Clues to Melanoma

You can see from this lesion that there are a variety of clues to allow you to diagnose this lesion as a melanoma. Taken together it really can be nothing else. But your next question should then be "How specific are all these clues?" Menzies and others have tried to answer this question by analysing the frequency in large numbers of histologically proven melanomas.
The Sensitivity of a clue means how good is it at picking up a melanoma? 100% sensitivity means the clue is seen in all melanomas. The Specificity means does this clue pick up other pigmented lesions as well? 100% Specificity means it is not seen in other pigmented lesions. So the ideal clue would have 100% sensitivity ie pick up all melanomas and 100% specificity ie not pick up any other pigmented lesions.

Have a look at the image and then click on each of the clues shown in the Archives area opposite for further information on these clues. Basically learn how much weight to put on them. The more clues you have the more likely your diagnosis is to be correct!

Note this image shows the following clues to melanoma
1. Lines radial segmental
2. Peripheral dots
3. Thick lines reticular
4. Structureless blue black and brown areas


It was reported as an ulcerated superficial spreading melanoma, Level 3, 0.93 mm thick. It had 7 mitoses per sq mm of the dermal component of the lesion. The ulceration and the number of mitoses worsen the prognosis.


Click on the clue links above for more details and examples of these clues.

Below is a detailed overview of Clues to a Melanoma taken from www.dermoscopymadesimple.blogspot.com 

View this YouTube video on Melanoma, mainly in situ. Click on the arrow and when it starts go to the bottom of the screen and change the 360 resolution to 1080 and then click on the box with the arrows pointing out to enlarge to full screen. These videos are recorded in high definition which makes for great viewing if you have a fast broadband connection. Press ESC on your keyboard to return to normal size.



We can show melanoma with each of the structures mentioned below but most melanomas have a mixture of structures or clues and several colours. With that in mind consider the following examples and also look again at the video on Clues to Melanoma.

Melanoma as thickened lines reticular

Melanoma as lines branched
Melanoma as lines curved

Melanoma as lines parallel ridges

Melanoma as Lines radial peripheral or pseudopods

Melanoma as white lines

Melanoma as grey circles

Melanoma as brown circles
Melanoma as clods

Melanoma as blue clods

Melanoma as grey dots

Melanoma as brown dots

Melanoma as peripheral black dots and clods

Melanoma as polygons

Melanoma as structureless Blue grey or Blue white

Melanoma as pink dot vessels

Melanoma as polymorphic vessels plus dots