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Malignant Melanoma (MM) is the most serious type of skin cancer that arises from pigmented cells of the skin called melanocytes.

The function of melanocytes is to produce melanin. which is the pigmentation seen in an individual’s skin. Melanomas can present anywhere in the body and can present in both sun-exposed and non-sun-exposed areas.


Melanomas are the most dangerous type of skin cancer, as they have the highest chance of invasion or metastasis compared to other types of skin cancers. These cancers can both locally invade and spread throughout the body and, as such, should be treated promptly. The prognosis and survival of patients with melanoma is dependent on the stage of the cancer.

Those whose lesions are detected early and diagnosed with stage I cancer can have a prolonged disease-free survival whereas those with stage II-IV cancer have a higher chance of developing metastatic disease.

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​Melanomas develop from the melanocytes that are normally present in the skin’s cell layer of the body. These cells normally function to produce melanin, which gives the pigmentation seen on the skin surface. Melanoma is the result of the abnormal growth of melanocytes developing on the skin surface.

There are different risk factures associated with the development of melanomas, some of which are:

  1. Skin pigmentation – those with light skin pigmentation are more prone to develop melanomas.

  2. Nevi or moles – individuals with a large number of moles or atypical nevi have a higher chance of developing melanomas.

  3. Genetic predisposition – those with a strong family history of melanomas can develop melanomas themselves.

  4. UV light or sun exposure – unlike non-melanoma skin cancers, which are associated with cumulative sun exposure and tend to form in areas of frequent sun exposure, high intensity and intermittent exposure to the sun’s UV rays, such as sunburns, are associated with melanomas.

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ABCDE of Melanoma


Melanomas often look like pigmented spots or moles. There are 5 initial features that is used to evaluate pigmented lesions to help determine if they should be further assessed by a healthcare professional. This is called the ABCDEs of melanoma.

A stands for Asymmetrical shape.

B stands for Borders that are irregular.

C stands for multiple Colours within the lesion.

D stands for Diameter of the lesion – melanomas are often greater than 6 mm in diameter (size of a pencil eraser).

E stands for Evolution – when there is a change in the way a lesion looks in terms of shape, borders, colour or diameter, there is a need for concern.

The above characteristics are general guidelines in the evaluation of melanomas. If you have any concerns regarding a lesion, you should always visit a healthcare profession for further evaluation.


Treatment of melanomas is dependent on the depth of the melanoma invasion and stage of the melanoma after the lesion has been surgically removed.  When there is a concerning lesion, a healthcare professional would either perform a punch biopsy of the lesion or an excisional biopsy (removal of a small sample of the lesion for diagnostic purposes).

The biopsy is examined under the microscope by a pathologist who determines if the lesion is a melanoma and its depth of invasion.  Depth of invasion ultimately determines the total area that needs to be excised.  

  • If the lesion is <1 mm in depth, a 1 cm diameter margin is taken from the surrounding area of the lesion.

  • If the lesion is 1 mm to < 2mm in depth, a 2cm diameter margin is taken from the surrounding area of the lesion.

  • If the lesion is > 2.01mm in depth, a 2cm diameter margin is taken from the surrounding area of the lesion.

Your surgeon may recommend additional surgery, such as sentinel lymph node biopsy (SNLB) or regional lymph node biopsy to see if the lesion has spread beyond the local area. Depending on the stage, you may require more treatments, such as immunotherapy, chemotherapy or radiation therapy.

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After the lesion is excised and closed with either permanent or dissolving sutures, it is sent to a pathologist who examines it under the microscope to confirm the diagnosis and to evaluate the depth of the lesion.

5-7days, if the lesion was on your face, or 10-14 days, if the lesion was on body parts other than the face, after your surgery, you come back to the office/clinic to review the pathology report, to check on your incision and to remove or trim your sutures. At that time, you will be made aware for the need of further local excision or the need for systemic management and referred to the appropriate specialist.


If you had a diagnosis of melanoma and completed all your treatments for your cancer, you may need continual follow-ups to monitor the area of the lesion for any sign of re-growth and you should also schedule yearly skin examinations to ensure that you catch these lesions early and can have them treated in a timely manner. Protection from further sun damage is also very important. The use of hats and clothing that cover exposed skin, as well as sunblock is vital to prevent the development of further skin cancers.

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