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Malignant melanoma of skin(CMM)

MedGen UID:
57486
Concept ID:
C0151779
Neoplastic Process
Synonyms: CMM; Cutaneous Malignant Melanoma; Cutaneous melanoma; Malignant melanoma, somatic
SNOMED CT: Cutaneous malignant melanoma (93655004); Malignant melanoma of skin (93655004); Melanoma of skin (93655004); MM (malignant melanoma) of skin (93655004)
 
Related genes: XRCC3, TERT, STK11, MITF, MC1R, CDKN2A, CDK4, BRAF
 
HPO: HP:0012056
Monarch Initiative: MONDO:0005012
OMIM®: 155600

Definition

Most melanomas affect only the outermost layer of skin (the epidermis). If a melanoma becomes thicker and involves multiple layers of skin, it can spread to other parts of the body (metastasize).

A large number of moles or other pigmented skin growths on the body, generally more than 25, is associated with an increased risk of developing melanoma. Melanoma is also a common feature of genetic syndromes affecting the skin such as xeroderma pigmentosum. Additionally, individuals who have previously had melanoma are nearly nine times more likely than the general population to develop melanoma again. It is estimated that about 90 percent of individuals with melanoma survive at least 5 years after being diagnosed.

Melanoma may develop from an existing mole or other normal skin growth that becomes cancerous (malignant); however, many melanomas are new growths. Melanomas often have ragged edges and an irregular shape. They can range from a few millimeters to several centimeters across. They can also be a variety of colors: brown, black, red, pink, blue, or white.

Melanoma is a type of skin cancer that begins in pigment-producing cells called melanocytes. This cancer typically occurs in areas that are only occasionally sun-exposed; tumors are most commonly found on the back in men and on the legs in women. Melanoma usually occurs on the skin (cutaneous melanoma), but in about 5 percent of cases it develops in melanocytes in other tissues, including the eyes (uveal melanoma) or mucous membranes that line the body's cavities, such as the moist lining of the mouth (mucosal melanoma). Melanoma can develop at any age, but it most frequently occurs in people in their fifties to seventies and is becoming more common in teenagers and young adults. [from MedlinePlus Genetics]

Term Hierarchy

Conditions with this feature

Xeroderma pigmentosum group B
MedGen UID:
78643
Concept ID:
C0268136
Disease or Syndrome
Xeroderma pigmentosum (XP) is characterized by: Acute sun sensitivity (severe sunburn with blistering, persistent erythema on minimal sun exposure) with marked freckle-like pigmentation of the face before age two years; Sunlight-induced ocular involvement (photophobia, severe keratitis, atrophy of the skin of the lids, ocular surface neoplasms); Greatly increased risk of sunlight-induced cutaneous neoplasms (basal cell carcinoma, squamous cell carcinoma, melanoma) within the first decade of life. Approximately 25% of affected individuals have neurologic manifestations (acquired microcephaly, diminished or absent deep tendon stretch reflexes, progressive sensorineural hearing loss, progressive cognitive impairment, and ataxia). The most common causes of death are skin cancer, neurologic degeneration, and internal cancer. The median age at death in persons with XP with neurodegeneration (29 years) was found to be younger than that in persons with XP without neurodegeneration (37 years).
Melanoma and neural system tumor syndrome
MedGen UID:
331890
Concept ID:
C1835042
Neoplastic Process
An extremely rare tumor association characterized by dual predisposition to melanoma and neural system tumors (typically astrocytoma). Fewer than 20 affected families have been reported to date. Affected individuals had cutaneous melanoma in association with dysplastic nevi, astrocytoma, benign or malignant peripheral nerve sheath tumor, neurofibroma, medulloblastoma, glioblastoma multiforme, ependymoma, glioma, and meningioma. In some cases, melanoma was described first followed by nervous system tumors, and in other cases, melanoma was a secondary cancer. The etiology of this tumor association is unknown. Genetic mutations or germline deletions are thought to underlie this cancer susceptibility syndrome.
Melanoma, cutaneous malignant, susceptibility to, 2
MedGen UID:
331891
Concept ID:
C1835044
Finding
Malignant melanoma is a neoplasm of pigment-producing cells called melanocytes that occurs most often in the skin, but may also occur in the eyes, ears, gastrointestinal tract, leptomeninges, and oral and genital mucous membranes (summary by Habif, 2010). For a discussion of genetic heterogeneity of cutaneous malignant melanoma, see CMM1 (155600).
Melanoma, cutaneous malignant, susceptibility to, 1
MedGen UID:
320506
Concept ID:
C1835047
Finding
Malignant melanoma is a neoplasm of pigment-producing cells called melanocytes that occurs most often in the skin, but may also occur in the eyes, ears, gastrointestinal tract, leptomeninges, and oral and genital mucous membranes (summary by Habif, 2010). Genetic Heterogeneity of Susceptibility to Cutaneous Malignant Melanoma The locus for susceptibility to familial cutaneous malignant melanoma-1 (CMM1) has been mapped to chromosome 1p36. Other CMM susceptibility loci include CMM2 (155601), caused by variation in the CDKN2A gene (600160) on chromosome 9p21; CMM3 (609048), caused by variation in the CDK4 gene (123829) on chromosome 12q14; CMM4 (608035), mapped to chromosome 1p22; CMM5 (613099), caused by variation in the MC1R gene (155555) on chromosome 16q24; CMM6 (613972), caused by variation in the XRCC3 gene (600675) on chromosome 14q32; CMM7 (612263), mapped to chromosome 20q11; CMM8 (614456), caused by variation in the MITF gene (156845) on chromosome 3p13; CMM9 (615134), caused by variation in the TERT gene (187270) on chromosome 5p15; and CMM10 (615848), caused by mutation in the POT1 gene (606478) on chromosome 7q31. Somatic mutations causing malignant melanoma have also been identified in several genes, including BRAF (164757), STK11 (602216), PTEN (601728), TRRAP (603015), DCC (120470), GRIN2A (138253), ZNF831, BAP1 (603089), and RASA2 (601589). A large percentage of melanomas (40-60%) carry an activating somatic mutation in the BRAF gene, most often V600E (164757.0001) (Davies et al., 2002; Pollock et al., 2003).
Melanoma, cutaneous malignant, susceptibility to, 3
MedGen UID:
373202
Concept ID:
C1836892
Finding
Malignant melanoma is a neoplasm of pigment-producing cells called melanocytes that occurs most often in the skin, but may also occur in the eyes, ears, gastrointestinal tract, leptomeninges, and oral and genital mucous membranes (summary by Habif, 2010). For a discussion of genetic heterogeneity of malignant melanoma, see 155600.
Large congenital melanocytic nevus
MedGen UID:
330752
Concept ID:
C1842036
Neoplastic Process
Congenital melanocytic nevus syndrome is characterized by pigmentary skin defects apparent at birth. Most individuals have 1 or more large or giant lesions greater than 20 cm and up to over 60 cm in diameter, which may cover up to 80% of total body area. These lesions may or may not be hairy. Smaller 'satellite' pigmented lesions numbering in the hundreds may also be present all over the body. Congenital melanocytic nevi (CMN) can be associated with malignant melanoma (see CMM1, 155600), but the risk appears to be low, ranging from 1 to 2% for all individuals, but rising to 10 to 15% in those with very large nevi (greater than 40 cm). A small subset of patients with CMNS have abnormalities of the central nervous system, known as 'neurocutaneous melanosis' or 'neuromelanosis' (249400), which may be symptomatic. Patients with CMNS also tend to have a characteristic facial appearance, including wide or prominent forehead, periorbital fullness, small short nose with narrow nasal bridge, round face, full cheeks, prominent premaxilla, and everted lower lip (summary by Kinsler et al., 2008; Kinsler et al., 2012). Spitz nevi are benign melanocytic melanomas composed of epithelioid or spindle cell melanocytes. They usually present as solitary skin tumors but can occur in multiple patterns, having agminated, dermatomal, and disseminated forms (summary by Sarin et al., 2013). Nevus spilus, also known as speckled lentiginous nevus, is a congenital hyperpigmented patch that progressively evolves, with affected individuals developing dark macules and papules during childhood and adolescence. Over time, nevus spilus may give rise to common lentigines, melanocytic nevi, Spitz nevi, and melanomas (summary by Sarin et al., 2014).
Xeroderma pigmentosum variant type
MedGen UID:
376352
Concept ID:
C1848410
Disease or Syndrome
Xeroderma pigmentosum (XP) is characterized by: Acute sun sensitivity (severe sunburn with blistering, persistent erythema on minimal sun exposure) with marked freckle-like pigmentation of the face before age two years; Sunlight-induced ocular involvement (photophobia, severe keratitis, atrophy of the skin of the lids, ocular surface neoplasms); Greatly increased risk of sunlight-induced cutaneous neoplasms (basal cell carcinoma, squamous cell carcinoma, melanoma) within the first decade of life. Approximately 25% of affected individuals have neurologic manifestations (acquired microcephaly, diminished or absent deep tendon stretch reflexes, progressive sensorineural hearing loss, progressive cognitive impairment, and ataxia). The most common causes of death are skin cancer, neurologic degeneration, and internal cancer. The median age at death in persons with XP with neurodegeneration (29 years) was found to be younger than that in persons with XP without neurodegeneration (37 years).
Xeroderma pigmentosum, group C
MedGen UID:
416702
Concept ID:
C2752147
Disease or Syndrome
Xeroderma pigmentosum (XP) is characterized by: Acute sun sensitivity (severe sunburn with blistering, persistent erythema on minimal sun exposure) with marked freckle-like pigmentation of the face before age two years; Sunlight-induced ocular involvement (photophobia, severe keratitis, atrophy of the skin of the lids, ocular surface neoplasms); Greatly increased risk of sunlight-induced cutaneous neoplasms (basal cell carcinoma, squamous cell carcinoma, melanoma) within the first decade of life. Approximately 25% of affected individuals have neurologic manifestations (acquired microcephaly, diminished or absent deep tendon stretch reflexes, progressive sensorineural hearing loss, progressive cognitive impairment, and ataxia). The most common causes of death are skin cancer, neurologic degeneration, and internal cancer. The median age at death in persons with XP with neurodegeneration (29 years) was found to be younger than that in persons with XP without neurodegeneration (37 years).
Melanoma, cutaneous malignant, susceptibility to, 8
MedGen UID:
463554
Concept ID:
C3152204
Finding
Malignant melanoma is a neoplasm of pigment-producing cells called melanocytes that occurs most often in the skin, but may also occur in the eyes, ears, gastrointestinal tract, leptomeninges, and oral and genital mucous membranes (summary by Habif, 2010). For a discussion of genetic heterogeneity of cutaneous malignant melanoma, see CMM1 (155600).
BAP1-related tumor predisposition syndrome
MedGen UID:
482122
Concept ID:
C3280492
Disease or Syndrome
BAP1 tumor predisposition syndrome (BAP1-TPDS) is associated with an increased risk for a specific skin lesion, BAP1-inactivated melanocytic tumors (BIMT; formerly called atypical Spitz tumors), and the following cancers, in descending order of frequency: uveal (eye) melanoma (UM), malignant mesothelioma (MMe), cutaneous melanoma (CM), renal cell carcinoma (RCC), and basal cell carcinoma (BCC). Hepatocellular carcinoma, cholangiocarcinoma, and meningioma may also be associated with BAP1-TPDS. Affected individuals can have more than one type of primary cancer. In general, the median age of onset of these tumors is younger than in the general population. UM tends to be a more aggressive class 2 tumor with higher risk for metastasis and reduced survival compared to UM occurring in the general population. Due to the limited number of families reported to date, the penetrance, natural history, and frequencies of BAP1-associated tumors are yet to be determined. Other suspected but unconfirmed tumors in BAP1-TPDS include (in alphabetic order): breast cancer, neuroendocrine carcinoma, non-small-cell lung adenocarcinoma, thyroid cancer, and urinary bladder cancer.

Recent clinical studies

Etiology

Shao X, Yu R, Zhao H, Wu J, Wu Q, Shu P
Arch Dermatol Res 2024 May 24;316(6):214. doi: 10.1007/s00403-024-03011-2. PMID: 38787420
Che B, Yuan S, Zhang H, Zhai J, Zhang Y, Wu C, Tang K
BMC Cancer 2024 May 13;24(1):586. doi: 10.1186/s12885-024-12354-y. PMID: 38741062Free PMC Article
Lee KC, Fulton JP, Kazemi L, George EA, Smith CK, Andoscia G, Kawaoka JC, Almeida-DoRosario A
R I Med J (2013) 2021 Aug 2;104(6):22-27. PMID: 34323875
Svirčev Z, Drobac D, Tokodi N, Lužanin Z, Munjas AM, Nikolin B, Vuleta D, Meriluoto J
J Environ Sci Health C Environ Carcinog Ecotoxicol Rev 2014;32(4):319-37. doi: 10.1080/10590501.2014.967053. PMID: 25436472
Lee JA
Photochem Photobiol 1989 Oct;50(4):493-6. doi: 10.1111/j.1751-1097.1989.tb05554.x. PMID: 2687904

Diagnosis

Yin W, Li R, Zhang Z, Wang Y, Tang X, Zhu L, Yao H, Li K
BMC Cancer 2024 Jul 17;24(1):849. doi: 10.1186/s12885-024-12603-0. PMID: 39020276Free PMC Article
Lee KC, Fulton JP, Kazemi L, George EA, Smith CK, Andoscia G, Kawaoka JC, Almeida-DoRosario A
R I Med J (2013) 2021 Aug 2;104(6):22-27. PMID: 34323875
Orso M, Serraino D, Abraha I, Fusco M, Giovannini G, Casucci P, Cozzolino F, Granata A, Gobbato M, Stracci F, Ciullo V, Vitale MF, Eusebi P, Orlandi W, Montedori A, Bidoli E; D.I.V.O. Group
BMJ Open 2018 Apr 20;8(4):e020631. doi: 10.1136/bmjopen-2017-020631. PMID: 29678984Free PMC Article
Shack L, Jordan C, Thomson CS, Mak V, Møller H; UK Association of Cancer Registries
BMC Cancer 2008 Sep 26;8:271. doi: 10.1186/1471-2407-8-271. PMID: 18822122Free PMC Article
Lee JA
Photochem Photobiol 1989 Oct;50(4):493-6. doi: 10.1111/j.1751-1097.1989.tb05554.x. PMID: 2687904

Therapy

Yin W, Li R, Zhang Z, Wang Y, Tang X, Zhu L, Yao H, Li K
BMC Cancer 2024 Jul 17;24(1):849. doi: 10.1186/s12885-024-12603-0. PMID: 39020276Free PMC Article
Shao X, Yu R, Zhao H, Wu J, Wu Q, Shu P
Arch Dermatol Res 2024 May 24;316(6):214. doi: 10.1007/s00403-024-03011-2. PMID: 38787420
Che B, Yuan S, Zhang H, Zhai J, Zhang Y, Wu C, Tang K
BMC Cancer 2024 May 13;24(1):586. doi: 10.1186/s12885-024-12354-y. PMID: 38741062Free PMC Article
Scarselli A, Corfiati M, Marinaccio A
Eur J Cancer Prev 2023 May 1;32(3):281-285. Epub 2023 Feb 27 doi: 10.1097/CEJ.0000000000000786. PMID: 36896837
Lee JA
Photochem Photobiol 1989 Oct;50(4):493-6. doi: 10.1111/j.1751-1097.1989.tb05554.x. PMID: 2687904

Prognosis

Zare Sakhvidi MJ, Yang J, Siemiatycki J, Dadvand P, de Hoogh K, Vienneau D, Goldberg M, Zins M, Lequy E, Jacquemin B
Sci Total Environ 2021 Sep 15;787:147553. Epub 2021 May 6 doi: 10.1016/j.scitotenv.2021.147553. PMID: 33989869
Gróf M, Vagašová T, Oltman M, Skladaný Ľ, Maličká L
Cent Eur J Public Health 2017 Dec;25 Suppl 2:S59-S63. doi: 10.21101/cejph.a5055. PMID: 29524371
Svirčev Z, Drobac D, Tokodi N, Lužanin Z, Munjas AM, Nikolin B, Vuleta D, Meriluoto J
J Environ Sci Health C Environ Carcinog Ecotoxicol Rev 2014;32(4):319-37. doi: 10.1080/10590501.2014.967053. PMID: 25436472
Shack L, Jordan C, Thomson CS, Mak V, Møller H; UK Association of Cancer Registries
BMC Cancer 2008 Sep 26;8:271. doi: 10.1186/1471-2407-8-271. PMID: 18822122Free PMC Article
Lee JA
Photochem Photobiol 1989 Oct;50(4):493-6. doi: 10.1111/j.1751-1097.1989.tb05554.x. PMID: 2687904

Clinical prediction guides

Shao X, Yu R, Zhao H, Wu J, Wu Q, Shu P
Arch Dermatol Res 2024 May 24;316(6):214. doi: 10.1007/s00403-024-03011-2. PMID: 38787420
Che B, Yuan S, Zhang H, Zhai J, Zhang Y, Wu C, Tang K
BMC Cancer 2024 May 13;24(1):586. doi: 10.1186/s12885-024-12354-y. PMID: 38741062Free PMC Article
Zare Sakhvidi MJ, Yang J, Siemiatycki J, Dadvand P, de Hoogh K, Vienneau D, Goldberg M, Zins M, Lequy E, Jacquemin B
Sci Total Environ 2021 Sep 15;787:147553. Epub 2021 May 6 doi: 10.1016/j.scitotenv.2021.147553. PMID: 33989869
Svirčev Z, Drobac D, Tokodi N, Lužanin Z, Munjas AM, Nikolin B, Vuleta D, Meriluoto J
J Environ Sci Health C Environ Carcinog Ecotoxicol Rev 2014;32(4):319-37. doi: 10.1080/10590501.2014.967053. PMID: 25436472
Shack L, Jordan C, Thomson CS, Mak V, Møller H; UK Association of Cancer Registries
BMC Cancer 2008 Sep 26;8:271. doi: 10.1186/1471-2407-8-271. PMID: 18822122Free PMC Article

Supplemental Content

Table of contents

    Clinical resources

    Practice guidelines

    • PubMed
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    Curated

    • NCCN, 2024
      NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) Melanoma: Cutaneous, 2024
    • NICE, 2022
      UK NICE Guideline NG14, Melanoma: assessment and management, 2022
    • NICE, 2015
      Vemurafenib for treating locally advanced or metastatic BRAF V600 mutation-positive malignant melanoma (Updated 1 January 2015)

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