# Malignant Melanoma

- Category: chronic
- Review status: reviewed (every claim checked against a document named on this page)
- Sources: ICPC-3 (WONCA International Classification of Primary Care, 3rd edition) class SD25.02 - condition scope only, no dose · Metastatic Melanoma - StatPearls - NCBI Bookshelf - https://www.ncbi.nlm.nih.gov/books/NBK470358/ · No dose - referral pathway, no medicine given in primary care
- Verified date: 2026-08

## Verified against

- No dose - referral pathway, no medicine given in primary care

## Treatment metadata

- No drug therapy in primary care (Referral & Advice)

## Complete treatment card

```text
MALIGNANT MELANOMA
Sources: ICPC-3 (WONCA International Classification of Primary Care, 3rd edition) class SD25.02 -
         condition scope only, no dose · Metastatic Melanoma - StatPearls - NCBI Bookshelf -
         https://www.ncbi.nlm.nih.gov/books/NBK470358/ · No dose - referral pathway, no medicine
         given in primary care
Review status: REVIEWED against the source listed above  (2026-08)

IS IT THIS? - reference only, to read alongside your own examination
  SYMPTOMS - what the patient reports (1)
    - A melanoma may itch, bleed, ulcerate, or develop nearby satellite lesions  [itching · skin
      lesions]
  SIGNS - what you find (6)
    - Asymmetric shape is one of the ABCDE melanoma warning signs
    - Irregular, ragged, notched, or blurred borders are a melanoma warning sign
    - Non-uniform or variegated color within the lesion is a melanoma warning sign
    - A lesion larger than 6 millimeters across is a melanoma warning sign
    - A change in size, shape, or color over time is a melanoma warning sign
    - An added F for family or personal history of melanoma is used when assessing nail-unit lesions
  TESTS (5)
    - Excisional biopsy is the preferred method to confirm and stage melanoma by depth of invasion
    - Incisional biopsy may be used instead for lesions under the nail, on palms or soles, or very
      large lesions
    - Bloodwork includes a full chemistry panel with alkaline phosphatase, liver enzymes, total
      protein, and albumin
    - Ultrasound may be the best imaging study to detect lymph node involvement
    - For finding metastatic spread, a PET-CT scan is likely the single best imaging option
  IF NOT THIS - what else fits (7)
    - Pigmented basal cell carcinoma
    - Blue nevus
    - Halo nevus
    - Dermatofibroma
    - Seborrheic keratosis
    - Lentigo is a differential diagnosis for malignant melanoma
    - Subungual hematoma
  Source  StatPearls "Malignant Melanoma" - disease-level clinical article
  Status  traced to the source above

1. NO DRUG THERAPY IN PRIMARY CARE (REFERRAL & ADVICE)    [1st line]
   Adult    An aggressive skin cancer arising from melanocytes, often within a pre-existing or new
            pigmented lesion; early recognition and prompt excision are critical since it can
            spread, so any suspicious pigmented lesion needs urgent dermatology/surgical referral
            rather than primary-care treatment. - Refer, with advice
   Peds     Children follow the same pathway: recognise and refer. No primary-care medicine is
            implied.
   Source   No dose - referral pathway, no medicine given in primary care
   Why      An aggressive skin cancer arising from melanocytes, often within a pre-existing or new
            pigmented lesion; early recognition and prompt excision are critical since it can
            spread, so any suspicious pigmented lesion needs urgent dermatology/surgical referral
            rather than primary-care treatment.
   Caution  RED FLAG - Subungual pigmentation (Hutchinson's sign) or amelanotic rapidly growing pink
            nodules: assess urgently and refer.
            No medicine is prescribed for this in primary care - this entry is for recognition and
            referral. Anything given is decided by the service it is referred to.
            RED FLAG - Use the ABCDE criteria for a suspicious pigmented lesion - asymmetry, border
            irregularity, color variegation, diameter >6mm, evolving - as the recognition criteria
            for early melanoma.
            RED FLAG - The additional alarm features of an existing pigmented lesion are itching,
            bleeding, ulceration, and satellite lesions.
            RED FLAG - Asymmetry, an irregular border, colour variation, or an evolving change in a
            pigmented lesion (the ABCDE criteria), or a new pigmented lesion that bleeds, itches, or
            ulcerates, needs urgent referral.

Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy.
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