A 59-year-old woman presents for evaluation of a lesion on her back. The patient notes that “my husband told me to get this checked out over a year ago.” She denies prior history of cancer, including skin cancer, or use of indoor tanning beds but admits to several episodes of severe sunburn as a child. The patient has fair skin, blue eyes, red hair, and a multitude of other skin growths. Physical examination reveals a 2.0- by 2.8-cm hyperpigmented, slightly elevated plaque with notched borders as viewed through a dermatoscope (Figure).
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Melanoma is a potentially deadly type of skin cancer that develops from melanocytes within the epidermis and dermis. The 2 main histopathologic subtypes are superficial spreading melanoma and nodular melanoma.1 Risk factors for the development of melanoma include history of sunburns as a child, fair skin, red hair, freckles, family history of melanoma, and exposure to indoor tanning beds.2 In the United States, approximately 197,700 new cases of melanoma are projected to be diagnosed in 2022.3 People of Caucasian descent have a higher incidence of melanoma compared with other races. The rates of melanoma development before 40 years of age are highest in women; however, by 75 years, the incidence is approximately 3 times higher in men vs women.2
Early recognition of melanoma impacts survival and dermoscopy is a useful noninvasive diagnostic tool. Dermoscopy can play an especially valuable role in the identification of thin melanomas. Melanoma-specific structures include an atypical pigment network, irregular dots and globules, regression structures, and a gray-blue veil.4
Stephen Schleicher, MD, is director of the DermDox Dermatology Centers, associate professor of medicine at Geisinger Commonwealth Medical College, and clinical instructor of dermatology at Arcadia University and Kings College.
1. Lattanzi M, Lee Y, Simpson D, et al. Primary melanoma histologic subtype: impact on survival and response to therapy. J Natl Cancer Inst. 2019;111(2):180-188. doi:10.1093/jnci/djy086
2. Rastrelli M, Tropea S, Rossi CR, Alaibac M. Melanoma: epidemiology, risk factors, pathogenesis, diagnosis, and classification. In Vivo. 2014;28(6):1005-1011.
3. Skin cancer. Incidence rates. American Academy of Dermatology Association. Accessed July 18, 2022. https://www.aad.org/media/stats-skin-cancer
4. Marghoob NG, Liopyris K, Jaimes N. Dermoscopy: a review of the structures that facilitate melanoma detection. J Am Osteopath Assoc. 2019;119(6):380-390. doi:10.7556/jaoa.2019.067