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Feature Article

When is it melanoma? An update on diagnosis and management

Matthew J Lin, John W Kelly

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An updated version is available in the linked supplement

Abstract

Early diagnosis and treatment of melanoma are crucial to maximise the chances of a favourable outcome.

Key Points

  • Early diagnosis of melanoma is crucial and is enhanced by identification of high-risk groups and appropriate surveillance. In addition to regular full skin examination, total body photography and sequential digital dermoscopic imaging are useful in selected patients.
  • Dermoscopy significantly improves diagnostic accuracy for melanoma and other skin lesions.
  • Clinicians should be aware of atypical presentations (e.g. amelanotic, hypopigmented and nodular melanomas), which are often the most aggressive forms.
  • Excisional biopsy is the ideal biopsy method for suspicious lesions, allowing wide local excision to be based on accurate Breslow thickness.
  • Referral of patients to a multidisciplinary melanoma unit should be considered.
  • Careful follow up is important to detect disease recurrence and subsequent primary melanomas.

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