Cutaneous Melanoma, or Melanoma of the Skin

Melanoma that occurs on the skin, called cutaneous melanoma, is the most common type of melanoma. This type of melanoma occurs in all parts of the skin, including the soles of feet, on the palms of the hand, in between toes and fingers, and underneath the finger and toe nails.

Cutaneous melanoma can be described in the following ways:

Superficial Spreading Melanoma

Superficial Spreading Melanoma (SSM) accounts for approximately 70% of all diagnosed melanomas. It usually occurs in a previously benign (non-cancerous) mole and is most commonly found on the trunk and back in men and on the legs and back in women. SSM is the leading cause of cancer death in young adults.

What does Superficial Spreading Melanoma look like?

Known as a dysplastic nevus, in early stages SSM may look like a freckle that is spreading sideways on the skin. Over time the pigmentation could darken or lighten, the area may itch, or the lesion could grow and develop increasingly irregular borders.

SSM can progress rapidly, so if you see a lesion or mole that you suspect could be melanoma, have it checked out by a dermatologist immediately.

Superficial spreading melanoma

The 4-by-8-mm, pink-tan lesion with irregular borders at the upper left (arrow) is a dysplastic nevus. Arising from it is an invasive malignant melanoma, with its characteristic blue-black color, notched border, and distorted surface. The gray area at the lower left represents tumor regression.

Superficial spreading melanoma This large (7 by 11 mm) macular lesion displays an irregular, scalloped border, which is indistinct in some areas. In addition to hues of tan and brown, several pink areas (arrows) are present. The presence of pink colors in the macular portion of a melanocytic nevus is quite distinctive for dysplastic nevi.
Superficial Spreading Melanoma
Source: National Cancer Institute
The delicate, hazy, tan macular rim of this lesion, although not clinically dramatic, represents persistent melanocytic proliferation beyond the lateral limits of the common mole at its center.

 

Nodular Melanoma

Nodular melanoma accounts for approximately 15% of all diagnosed melanomas. Unfortunately, it is the most aggressive type of melanoma. It is more common in males and can occur at any age but is most often seen in individuals aged 60 and older.

What does nodular melanoma look like?

Nodular Melanoma

Nodular melanoma may appear where a mole or lesion did not exist before. It tends to spread more rapidly in depth, making it more difficult to visibly see the progression. Lesions are usually darkly pigmented but can also be light brown or colorless.

 

Acral Lentiginous Melanoma (ALM)

Although acral lentiginous melanoma (also called Subungual Melanoma) only accounts for about 5% of all diagnosed melanomas, it makes up about 50% of diagnosed melanomas in Asians and individuals with dark skin. These lesions can develop anywhere on the body, including the palms of the hands, the soles of the feet and underneath the fingernails and toenails.

What does acral lentiginous melanoma (ALM) look like?

ALM is often overlooked or mistaken, because it tends to appear like a bruise or a streak in the fingernail or toenail in its early stages. On the palm or sole of the foot, ALM can look like a bruise or an irregular tan, brown or black spot. Under the nail, ALM can appear as a dark stripe and is found most often on the thumb or the big toe.

ALM can also develop on the mucous membranes inside the nose or mouth, and early indicators are usually a stuffy nose, nose bleeds, or a darkened mass inside the mouth.

Reggae musician Bob Marley died in 1981 of complications from acral lentiginous melanoma, which originated under his toenail and metastasized to other parts of his body.

Lentigo Maligna Melanoma

Lentigo Maligna Melanoma (LMM) accounts for approximately 10% of all diagnosed melanomas. It often occurs on the face of middle-aged to elderly individuals who have experienced sun damage.

What does lentigo maligna melanoma look like?

Lentigo Maligna Melanoma is sometimes mistaken as sun spots and goes undetected, making it very dangerous.

As these lesions spread in width and in depth it will typically have a very irregular border and vary in shades of brown or black. Sometimes dark nodules will appear with in the brown or black area and will feel like small bumps.

Genetic Mutations

Mutations in certain proteins are allowing scientists to further define the melanoma at the molecular level. The BRAF mutation is the most common type of genetic mutation in cutaneous melanoma, appearing in approximately 50% of melanoma cases. The NRAS is also commonly found, occurring in approximately 20% of cutaneous melanoma cases. All melanoma patients should have their melanoma tested for genetic mutations so the proper treatment options can be discussed.