Cancer - melanoma
Description
- Malignancy of melanocytes; the solid tumour where immunotherapy was first proved
Subtypes
| Subtype | % | Features |
|---|---|---|
| Superficial spreading | ~70% | Intermittent sun exposure, trunk/legs, radial growth phase first |
| Nodular | ~15% | Vertical growth from the outset - thick at diagnosis, worst prognosis, often amelanotic |
| Lentigo maligna | ~10% | Chronically sun-damaged skin, elderly, face; long in-situ phase |
| Acral lentiginous | ~5% | Palms, soles, subungual; not sun-related, equal across ethnicities, often late |
| Desmoplastic | rare | Neurotropic, high local recurrence, high TMB - very immunotherapy-responsive |
Non-cutaneous
- Uveal - GNAQ/GNA11 driven, no BRAF; haematogenous spread to liver, not lymphatics; tebentafusp if HLA-A*02:01
- Mucosal - anorectal, vulvovaginal, sinonasal; KIT mutations; poor prognosis
- Both are biologically distinct - do not apply cutaneous algorithms
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