaz-Cascajo C, Weyers W, Borghi S (2003) Pigmented atypical fibroxanthoma: a tumor that may be easily mistaken for malignant melanoma. Am J Dermatopathol 25:1–5
McGregor DH, Cherian R, Romanas MM et al (2008) Amelanotic malignant melanoma: two collision tumors presenting as basal cell carcinoma and atypical fibroxanthoma. Ann Clin Lab Sci 38(2):157–162
Hiscutt EL, Adams JR, Ryan JM, Langtry JA et al (2009) Atypical fibroxanthoma, lentigo maligna melanoma and squamous cell carcinoma arising in the site of a thermal burn treated with skin grafts. Br J Oral Maxillofac Surg 47(2):157–158
Kossard S (2002) Atypical lentiginous junctional naevi of the elderly and melanoma. Aust J Dermatol 43(2):93–101
Pralong P, Bathelier E, Dalle S et al (2012) Dermoscopy of lentigo maligna melanoma: report of 125 cases. Br J Dermatol 167(2):280–287
Quinn MJ, Crotty KA, Thompson JF, et al (1998) Desmoplastic and desmoplastic neurotropic melanoma: experience with 280 patients. Cancer 83:1128–35
Jaimes N, Chen L, Dusza SW, Carrera C et al (2013) Clinical and dermoscopic characteristics of desmoplastic melanomas. JAMA Dermatol 149(4):413–421
McCarthy SW, Scolyer RA, Palmer AA (2004) Desmoplastic melanoma: a diagnostic trap for the unwary. Pathology 36(5):445–451
Gartner MF, Fearns C, Wilson EL, et al (1992) Unusual growth characteristics of human melanoma xenografts in the nude mouse: a model for desmoplasia, dormancy and progression. Br J Cancer 65:487–90
Fearns C, Dowdle EB The desmoplastic response: induction of collagen synthesis by melanoma cells in vitro. Int J Cancer 50:621–7
Bryant E, Ronan SG, Felix EL, Manaligod JR (1982) Desmoplastic malignant melanoma: a study by conventional and electron micro-scopy. Am J Dermatopathol 4:467–474
From L, Hanna W, Kahn HJ, Gruss J, Marks A, Baumal R (1983) Origin of the desmoplasia in desmoplastic malignant melanoma. Hum Pathol 14:1072–1080
De Almeida LS, Requena L, Rutten A et al (2008) Desmoplastic malignant melanoma: a clinicopathologic analysis of 113 cases. Am J Dermatopathol 30:207–215
Zettersten E, Sagebiel RW, Miller III Jr et al (2002) Prognostic factors in patients with thick cutaneous melanoma (>4 mm). Cancer 94:1049–1056
Hudson DA, Krige JE (1995) Melanoma in black South Africans. J Am Coll Surg 180:65–71
Chang JW, Yeh KY, Wang CH et al (2004) Malignant melanoma in Taiwan: a prognostic study of 181 cases. Melanoma Res 14:537–541
Cress RD, Holly EA (1997) Incidence of cutaneous melanoma among non-Hispanic whites, Hispanics, Asians, and blacks: an analysis of California cancer registry data, 1988–93. Cancer Causes Control 8:246–252
Cress RD, Holly EA (1997) Incidence of cutaneous melanoma among non-Hispanic whites, Hispanics, Asians and blacks: an analysis of California cancer registry data, 1988–93. Cancer Causes Control 8:246
Curtin JA, Fridlyand J, Kageshita T et al (2005) Distinct sets of genetic alterations in melanoma. N Engl J Med 353:2135–2147
Torres-Cabala CA, Wang WL, Trent J et al (2009) Correlation between KIT expression and KIT mutation in melanoma: a study of 173 cases with emphasis on the acral-lentiginous/mucosal type. Mod Pathol 22:1446–1456
Stern DK, Creasey AA, Quijije J et al (2011) UVA and UVB penetration of normal human cadaveric fingernail plate. Arch Dermatol 147(4):439–441
Gosselink CP, Sindone JL, Meadows BJ et al (2009) Amelanotic subungual melanoma: a case report. J Foot Ankle Surg 48(2):220–224
Mohrle M, Hafner HM (2002) Is subungual melanoma related to trauma? Dermatology 204(4):259–261
Bormann G, Marsch WC, Haerting J et al (2006) Concomitant traumas influence prognosis in melanomas of the nail apparatus. Br J Dermatol 155(1):76–80
Reintgen DS, Cox C, Slingluff CLJ, Seigler HF (1992) Recurrent malignant melanoma: the identification of prognostic factors to predict survival. Ann Plast Surg 28:45–49
Mathes SJ and Hentz VR (2006) Malignant melanoma. Saunders, Philadelphia
Erol B, Ufuk U, Husamettin T et al (2008) True hematogenous metastases of melanoma on contralateral skin graft donor site: a case report. Melanoma Res 18(6):443–446
Hall JG, Herman C, Cook JL et al (2005) Melanoma arising in a skin graft. Ann Plast Surg 54:92–96
Mueller BM, Reisfeld RA, Edgington TS et al (1992) Expression of tissue factor by melanoma cells promotes efficient hematogenous metastasis. Proc Natl Acad Sci USA 89:11832–11836
Bromberg ME, Konigsberg WH, Madison JF et al (1995) Tissue factor promotes melanoma metastasis by a pathway independent of blood coagulation. Proc Natl Acad Sci USA 92:8205–8209
Balch CM, Gershenwald JE, Soong SJ, Thompson JF, Atkins MB et al (2009) Final version of 2009 AJCC melanoma staging and classification. J Clin Oncol 27:6199–6206
Weide B, Faller C, Büttner P, Pflugfelder A et al (2013) Prognostic factors of melanoma patients with satellite or in-transit metastasis at the time of stage III diagnosis. PLoS One 8(4):e63137
Balch CM, Gershenwald JE, Soong SJ, Thompson JF, Atkins MB, Byrd DR, Buzaid AC, Cochran AJ, Coit DG, Ding S, Eggermont AM, Flaherty KT, Gimotty PA, Kirkwood JM, McMasters KM, Mihm MC Jr, Morton DL, Ross MI, Sober AJ, Sondak VK (2009) Final version of 2009 AJCC melanoma staging and classification. J Clin Oncol 27(36):6199–6206. doi:10.1200/JCO.2009.23.4799 Epub 2009 Nov 16
Wong JH, Cagle LA, Kopald KH et al (1990) Natural history and selective management of in transit melanoma. J Surg Oncol 44:146–150
Cascinelli N, Bufalino R, Marolda R et al (1986) Regional non-nodal metastases of cutaneous melanoma. Eur J Surg Oncol 12:175–180
Calabro A, Singletary SE, Balch CM (1989) Patterns of relapse in 1001 consecutive patients with melanoma nodal metastases. Arch Surg 124:1051–1055
Zogakis TG, Bartlett DL, Libutti SK et al (2001) Factors affecting survival after complete response to isolated limb perfusion in patients with in-transit melanoma. Ann Surg Oncol 8:771–778
Francken AB, Accortt NA, Shaw HM, Wiener M, Soong SJ et al (2008) Prognosis and determinants of outcome following locoregional or distant recurrence in patients with cutaneous melanoma. Ann Surg Oncol 15:1476–1484
Roses DF, Karp NS, Oratz R, Dubin N, Harris MN et al (1991) Survival with regional and distant metastases from cutaneous malignant melanoma. Surg Gynecol Obstet 172:262–268
Kretschmer L, Preusser KP, Marsch WC, Neumann C (2000) Prognostic factors of overall survival in patients with delayed lymph node dissection for cutaneous malignant melanoma. Melanoma Res 10:483–489
Karakousis CP, Choe KJ, Holyoke ED (1980) Biologic behavior and treatment of intransit metastasis of melanoma. Surg Gynecol Obstet 150:29–32
Estourgie SH, Nieweg OE, Valdes Olmos RA et al (2003) Review and evaluation of sentinel node procedures in 250 melanoma patients with a median follow-up of 6 years. Ann Surg Oncol 10:681–688
Estourgie SH, Nieweg OE, Kroon BB (2004) High incidence of in-transit metastases after sentinel node biopsy in patients with melanoma. Br J Surg 91:1370–1371
Pawlik TM, Ross MI, Thompson JF et al (2005) The risk of in-transit melanoma metastasis depends on tumor biology and not the surgical approach to regional lymph nodes. J Clin Oncol 23(21):4588–4590
Van Poll D, Thompson JF, McKinnon JG et al (2005) A sentinel node biopsy does not increase the incidence of in-transit metastasis in patients with primary cutaneous melanoma. Ann Surg Oncol 12(8):597–608
Kretschmer L, Beckmann I, Thoms KM et al (2005) Sentinel lymphonodectomy does not increase the risk of loco-regional cutaneous metastases of malignant melanomas. Eur J Cancer 41:531–538
Thompson JF, Uren RF, Shaw HM et al (1999) Location of sentinel lymph nodes in patients with cutaneous melanoma: new insights into lymphatic anatomy. J Am Coll Surg 189:195–204
Meier F, Will S, Ellwanger U et al (2002) Metastatic pathways and time courses in the orderly progression of cutaneous melanoma. Br J Dermatol 147:62–70
Das Gupta T, Bowden L, Berg JW (1963) Malignant melanoma of unknown primary origin. Surg Gynecol Obstet 117:341–345
Ridolfi RL, Rosen PP, Thaler H (1977) Nevus cell aggregates associated with lymph nodes: Estimated frequency and clinical significance. Cancer 39:164–171
Shenoy BV, Fort L 3rd, Benjamin SP (1987) Malignant melanoma primary in lymph node: the case of the missing link. Am J Surg Pathol 11:140–146
Maurer H, McIntyre OR, Rueckert F (1974) Spontaneous regression of malignant melanoma: pathologic and immunologic study in a ten year survivor. Am J Surg 127:397–403
Giuliano AE, Moseley HS, Irie RF et al (1980) Immunologic aspects of unknown primary melanoma. Surgery 87:101–105
Tefany FJ, Barnetson RS, Halliday GM et al (1991) Immunocytochemical analysis of the cellular infiltrate in primary regressing and non-regressing malignant melanoma. J Invest Dermatol 97:197–202
Singh AD, Topham A (2003) Incidence of uveal melanoma in the United States: 1973–1997. Ophthalmology 110:956–961
Jemal A, Siegel R, Xu J, Ward E (2010) Cancer statistics, 2010. CA Cancer J Clin 60:277–300
Battaglia A (2014) The importance of multidisciplinary approach in early detection of BAP1 tumor predisposition syndrome: clinical management and risk assessment. Clin Med Insights Oncol 28(8):37–47
Materin MA, Faries M, Kluger HM (2011) Molecular alternations in uveal melanoma. Curr Probl Cancer 35(4):211–224
Field MG, Harbor JW (2014) Recent developments in prognostic and predictive testing in uveal melanoma. Curr Opin Ophthalmol 25(3):234–239
Luke JJ, Triozzi PL, McKenna KC, Van Meir EG, Gershenwald JE, Bastian BC, Gutkind JS, Bowcock AM, Streicher HZ, Patel PM, Sato T, Sossman JA, Sznol M, Welch J, Thurin M, Selig S, Flaherty KT, Carvajal RD (2014) Biology of advanced uveal melanoma and next steps for clinical therapeutics. Pigment Cell Melanoma Res 28:135–147
Carvajal RD, Sosman JA, Quevedo JF, Milhem MM, Joshua AM, Kudchadkar RR, Linette GP, Gajewski TF, Lutzky J, Lawson DH, Lao CD, Flynn PJ, Albertini MR, Sato T, Lewis K, Doyle A, Ancell K, Panageas KS, Bluth M, Hedvat C, Erinjeri J, Ambrosini G, Marr B, Abramson DH, Dickson MA, Wolchok JD, Chapman PB, Schwartz GK (2014) Effect of selumetinib vs chemotherapy on progression-free survival in uveal melanoma: a randomized clinical trial. JAMA 311(23):2397–2405
Chang AE, Karnell LH, Menck HR (1998) The national cancer data base report on cutaneous and noncutaneous melanoma: a summary of 84,836 cases from the past decade. The American College of surgeons commission on cancer and the American Cancer Society. Cancer 83:1664
Patrick RJ, Fenske NA, Messina JL (2007) Primary mucosal melanoma. J Am Acad Dermatol 56(5):828–834
Bishop KD, Olszewski AJ (2014) Epidemiology and survival outcomes of ocular and mucosal melanomas: a population-based analysis. Int J Cancer 134(12):2961–2971
McLean N, Tighiouart M, Muller S (2008) Primary mucosal melanoma of the head and neck. Comparison of clinical presentation and histopathologic features of oral and sinonasal melanoma. Oral Oncol 44(11):1039–1046. doi:10.1016/j.oraloncology.2008.01.014
Yii NW, Eisen T, Nicolson M, A’Hern R, Rhys-Evans P, Archer D, Henk JM, Gore ME (2003) Mucosal malignant melanoma of the head and neck: the Marsden experience over half a century. Clin Oncol (R Coll Radiol) 15(4):199–204
DeMatos P, Tyler D, Seigler HF (1998) Mucosal melanoma of the female genitalia: a clinicopathologic study of forty-three cases at Duke University Medical Center. Surgery 124(1):38–48
Mehra T, Grözinger G, Mann S, Guenova E, Moos R, Röcken M, Claussen CD, Dummer R, Clasen S, Naumann A, Garbe C (2014) Primary localization and tumor thickness as prognostic factors of survival in patients with mucosal melanoma. PLoS One 9(11):e112535
Cagir B, Whiteford MH, Topham A, Rakinic J, Fry RD (1999) Changing epidemiology of anorectal melanoma. Dis Colon Rectum 42:1203–1208
Brady MS, Kavolius JP, Quan SH (1995) Anorectal melanoma: a 64-year experience at Memorial Sloan-Kettering Cancer Center. Dis Colon Rectum 38:146–151
Tas F (2012) Metastatic behavior in melanoma: timing, pattern, survival, and influencing factors. J Oncol 2012(647684)
Flanigan JC, Jilaveanu LB, Faries M, Sznol M, Ariyan S, Yu JB, Knisely JP, Chiang VL, Kluger HM (2011) Melanoma brain metastases: is it time to reassess the bias? Curr Probl Cancer 35(4):200–210
Poo-Hwu WJ, Ariyan S, Lamb L, Papac R, Zelterman D, Hu GL, Brown J, Fischer D, Bolognia J, Buzaid AC (1999) Follow-up recommendations for patients with American Joint Committee on cancer stages I-III malignant melanoma. Cancer 86:2252–2258
Lee CC, Faries MB, Wanek LA et al (2009) Improved survival for stage IV melanoma from an unknown primary site. J Clin Oncol 27:3489–3495
Egberts F, Bergner I, Krüger S, Haag J, Behrens HM, Hauschild A, Röcken C (2014) Metastatic melanoma of unknown primary resembles the genotype of cutaneous melanomas. Ann Oncol 25(1):246–250
King R, Page RN, Googe PB et al (2005) Lentiginous melanoma: a histologic pattern of melanoma to be distinguished from lentiginous nevus. Mod Pathol 18(10):1397–1401
Satzger I, Völker B, Kapp A, Gutzmer R (2007) Tumoral melanosis involving the sentinel lymph nodes: a case report. J Cutan Pathol 34(3):284–286
Essner R, Lee JH, Wanek LA, Itakura H, Morton DL (2004) Contemporary surgical treatment of advanced-stage melanoma. Arch Surg 139:961–966
Egan KM, Seddon JM, Glynn RJ, Gragoudas ES, Albert DM (1988) Epidemiologic aspects of uveal melanoma. Surv Ophthalmol 32:239–251
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2016 Springer International Publishing Switzerland
About this chapter
Cite this chapter
Kibbi, N., Kluger, H., Choi, J.N. (2016). Melanoma: Clinical Presentations. In: Kaufman, H., Mehnert, J. (eds) Melanoma. Cancer Treatment and Research, vol 167. Springer, Cham. https://doi.org/10.1007/978-3-319-22539-5_4
Download citation
DOI: https://doi.org/10.1007/978-3-319-22539-5_4
Published:
Publisher Name: Springer, Cham
Print ISBN: 978-3-319-22538-8
Online ISBN: 978-3-319-22539-5
eBook Packages: MedicineMedicine (R0)