Malignant Melanoma

Patients may report an unusual dark spot, lesion, or mole that has changed in size, shape, or color. Often painless, it may appear on non-sun-exposed areas like the palms, soles, or nails in Black patients. They may also report itching, bleeding, or ulceration in the lesion. History of atypical moles, family history, and immunosuppression. In Black patients, acral melanoma has a poorer prognosis due to late detection.

In Black patients, melanomas are more commonly found in acral locations (e.g., under the nails, palms, or soles). Look for asymmetrical lesions with irregular borders, varying colors (brown, black, red), and large diameters, often >6 mm. The ABCDE rule (Asymmetry, Border irregularity, Color variation, Diameter, Evolving nature) is crucial for assessing suspect lesions. 

Surgical Excision: The primary treatment is wide local excision with clear margins. Depending on tumor thickness:

• For lesions <1 mm: 1 cm margin.

• For lesions 1-2 mm: 1-2 cm margin.

• For lesions >2 mm: 2 cm margin recommended.

Adjuvant Therapy:

• Immunotherapy: Agents like Pembrolizumab or Nivolumab may be considered for advanced stages. Dosage: Pembrolizumab 200 mg every 3 weeks; Nivolumab 240 mg every 2 weeks.

• Targeted Therapy: BRAF and MEK inhibitors (e.g., Dabrafenib and Trametinib) are used in patients with specific mutations.

Risk Factors, Prognosis, and Complications

• Complications: Metastasis is a significant risk, especially in advanced cases, and leads to poorer outcomes. Regular follow-ups and full skin examinations are vital.