Clinical Review
Primary cutaneous malignant melanoma and its precursor lesions: Diagnostic and therapeutic overview☆,☆☆,★

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Abstract

During the past few decades, scientific data relating to melanoma have flourished. New information regarding acquired nevi, dysplastic nevi (atypical nevi), and congenital nevi has given us a better understanding of these precursor lesions and their relationships to malignant melanoma. The roles of laboratory testing, photography, and newer diagnostic tools (eg, epiluminescence) to evaluate patients for melanoma or precursor lesions have fallen under close scrutiny. Traditional surgical therapeutic interventions continue to be replaced by less aggressive protocols based on prospective randomized studies. Many new interventions such as sentinel lymph node procedures are currently being evaluated at research/referral centers around the world. We present clinicians with an evidence-based summary of the current literature with regard to primary cutaneous melanoma, its diagnosis, precursor lesions, and therapy. (J Am Acad Dermatol 2001;45:260-76.)

Section snippets

Acquired melanocytic nevi

Common acquired nevi typically appear after 6 to 12 months of age. These nevi enlarge and increase in number in early childhood and puberty. Most common acquired nevi remain less than 5 mm in diameter.1 Nevi continue to increase in number through the third and fourth decades, and then slowly disappear with age. Fifty-five per cent of adults have between 10 and 45 nevi greater than 2 mm in diameter.2 Several studies have been published regarding the prevalence of normal nevi in adults with

Staging

The original staging classification for melanoma was very simple, but also very imprecise. Patients were considered to have “stage I” disease if the melanoma was limited to the primary site. “Stage II” disease implied metastases up to the regional lymph node basin, but not beyond. “Stage III” disease implied distant metastases. Because each stage encompassed patients with a wide range of prognoses, this staging system was only of marginal benefit.

Dr Clark, and later Dr Breslow, published the

Surgical margins

The primary surgical goal in the treatment of melanoma is to excise the tumor to achieve histologically free margins with low likelihood of local recurrence or persistent disease. Complete excision results in an 8-year survival rate of more than 95% for thin (<1 mm), invasive melanomas and essentially cures melanoma in situ.88, 89 A large survey of practicing dermatologists conducted by the New York University Melanoma Group found marked variability in surgical margins being used to remove

Conclusion

We have attempted to present an evidence-based summary of the current literature with regard to primary cutaneous melanoma, its diagnosis, precursor lesions, and therapy. Many of the recent advances published regarding melanoma require confirmation. The roles of laboratory testing, photography, and newer diagnostic tools such as ELM to evaluate patients for melanoma or precursor lesions have been presented. These tools can be used as adjuncts in diagnosis and staging melanoma in the hands of

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    ☆

    Reprints not available from authors.

    ☆☆

    Correspondence: Matthew H. Kanzler, MD, Santa Clara Valley Medical Center, 751 S Bascom Ave, San Jose, CA 95128. E-mail: [email protected].

    ★

    J Am Acad Dermatol 2001;45:260-76

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    Copyright © 2001 American Academy of Dermatology, Inc. Published by Mosby, Inc. All rights reserved.