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Melanoma Pictoral Atlas

Is it Melanoma?

Growth and Development of Primary Skin Melanomas: A Short Atlas

Author: DuPont Guerry, MD Affiliations: Director, Melanoma Program University of Pennsylvania Cancer Center Chair, Melanoma International Foundation Advisory Board

Copyright © 1996, The Trustees of the University of Pennsylvania

Melanomas develop initially as a flat phase without competence for metastasis called the radial growth phase. They then may evolve focally an elevated part, the vertical growth phase, with metastatic competence.

Generally, the radial growth phase is described by the A,B,C,D's of melanoma:

A = asymmetry

B = border irregularity

C = color variability (brown, black, blue, gray, pink)

D = diameter of (often) greater than 1/4 inch

E=evolution or evolving

Radial growth phase melanomas, although invasive, have a cure rate that approaches 100% with surgery alone. Figures 1 and 2 are radial growth phase melanomas of the superficial spreading type, the most common form in white populations. This type is associated with excessive, intermittent sun exposure (especially in childhood and youth).


Figure 1	Figure 2

Figures 3 and 4 are radial growth phase melanomas of the lentigo maligna type. This type is associated with a lifetime of immoderate sun exposure and hence generally occurs in aged, sun damaged, maximally exposed skin.


Figure 3	Figure 4

Figures 5 and 6 are radial growth phase, acral-lentiginous melanomas. These occur in all races at a very low rate on palms, soles of the feet, and under the nails.


Figure 5	Figure 6

Figures 7, 8, and 9 are melanomas that have evolved focal areas of vertical phase. Overall, patients with vertical growth phase melanomas have a cure rate of 70%. Individual prognosis is dependent on such factors as tumor thickness, lymphocytic infiltration into the vertical growth phase, proportion of tumor cells in mitosis, ulceration, tumor location, and the patient's sex.


Figure 7	Figure 8

Figure 9

References:

Guerry, D., Synnestvedt, M, Elder, DE, Schultz D: Lessons from Tumor Progression: The Invasive Radial Growth Phase of Melanoma is Common, Incapable of Metastasis and Indolent. J. Invest. Dermatol. 100: 3425-3455, 1993.

Clark WH, Elder DE, Guerry D, Braitman LE, Trock BJ, Shultz D, Synnestvedt M, Halpern A: Model Predicting Survival in Stage I Melanoma Based on Tumor Progression. J. Natl Cancer Inst. 24: 1893-1904, 1989.

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The MIF Website is designed for educational purposes only and is not engaged in rendering medical advice or professional services. The information provided through this Website should not be used for diagnosing or treating a health problem or a disease. It is not a substitute for professional care. If you have or suspect you may have a health problem, you should consult your health care provider.

UPDATE: March 6, 2011

This site complies with the HONcode standard for trustworthy health information:
verify here.

The MIF Website is designed for educational purposes only and is not engaged in rendering medical advice or professional services. The information provided through this Website should not be used for diagnosing or treating a health problem or a disease. It is not a substitute for professional care. If you have or suspect you may have a health problem, you should consult your health care provider.