Malignant Melanoma

Malignant Melanoma is the most malignant and dangerous of all skin tumors. It appears at any age but usually in elderly people. Its incidence is on the increase in white colored people who have to sit in the sun or have frequent UVR exposure.

Symptoms and signs of Malignant Melanoma

It is precipitated by irritation, pressure or interference. The indications of malignancy in a mole are enlargement of size, deepening of color, induration, itching, easy bleeding and radiating lines of pigment in the lymphatics. Though such melanomas are often pigmented, they need not be so.

From Xeroderma pigmentosum: Lentigines become malignant neoplasms. This origin is not common in practice because firstly, Xeoderma pigmentosum is rare, and secondly, the keratoses which occur in this condition usually develop into squamous cell epitheliomas. But sometimes, though rarely, malignant melanomas may also develop from senile pigmented macules. The common site is the face.

From normal skin: The common sites are the feet, nail-beds and the face. It starts as a blue black or non-pigmented nodule and whitlow which proceeds to grow rapidly. Malignant melanomas metastasize rapidly first to the regional lymph glands, and later, to other parts of the integument, the liver, lungs and brain.

Histopathology: It is characteristic and consists of anaplastic naevus cells, deep, irregular infiltration and inflammatory reaction. Pigment can usually be demonstrated.

Prognosis of Malignant Melanoma

It is usually grave, more so, if metastases have occurred.

Treatment of Malignant Melanoma

• Pyophylactic in pigmented naevi: They should not be interfered with half-heartedly. If likely to be irritated by trauma or pressure, they should be excised completely by surgery.
• Curative: Wide and deep excision is most important. Regional lymph glands and lymphatics must be dissected. Radiotherapy is only palliative in non-operable cases. Metastatic melanomas are treated with chemotherapy (decarbazine, nitrosureas and methotrexate) and immunotherapy with B.C.G. vaccine.