Melanoma (Melanonychia) - What is it

Melanoma

Malignant melanoma is a neoplasm of melanocytes or a neoplasm of the cells that develop from melanocytes.

Although it was once considered uncommon, the annual incidence has increased dramatically over the past few decades.

Melanonychia
Clinical Presentation:
Most melanonychia patients present with a history of asymptomatic hyperpigmentation of the nail plate.

A careful history should include information on medications, past treatments, hobbies, illnesses, family history, any history of trauma to the area, prior history of a biopsy of the nail unit, number of nails affected, results of any prior nail clippings sent for histologic examination, results of cultures sent for infectious organisms, change of appearance of the band (or bands) over time, and ethnic background.

In cases of subungual melanoma, the patient may describe a long-standing history of longitudinal melanonychia that recently changed in appearance. Changes that warrant concern include alteration of color, pattern, or size of the band; new onset of pain or ulceration in the site of longitudinal melanonychia; or the presence of subungual blood


Medical History
The history should address the following:

Family history of melanoma or skin cancer
Family history of irregular, prominent moles
Family history of pancreatic cancer or astrocytoma
Previous melanoma (sometimes multiple; patients have reported as many as 8 or more primary melanomas)
Previous sun exposure
Changes noted in moles (eg, size, color, symmetry, bleeding, or ulceration)
History or family history of multiple nevus syndrome

Physical examination
Total-body skin examination, to be performed on initial evaluation and during all subsequent visits

Serial photography, epiluminescence microscopy, and computerized image analysis, to be considered as adjuncts

Skin examination involves
assessing the number of nevi present
distinguishing between typical and atypical lesions.

Early melanomas may be differentiated from benign nevi by the ABCDs, as follows:

A - Asymmetry
B - Border irregularity
C - Color that tends to be very dark black or blue and variable
D - Diameter ≥6 mm

If a patient is diagnosed with a melanoma, examine all lymph node groups.

Treatment

Surgery is the definitive treatment for early-stage melanoma

medical management generally reserved for adjuvant treatment of advanced melanoma.

Prevention
The Skin Cancer Foundation recommends that you:
Seek the shade, especially between 10 AM and 4 PM.
Don’t get sunburned.
Avoid tanning, and never use UV tanning beds.
Cover up with clothing, including a broad-brimmed hat and UV-blocking sunglasses.
Keep newborns out of the sun. Use sunscreen on babies over the age of six months.
Examine your skin head-to-toe every month.
See a dermatologist at least once a year for a professional skin exam.
Use a broad-spectrum (UVA/UVB) sunscreen with an SPF of 15 or higher every day.
For extended outdoor activity, use a water-resistant, broad- spectrum (UVA/UVB) sunscreen with an SPF of 30 or higher.

Apply 1 ounce (2 tablespoons) of sunscreen to your entire body 30 minutes before going outside.
Reapply every two hours or after swimming or excessive sweating.







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