From the Guidelines
Melanoma typically does not start as inflamed and red, and the most common initial presentation is a new, unusual-looking mole or a change in an existing mole, following the ABCDE rule: Asymmetry, Border irregularity, Color variation, Diameter larger than 6mm, and Evolution or change over time. The ABCDE rule is a widely accepted guideline for identifying suspicious lesions, and it is essential to note that inflammation and redness are more often associated with other skin conditions like infections, allergic reactions, or non-melanoma skin cancers 1. According to the ESMO clinical practice guidelines for diagnosis, treatment, and follow-up of cutaneous melanoma, suspicious lesions are characterized by Asymmetry, Border irregularities, Color heterogeneity, Dynamics, and the "ugly duckling" concept can help identify melanomas 1.
Some studies suggest that inflammation can be present in melanomas, but it is not a common initial presentation. For example, a study published in 1990 found that inflammation was seen in 51% of melanomas, but this study is outdated and has been superseded by more recent guidelines 1. More recent studies, such as the 2015 ESMO guidelines, do not emphasize inflammation as a common initial presentation of melanoma 1.
It is crucial to note that early detection of melanoma significantly improves treatment outcomes, and if you notice a new or changing skin lesion, especially one that is asymmetric, has irregular borders, multiple colors, is growing, or is different from your other moles, you should have it evaluated by a healthcare provider promptly. The diagnosis should be based on a full-thickness excisional biopsy with a minimal side margin, and the histology report should follow the American Joint Committee on Cancer (AJCC) classification 1.
In terms of diagnosis, dermoscopy by an experienced physician can enhance diagnostic accuracy, and the "ugly duckling" concept can help identify melanomas 1. The histopathological report must include at least the diagnosis of the melanocytic nature of the lesion, confirmation of its malignancy, and information on the maximum thickness, mitotic rate, presence of ulceration, and clearance of the surgical margins 1.
In conclusion, while some melanomas can appear red, this is not the most common initial presentation, and the ABCDE rule remains the most widely accepted guideline for identifying suspicious lesions. If you have any concerns about a skin lesion, it is essential to consult a healthcare provider for prompt evaluation and diagnosis.
From the Research
Melanoma Presentation
- Melanoma can present with various clinical features, but the provided studies do not directly address whether it initially presents with inflammation and erythema (redness) 2, 3, 4, 5, 6.
Clinical Features of Melanoma
- A study published in 2021 identified patient-identified early clinical warning signs of nodular melanoma, including coloration, shape, and texture changes, as well as sensations such as itchiness or the mole feeling "not right" 5.
- Another study from 2003 discussed the surgical management and other treatment options for primary cutaneous melanoma, highlighting the importance of tumor thickness and ulceration in determining prognosis and treatment 6.
Histological Diagnosis
- A 1996 study outlined the histological features that distinguish malignant melanoma from benign counterparts, including intraepidermal growth patterns, dermal component maturation, and cytological atypia 4.