Clinical Background
Melanoma is a malignancy of the melanocytes; this disease is experiencing a rising incidence and mortality worldwide.
Epidemiology
- Incidence - 18/100,000
- Tripled over the last 20 years
- Highest incidence worldwide is in Australia
- Age - median is 57 years; rare in children
- Sex - M:F;1.5:1
- Ethnic - tenfold increase in incidence in Caucasians
Risk Factors
- Sunlight - sunburns in childhood, intermittent UV exposure associated with higher risk
- Blue or green eyes; red or blond hair
- Melanocytic nevus - increased risk by number and size of nevi
- Family history - twofold risk if first-degree relative had melanoma
- Clustering of melanoma in familial retinoblastoma, Lynch type II, Li-Fraumeni syndrome
- Increased risk if family history of pancreatic cancer or astrocytoma exists
- Immunosuppression
Clinical Presentation
- Nevus with asymmetry, border irregularity, color variation, diameter >6 mm and evolving changes (ABCDE guideline)
- Ulceration, pigment loss
- Types - superficial spreading, nodular, lentigo maligna, acral lentiginous
- Superficial spreading is most common
- Rare sites - eye (iris, ciliochoroidal), mucosal
Prevention
- Decrease sun exposure
- Sunscreen
Diagnosis
Diagnosis
- Histology
- Histologic appearance is diagnostic
- Laboratory testing
- S-100B, serum
- Used for determining prognosis
- Rising concentrations indicate disease progression
Tests generally appear in the order most useful for common clinical situations
| Test name: S-100B Protein, Serum
|
| ARUP #: 0081328 |
| Methodology: Enzyme-Linked Immunosorbent Assay
|
| Use: Monitor treatment and determine prognosis of patients with malignant melanoma |
| Limitations: Not used for diagnosis; S-100B is not specific for malignant melanoma; increased serum concentrations are found in patients with liver and renal injury, inflammation, infection, and brain injury |
| Test name: Immunohistochemistry Stain Offering
|
| ARUP #: arup005 |
| Methodology: Immunohistochemistry
|
| Use: For fixed tissue samples, consultative services as well as immunohistochemical staining for CAM 5.2 (LMW), Ki-67 (Mib-1), Melan A, p21, S-100, Vimentin and HMB-45 are available |
References
General References
Banerjee SS, Eyden B. Divergent differentiation in malignant melanomas: a review. Histopathology.
2008;
52(
2):
119-129.
Garbe C, Eigentler TK. Diagnosis and treatment of cutaneous melanoma: state of the art 2006. Melanoma Res.
2007;
17(
2):
117-127.
Markovic SN, Erickson LA, Rao RD, Weenig RH, Pockaj BA, Bardia A, Vachon CM, Schild SE, McWilliams RR, Hand JL, Laman SD, Kottschade LA, Maples WJ, Pittelkow MR, Pulido JS, Cameron JD, Creagan ET. Malignant melanoma in the 21st century, part 1: epidemiology, risk factors, screening, prevention, and diagnosis. Mayo Clin Proc.
2007;
82(
3):
364-380.
Markovic SN, Erickson LA, Rao RD, Weenig RH, Pockaj BA, Bardia A, Vachon CM, Schild SE, McWilliams RR, Hand JL, Laman SD, Kottschade LA, Maples WJ, Pittelkow MR, Pulido JS, Cameron JD, Creagan ET. Malignant melanoma in the 21st century, part 2: staging, prognosis, and treatment. Mayo Clin Proc.
2007;
82(
4):
490-513.
Salama I, Malone PS, Mihaimeed F, Jones JL. A review of the S100 proteins in cancer. Eur J Surg Oncol.
2008;
34(
4):
357-364.
References from the ARUP Institute for Clinical and Experimental Pathology Research®
Lewis TB, Robison JE, Bastien R, Milash B, Boucher K, Samlowski WE, Leachman SA, Dirk Noyes R, Wittwer CT, Perreard L, Bernard PS. Molecular classification of melanoma using real-time quantitative reverse transcriptase-polymerase chain reaction. Cancer.
2005;
104(
8):
1678-1686.
Willmore-Payne C, Holden JA, Hirschowitz S, Layfield LJ. BRAF and c-kit gene copy number in mutation-positive malignant melanoma. Hum Pathol.
2006;
37(
5):
520-527.
Willmore-Payne C, Holden JA, Tripp S, Layfield LJ. Human malignant melanoma: detection of. Hum Pathol.
2005;
36(
5):
486-493.
Medical Reviewers
Grenache, David G., Ph.D. Medical Director, Special Chemistry at ARUP Laboratories; Assistant Professor, Clinical Pathology, University of Utah
Comprehensive Review: May 2008
Last Update: September 2008
