Weird Skin Stuff

July 2009

FocusWeird Skin Stuff

Cutaneous melanoma

Atypical variants and presentations

Volume 38, No.7, July 2009 Pages 476-482

Alex Chamberlain

Jonathan Ng


The incidence of melanoma continues to rise in Australia. General practitioners treat the majority of skin cancers affecting Australians. In the past decade, there has been improved uptake of dermoscopy by GPs who realise its value in the assessment of pigmented and nonpigmented lesions.


This article outlines those variants or presentations of melanoma that create diagnostic difficulty for all clinicians. Practice tips regarding clinical features or useful dermoscopic clues are included.


A clinical overview of lentigo maligna, acral lentiginous and subungual melanoma, nodular melanoma, desmoplastic melanoma, verrucous melanoma and hypomelanotic melanoma is presented. Dermoscopy has become a vital diagnostic aid in the assessment of all skin lesions. Its value in the diagnosis of melanoma is highlighted where relevant. Expert dermatopathology assessment is equally as crucial in reaching a correct diagnosis, especially for some of these atypical variants.

Given that the prognosis associated with cutaneous malignant melanoma is closely associated with tumour thickness, it is imperative that melanomas are diagnosed at the earliest stage possible. When melanoma is suspected, early excisional biopsy or urgent referral is the most critical management step. Readers are urged to familiarise themselves with the current national recommendations regarding biopsy techniques, appropriate excision margins, relevant investigations and appropriate follow up, which are outlined in the recently revised Australian Cancer Network Melanoma clinical practice guidelines.1

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