Table of contentsIntroduction to malignant melanoma:Melanoma in situ:Distinguishing factors between benign and malignant moles:Melanoma with superficial spread:Nodular melanoma:Lentigo malignant melanoma:Acral lentiginous melanoma:Conclusion :References:Introduction to Malignant Melanoma: Melanoma is the most dangerous type of skin cancer. This cancer develops from melanocytes, which are the cells that produce melanin and are found in the basal layer. One of the most common causes of skin cancer is exposure to UV rays from the sun. Overexposure leads to DNA damage, when DNA is damaged and allowed to multiply, mutations occur, which causes skin cells to replicate rapidly, thus forming a tumor. Say no to plagiarism. Get a tailor-made essay on “Why Violent Video Games Should Not Be Banned”? Get an original essay Melanomas usually look like moles and as such it is very easy to confuse them, although they have one key difference that helps identify whether it is melanoma or not . This is crucial because in its early stages it is almost always curable, making it all the more important that practitioners know how to identify it. If it can be diagnosed early, it can save a person's life. There are 4 main types of malignant melanoma, namely nodular melanoma, lentigo maligna melanoma, acral lentiginous melanoma and superficial spreading melanoma. Melanomas don't always look the same, which makes it important for practitioners to know all the different ways they can appear. Melanoma in situ: If melanoma is diagnosed early, it may still be in situ. This is the earliest stage and means that the cancer cells have not yet spread throughout the body and are still confined to the area where they started to grow. This is the most important time to make a correct diagnosis because the cancer cells are still localized. If part of the skin is suspected to have malignant growth (due to melanoma symptoms), the entire affected area will be removed through a process called excision and if the area is too large, an incisional biopsy will be carried out. The sample is then examined under a microscope and a pathology report will be written which will help plan the next step if it is found to be malignant. Distinguishing factors between benign and malignant moles: Moles are very common and are usually benign, but in some cases they can evolve or change. There are a few warning signs of melanoma that differentiate them from benign moles. The warning signs are known as the ABCDE rules. These are asymmetry, irregularity of borders, color variation, large diameter and evolution. Normal moles are usually symmetrical, while malignant moles are usually asymmetrical in shape. A benign mole usually has a smooth, even border. In melanoma, the borders tend to be uneven and jagged. Benign moles usually have the same color all around, usually one shade of brown, malignant moles can be several shades of brown and black. It may also turn a shade of red or white. The diameter of moles is also smaller than that of melanoma, its diameter can be up to 6 mm, although they may have been smaller when initially detected. Over time, melanomas begin to grow and change. It is important that if the person notices anychanges, they should be reported immediately, as this does not occur with normal benign moles. Superficial spreading melanoma: This is the most common type of skin cancer, accounting for approximately 70% of all cases. This melanoma grows on the top layer of the skin until it eventually penetrates deeper into the skin, although this usually takes months. It usually appears as a flat or slightly raised area of ​​skin with irregular edges and an asymmetrical shape. It can appear in a variety of colors, including red, blue, black and brown. Figure 2 shows how different the same type of melanoma can be. This type of melanoma has a chance of developing from a previously benign mole, although it may develop as a new lesion and not necessarily on a mole. This type of melanoma first has a horizontal growth stage, meaning it initially looks like a flat area of ​​discolored skin that slowly enlarges. It is very often confused with a mole, lentigo or freckles. When a patient is suspected of having superficial spreading melanoma (SSM), the practitioner can diagnose the melanoma using a skin biopsy or dermoscopy. If the suspected melanoma is 0.8 mm thick, a blood test and lymph node biopsy are advised. In the pathology report there will be the following if melanoma is present. There should be the proliferation rate, Breslow thickness and invasion at Clark level which show the anatomical plane of invasion (the deeper the Clark level, the greater the risk). The report can also indicate the cell type, growth pattern, and whether the disease is in situ or associated with an original mole. (These steps are still necessary to confirm the presence of cancer cells). People with darker skin are less likely to get melanoma, it is as common in men as it is in women and only 15% of people get melanoma before the age of 40 and only 1% of people contract it before the age of 20. Other things that can put a person at risk are having lots of moles, having skin burned easily, and having previously had melanoma. Nodular melanoma: Nodular melanoma grows vertically rather than horizontally like SSM. It can arise from normal-appearing skin or from an already existing melanoma, it can develop from a superficial melanoma spreading if the malignant cells pass through the epidermis into the dermis. Within a few months, it can penetrate deep into the skin. People with nodular melanoma (NM) tend to have fair skin and tan easily, unlike people with darker skin who are less likely to have it. Although there is a stronger correlation with sun exposure, SSM and Lentigo than with nodular melanoma. An increase in age, previous cases of melanoma, and a large number of moles or birthmarks. Melanoma can develop anywhere, but there is a higher risk of it appearing on exposed areas of the skin. Nodular melanoma sometimes does not follow the ABCD rules in its early stages because it is usually symmetrical in shape, has regular borders, uniform colors, and a relatively small diameter (less than 6 mm). For this reason, the EFG rule must be used. .The EFG summarizes the clinical features of NM, namely elevation, firmness on palpation, and constant growth over a month. It is important that during the history taking, the patient can give allinformation about the lesion in question. In this case, the lesion may bleed or change in elevation, so these questions should be asked of the patient to see if they have observed these changes. Under normal circumstances, the NM will follow the ABCD rule and be asymmetrical, have irregular borders, a large diameter (larger than a mole) and may have different colors such as black, brown or red. The melanomas seen in Figure 3 all follow the rule. Lentigo maligna melanoma: Lentigo maligna melanoma (LMM) is an invasive skin cancer that develops from lentigo maligna. Lentigo maligna is limited to the epidermis and therefore remains on the other surface of the skin. It is only when lentigo maligna invades the dermal layer that LMM is diagnosed. The chance of this happening is very low, around 5%. The number increases if the lesion is larger than 4 cm, in which case the risk rises to 50%. Usually, people who work outside in the sun, people with fair skin, and the elderly are more likely to get lentigo maligna. Men are also more likely to get it, but this may be due to sun exposure from their work. Areas of the body normally exposed to the sun, including the face and nose, are more likely to be affected. Lentigo maligna grows slowly while MML spreads very quickly and aggressively. Lentigo maligna and LLM also share a very similar appearance but it is important for the practitioner to be able to tell them apart. Figures 4 and 5 show how easy it is to confuse one with the other. The ABCDE rule can be used but they both share the same characteristics since they are both asymmetrical, have irregular borders, exhibit abnormal color variation (dark brown-red or pink), have a large radius and scale . There are just a few characteristics they don't share, namely that the lesion may start to bleed and itch, it may start to thicken, and it may show abnormal colors like blue or black. Figure 4: This is the LLM presentation://www.dermnetnz.org/topics/lentigo-maligna-and-lentigo-maligna-melanoma/ In a study conducted by lentigo, melanomas like lentigos have a high chance of be identified by patients. Dermatologists themselves have also recognized this type of lesions as malignant, especially when they have their typical appearance. Patients with this type of melanoma usually have severe dermatoheliosis (up to 30%) and also have a history of sunburn (up to 90%). This data could help practitioners correlate with the patient's history and the lesion presented to them. Acral lentiginous melanoma: Acral lentiginous melanoma (ALM) is the only type of melanoma mentioned that has no correlation with sun exposure, as the areas where ALM appears are usually not exposed to the sun. In a study conducted by Al-Hassani, F., Chang, C., Peach, H., they came to the conclusion that this type of melanoma is linked to microtrauma, more precisely to trauma to the support areas , because this is where the microtraumas are located. the highest concentration of ALM was found (83.5% on the support areas of the foot). ALM usually affects the palms and soles of the feet, but is more commonly seen on the feet. In its early stages, it looks like a flat area of ​​discolored skin that slowly spreads. Initially, it remains in the epidermis, which is the tissue of origin of ALM, but over the months it begins to grow and eventually becomes invasive (i.e. when the dermis is penetrated ). ALM is relatively rare compared to1-2