From the Guidelines
Melanoma usually exhibits both color changes and spreading, but color changes are often the first noticeable sign, as indicated by the "ABCD" rule, which includes Color heterogeneity as a key criterion. According to the ESMO clinical practice guidelines for diagnosis, treatment, and follow-up of cutaneous melanoma 1, the "ABCD" rule is a useful tool for clinically analyzing suspicious pigmented lesions, with "Dynamics (or evolution) in colours, elevation or size" being a crucial aspect of diagnosis. This suggests that changes in color, such as darkening, multiple colors, or uneven coloration, can be an early warning sign of melanoma.
The guidelines also highlight the importance of dermoscopy by an experienced physician in enhancing diagnostic accuracy [II, B] 1, and the use of automated videodermoscopy systems and full-body imaging with high-resolution pictures can improve early detection 1. While machine-learning algorithms have shown promise in diagnosing pigmented skin lesions, their use in clinical practice remains to be evaluated 1.
Key characteristics of melanoma include:
- Asymmetry
- Border irregularities
- Color heterogeneity
- Dynamics (or evolution) in colors, elevation, or size It is essential to note that any suspicious mole should be evaluated by a healthcare provider immediately, especially if color changes or spreading are noticed, as early detection significantly improves treatment outcomes 1. Regular skin self-examinations and dermatologist visits are recommended for early detection.
From the Research
Melanoma Progression
- Melanoma can progress in different ways, but the provided studies do not directly address whether melanoma usually changes color or spreads out first 2, 3, 4, 5, 6.
- The studies focus on the diagnosis, treatment, and management of melanoma, including biopsy methods, excision margins, and immunotherapy options.
- There is no clear evidence in the provided studies to suggest that melanoma typically changes color before spreading or vice versa.
Biopsy and Excision
- The studies emphasize the importance of proper biopsy and excision techniques for diagnosing and managing melanoma 2, 3.
- Excision biopsy is recommended for suspected malignant melanoma, and punch biopsies are not recommended unless excision biopsy is not feasible 2.
- The studies discuss the guidelines for definitive excision margins for primary cutaneous melanoma, including margins for melanoma in situ and invasive melanoma 3.
Treatment and Management
- The studies discuss various treatment options for melanoma, including immunotherapy, targeted therapy, and surgery 4, 5, 6.
- The use of PD-1 inhibitors, T-VEC, mRNA vaccines, and tumor-infiltrating lymphocyte therapy are highlighted as innovative treatment strategies for advanced melanoma 6.
- The studies emphasize the importance of considering patient factors, such as the extent of disease and central nervous system involvement, when selecting treatment options 5.