Melanoma is a potentially deadly skin cancer that requires a combination of professional assessment methods for diagnosis. Early detection and accurate diagnosis are crucial for improving treatment success rates. Therefore, physicians conduct systematic analysis, from initial visual inspection to precise histopathological examination, with each step aimed at ruling out other skin lesions and confirming malignant features.
The diagnostic process typically includes visual observation, medical history inquiry, imaging examinations, and tissue analysis. Physicians pay special attention to key indicators such as the shape, color, and size changes of skin lesions, and combine this with the patient's personal and family medical history for risk assessment. If melanoma is initially suspected, further pathological examination becomes the definitive step for confirmation.
Clinical assessment is the first step in diagnosing melanoma. Physicians evaluate skin lesions through visual inspection and structured methods. A full-body skin examination is performed, focusing especially on abnormal moles or newly appearing pigmented lesions. This process often uses the "ABCDE rule": Asymmetry, Border irregularity, Color variation, Diameter greater than 6 mm, and Evolution of shape or color. The combination of these features effectively screens high-risk lesions.
Doctors will ask detailed questions about the patient's medical history, including the development time of skin lesions, appearance changes, history of sunburns, and family history of cancer. If the patient has a family history of melanoma or immune system abnormalities, physicians may raise their vigilance. Additionally, dermatoscopy (skin microscopy) allows magnified observation, revealing structural features difficult to see with the naked eye, such as reticular pigment patterns or starburst spread, aiding in distinguishing benign from malignant lesions.
When clinical assessment identifies high-risk lesions, tissue biopsy is a key step for confirmation. The most common method is excisional biopsy, where the entire lesion is removed for histological analysis. If the lesion is large, punch biopsy may be performed first to obtain a core tissue sample. Pathologists examine cellular atypia, mitotic activity, and invasion depth under the microscope.
Immunohistochemical staining techniques can label specific proteins associated with melanoma, such as S-100 and HMB-45, helping differentiate malignant melanoma from other skin cancers. Molecular biological testing may be used to detect specific gene mutations (e.g., BRAF), which are useful not only for diagnosis and classification but also for guiding subsequent treatment options.
Development of screening tools aims to improve early detection rates. Common tools include self-skin examination guidelines and professional medical instruments. Patients are encouraged to perform regular "head-to-toe" self-examinations, paying special attention to changes in existing moles' shape or color. Medical institutions may use skin imaging systems to create digital records of lesions, with artificial intelligence algorithms assisting in tracking abnormal indicators.
Risk assessment tools such as the "ABCDEF-G" checklist extend beyond the traditional ABCDE criteria, adding indicators like "Dermatologists' Erythema" (inflammation signs) and "Growth" (rapid enlargement). These tools combine visual assessment with clinical symptoms to more accurately identify high-risk lesions. Medical personnel often use dermoscopy image databases to compare with known malignant features.
Differential diagnosis is a critical step in distinguishing melanoma from various benign skin lesions. Common mimickers include common nevi, actinic keratosis, and basal cell carcinoma. These benign lesions usually have clear borders and uniform color, whereas malignant melanoma often presents with blurred edges and mottled pigmentation.
Special attention should be paid to atypical lesions, such as acral lentiginous melanoma, which can be confused with trauma or age spots. In Asian populations, lesions on acral skin and mucous membranes pose additional diagnostic challenges, requiring combined histological features and immunohistochemical results. Occasionally, differentiation from malignant melanoma in situ is necessary, as the latter typically lacks characteristic melanin deposits.
Early diagnosis significantly improves prognosis. The 5-year survival rate for stage 0 melanoma (melanoma in situ) can reach 98%, while it drops to about 20% in stage IV. Early detection allows for local excision with curative intent, preventing metastasis and more complex treatments. Delays in diagnosis may lead to cancer cells penetrating the dermis and causing lymphatic or distant organ metastasis.
Regular skin examinations are key to early detection. High-risk groups (history of sunburns, family history) should undergo professional examinations every 3-6 months. Digital dermoscopy tracking systems can accurately detect minute changes in lesions, assisting physicians in deciding whether immediate biopsy is necessary. Early diagnosis not only reduces surgical extent but also avoids unnecessary wide excisions.
Pay special attention to the "ABCDE" rule: Asymmetry, Border irregularity, Color variation, Diameter greater than 6 mm, and Evolution of shape or color. If moles or spots are itchy, bleeding, or rapidly enlarging, seek medical examination immediately.
After treatment, what examinations or follow-up are melanoma patients typically required to undergo?Post-treatment usually involves skin examinations, blood tests (such as lactate dehydrogenase LDH levels), and imaging tests (such as CT or PET-CT) every 3 to 6 months. High-risk patients may need follow-up every 3 months for 2-3 years to monitor for recurrence.
What specific advice do you have for daily sun protection to prevent melanoma?Use broad-spectrum sunscreens with SPF 30 or higher and PA+++ protection, reapply every 2 hours, and wear hats, long-sleeved clothing, and sunglasses. Avoid sun exposure between 11 a.m. and 3 p.m., and regularly check for abnormal skin changes after sunburns.
Is it true that only moles on the skin can become malignant?No. While melanoma most often occurs on the skin, it can also develop in mucous membranes (such as the oral cavity and anus) or the choroid of the eye. Atypical lesions may lack the characteristic features of moles, so comprehensive skin examinations should include all body parts, including nails and soles.
Why is early diagnosis of melanoma critical for improving treatment success?If melanoma is confined to the superficial skin layer (melanoma in situ), the 5-year survival rate after surgical removal can reach 99%. However, once metastasized to lymph nodes or internal organs, survival rates decline sharply. Early diagnosis can prevent spread, making prompt medical evaluation of abnormal skin lesions essential.
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