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Melanoma
Diagnosis/Definition
Suspected or biopsy-proven malignant melanoma.
Initial Diagnosis and Management
Suspect melanoma is a pigmented lesion based on the following changing factors and remembered by the mnemonic “ABCD”.
- Asymmetry: self-explanatory, and very important.
- Border: irregularity of the margin of a pigmented lesion.
- Color: variable colors within a single pigmented lesion.
- Diameter: lesion greater than 6mm diameter.
- If melanoma is strongly suspected appropriate excisional biopsy may be done or, refer directly to Dermatology or General Surgery (arranged provider to provider) prior to biopsy for initial specialty assessment.
- Excisional biopsy is preferred on small lesions with minimal margin; for larger lesions, or lesions in cosmetically sensitive areas, punch biopsy of suspicious portion is preferred.
- Avoid transversely oriented excisional biopsies on an extremity (a biopsy which, when completed, will result in a transverse closure).
- Avoid performing “shave biopsies” on a lesion suspected of being melanoma.
- Entry (listing site, depth, management) into the patient’s Master Problem List by the provider confirming the diagnosis.
Ongoing Management and Objectives
If a melanoma is discovered by biopsy or strongly suspected, consider requesting baseline CBC, liver function panel, and chest x-ray at time of specialty consultation.
Indications for Specialty Care Referral
Refer ASAP all patients with suspected or new diagnosis to either Dermatology or General Surgery.
Criteria for Return to Primary Care
After initial definitive diagnosis and therapy, patients with melanoma should be followed at specialty level clinic (General Surgery,
Dermatology, or Oncology) as follows:
- Patients who have undergone curative resection and with no clinically detectable metastatic disease should be followed in General Surgery or
- Dermatology Clinic for the first two years after initial therapy, after which time they may be followed at a primary care level. Detailed exam of the initial melanoma site, all regional lymphatic beds, and general surveillance of other moles should take place at each visit.
- Patients with proven nodal metastases or other proven metastatic disease, should be followed in Oncology Clinic together with the patient’s primary care provider, as appropriate.
