[The clinical diagnosis of melanoma]

EARLY DIAGNOSIS FOR EFFICIENT MANAGEMENT: The melanoma is a cutaneous tumour of poor prognosis and its incidence is increasing. Some risk factors are now well established ( field, phototype, family history) and its early discovery is clinically possible since the lesions are visible to the eye. When diagnosed early, the prognosis is clearly improved. CLINICAL FORMS OF VARYING PROGNOSIS: Depending on the clinical, histopathological and progressive differences, it is possible to distinguish a Superficial Spreading Melanoma (60 to 70%), nodular melanoma (10 to 15%), Dubreuilh's melanoma (5 to 10%) and acrolentigenous melanoma (5%). Apart from these 4 major clinical forms, there is also the sub-ungual melanoma and the mucosal melanoma. Particular situations may also exist: the discovery of metastasis without identification of cutaneous tumour, a melanoma in a pregnant woman or a child, a familial melanoma or multiple melanomas. THE ELEMENTS OF DIAGNOSIS: The semiological analysis of an often-pigmented lesion of the skin, relying on the ABCDE rule and the notion of rapid progression, is the first stage in the diagnostic approach. It is completed, following complete exeresis, by anatomopathological exploration (Breslow's index, existence of ulceration, signs of regression, Clark's classification, histological type and mitotic activity). Two further elements should also be taken into account: the results of a dermatoscopy and the analysis of the sentinel nodes.