Cutaneous melanoma is a highly malignant tumour. The incidence has increased dramatically over the last few decades and is now estimated at between 4-5000 new cases per year in France. The term 'naevus', unless otherwise specified, refers to an acquired or congenital benign melanocytic tumour (commonly known as a naevus, naevi or mole). A melanoma can develop de novo, or within a pre-existing benign naevus. A melanoma can arise in any area containing melanocytes, but approximately 90% are cutaneous tumours. These recommendations refer to localized primary tumours, those presenting with regional nodes and those with distant metastases. The management of mucosal, visceral and ophthalmic melanomas is not covered. These recommendations are based on literature published until the end of 1998. Data published since does not change these recommendations. An update is planned for early 2001. RISK FACTORS AND PREVENTION The identification of risk factors is useful for the prevention of melanoma. Two types of risk factors have been identified: individual (constitutional) factors (photosensitivity, numerous naevi, atypical naevi, giant congenital naevi, personal or family history of melanoma) and behavioural factors (excess exposure to sun or artificial ultraviolet rays) (level of evidence A). The primary prevention of melanoma depends on a reduction in exposure to ultraviolet rays, either solar or artificial. Secondary prevention is based on the early diagnosis of a melanoma at a curable stage and the surveillance of high-risk patients. DIAGNOSIS AND HISTOPATHOLOGICAL ASSESSMENT Diagnosis is the first step in the management of a melanoma (stan-dard). Certain clinical criteria in a pigmented cutaneous lesion are suggestive of malignancy (standard). The criteria are classified as follows: q criteria A : asymmetry q criteria B : irregular borders q criteria C : heterogeneous colour q criteria D : large diameter q criteria E : evolution (recent change)-this criteria must co-exist with at least one of the preceding criteria. Some authors use the three change criteria: change in size, colour and shape. Other authors have proposed a list of seven criteria: three major criteria (change in size, change in colour, change in shape) and four minor criteria (diameter greater than 7 mm, hyper-sensitivity, bleeding and inflammation). Epiluminescence microscopy (ELM), or dermatoscopy, can improve the clinical diagnosis of pigmented lesions. It can differentiate a melanocytic from a non-melanocytic pigmented lesion such as a seborrheic keratosis, pigmented basal-cell carcinoma or haemangioma. Dermatoscopy for the early diagnosis of a mela-noma should only be used by those familiar with the technique. Its accuracy depends on the experience of the dermatologist. Currently, it cannot be recommended as a routine technique. The standard practice for the management of cutaneous melano-cytic lesions thought to be malignant is a limited but complete excision under local anaesthetic of the lesion with a narrow rim (2 mm) of normal skin. The incisio...
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