Hopp til hovedinnhold

Malignt melanom

Sist oppdatert: Sist revidert:
Sist revidert av:

Definisjon:
Ondartet svulst utgått fra melanocytter, oftest utgått fra basallaget i epidermis, kan også utgå fra slimhinner eller øye
Forekomst:
Rundt 2300 nye tilfeller årlig i Norge. Norge er på femteplass på verdensbasis når det gjelder aldersjustert insidens
Symptomer:
Rask tilkomst av en ny pigmentert lesjon, eventuelt endringer i en eksisterende nevus 
Funn:
ABCD(E)-regelen og "the ugly duckling sign". Mistanke ved lesjon >6 mm som er asymmetrisk med uskarp avgrensning, fargevariasjon eller har endret seg siste tid
Diagnostikk:
Eksisjonsbiopsi til histopatologisk undersøkelse
Behandling:
Hovedbehandlingen er kirurgi. Adjuvant immunterapi ved stadium ≥ IIC. Ved inoperabel sykdom immunterapi, kjemoterapi, strålebehandling
  • Nasjonalt handlingsprogram med retningslinjer for diagnostikk, behandling og oppfølging av maligne melanomer, Helsedirektoratet, 2020.
  1. Helsedirektoratet. Nasjonalt handlingsprogram med retningslinjer for diagnostikk, behandling og oppfølging av maligne melanomer. Helsedirektoratet, sist oppdatert mai 2020. www.helsedirektoratet.no  
  2. Kreftregisteret. Cancer in Norway 2019. Oslo: Kreftregisteret, 2020. www.kreftregisteret.no  
  3. Ferlay J, Ervik M, Lam F et al. (2020). Global Cancer Observatory: Cancer Today. Lyon, France: International Agency for Research on Cancer. Accessed 21 Apr 2022. Available from: gco.iarc.fr  
  4. Årsrapport 2018: Resultater og forbedringstiltak fra Nasjonalt kvalitetsregister for melanom. Oslo: Kreftregisteret, 2019. ISBN: 978-82-473-0071-8 www.kreftregisteret.no  
  5. Kottschade LA, Grotz TE, Dronca RS et al. Rare presentations of primary melanoma and special populations: a systematic review. Am J Clin Oncol 2014; 37: 635-41. pmid:23563206 PubMed  
  6. Wu S, Han J, Laden F, Qureshi AA. Long-term ultraviolet flux, other potential risk factors, and skin cancer risk: A cohort study. Cancer Epidemiol Biomarkers Prev 2014; 23: 1080. pmid: 24876226 PubMed  
  7. Keim U, Gandini S, Amaral T et al. Cutaneous melanoma attributable to UVR exposure in Denmark and Germany. Eur J Cancer. 2021 Dec;159:98-104. Epub 2021 Nov 3. PMID: 34742161. PubMed  
  8. Pampena R, Kyrgidis A, Lallas A, et al. A meta-analysis of nevus-associated melanoma: Prevalence and practical implications. J Am Acad Dermatol 2017; 77: 938-45. pmid:28864306 PubMed  
  9. Vourc'h-Jourdain M1, Martin L, Barbarot S. Large congenital melanocytic nevi: therapeutic management and melanoma risk: a systematic review. J Am Acad Dermatol 2013; 68(3): 493-8. pmid:23182059 PubMed  
  10. Reddy KK, Farber MJ, Bhawan J et al. Atypical (dysplastic) nevi: outcomes of surgical excision and association with melanoma. JAMA Dermatol 2013; 149: 928-34. pmid:23760581 PubMed  
  11. Ribero S, Zugna D, Osella-Abate S, et al. Prediction of high naevus count in a healthy UK population to estimate melanoma risk. Br J Dermatol 2015. pmid: 26479165 PubMed  
  12. Mocellin S, Lens MB, Pasquali S, Pilati P, Chiarion Sileni V. Interferon alpha for the adjuvant treatment of cutaneous melanoma. Cochrane Database of Systematic Reviews 2013, Issue 6. Art. No.: CD008955. pmid: 23775773 PubMed  
  13. Chen T, Fallah M, Försti A et al. Risk of Next Melanoma in Patients With Familial and Sporadic Melanoma by Number of Previous Melanomas. JAMA Dermatol 2015; 151: 607. pmid:25671687 PubMed  
  14. Wu S, Cho E, Li W et al. History of Severe Sunburn and Risk of Skin Cancer Among Women and Men in 2 Prospective Cohort Studies. Am J Epidemiol 2016; 183(9): 824-33. pmid:27045074 PubMed  
  15. Gandini S, Doré JF, Autier P et al. Epidemiological evidence of carcinogenicity of sunbed use and of efficacy of preventive measures. J Eur Acad Dermatol Venereol. 2019 Mar;33 Suppl 2:57-62. PMID: 30811691. PubMed  
  16. Gaudy-Marqueste C, Wazaefi Y, Bruneu Y et al. Ugly Duckling Sign as a Major Factor of Efficiency in Melanoma Detection. JAMA Dermatol 2017; 153: 279-84. pmid:28196213 PubMed  
  17. Bhatt M, Nabatian A, Kriegel D, Khorasani H. Does an increased number of moles correlate to a higher risk of melanoma? Melanoma Manag. 2016 Jun;3(2):85-87. Epub 2016 May 19. PMID: 30190875 PubMed  
  18. American Academy of Dermatology Ad Hoc Task Force for the ABCDEs of Melanoma. Early detection of melanoma: reviewing the ABCDEs. J Am Acad Dermatol. 2015 ;72(4):717-23. pmid: 25698455 PubMed  
  19. Williams NM, Rojas KD, Reynolds JM et al. Assessment of Diagnostic Accuracy of Dermoscopic Structures and Patterns Used in Melanoma Detection: A Systematic Review and Meta-analysis. JAMA Dermatol. 2021 Aug 4. Epub ahead of print. PMID: 34347005. PubMed  
  20. Tzellos T, Kyrgidis A, Mocellin S, Chan AW, Pilati P, Apalla Z. Interventions for melanoma in situ, including lentigo maligna. Cochrane Database of Systematic Reviews 2014, Issue 12. Art. No.: CD010308. pmid: 25526608 PubMed  
  21. Utjés D, Malmstedt J, Teras J et al. 2-cm versus 4-cm surgical excision margins for primary cutaneous melanoma thicker than 2 mm: long-term follow-up of a multicentre, randomised trial. Lancet 2019; 394: 471-77. pmid:31280965 PubMed  
  22. Kyrgidis A, Tzellos T, Mocellin S, Apalla Z, Lallas A, Pilati P, Stratigos A. Sentinel lymph node biopsy followed by lymph node dissection for localised primary cutaneous melanoma. Cochrane Database of Systematic Reviews 2015, Issue 5. Art. No.: CD010307. DOI: 10.1002/14651858.CD010307.pub2. The Cochrane Library  
  23. Hao C, Tian J, Liu H et al. Efficacy and Safety of anti-PD-1 and anti-PD-1 Combined With anti-CTLA-4 Immunotherapy to Advanced Melanoma: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Medicine (Baltimore) 2017; 96: E7325. pmid:28658143 PubMed  
  24. Larkin J, Chiarion-Seleni V, Gonzalez R, et al. Combined nivolumab and ipilimumab or monotherapy in untreated melanoma. N Engl J Med 2015. pmid: 26027431 PubMed  
  25. Long GV, Atkinson V, Lo S et al. Combination nivolumab and ipilimumab or nivolumab alone in melanoma brain metastases: a multicentre randomised phase 2 study. Lancet Oncol 2018; 19: 672-81. pmid:29602646 PubMed  
  26. Eggermont AM, Chiarion-Sileni V, Grob JJ, et al. Adjuvant ipilimumab versus placebo after complete resection of high-risk stage III melanoma (EORTC 18071): a randomised, double-blind, phase 3 trial. Lancet Oncol. 2015 May;16(5):522-30. pmid: 25840693 PubMed  
  27. Eggermont AM, Chiarion-Sileni V, Grob JJ et al. Prolonged Survival in Stage III Melanoma with Ipilimumab Adjuvant Therapy. N Engl J Med 2016; 375(19): 1845-55. pmid:27717298 PubMed  
  28. Pasquali S, Hadjinicolaou AV, Chiarion Sileni V, Rossi CR, Mocellin S. Systemic treatments for metastatic cutaneous melanoma. Cochrane Database of Systematic Reviews 2018, Issue 2. Art. No.: CD011123. DOI: 10.1002/14651858.CD011123.pub2. The Cochrane Library  
  29. Long GV, Hauschild A, Santinami M et al. Adjuvant Dabrafenib plus Trametinib in Stage III BRAF-Mutated Melanoma. N Engl J Med 2017; 377: 1813-23. pmid:28891408 PubMed  
  30. Spasojevic M, Mariathasan AB, Frich L et al.. Kreftbehandling med isolert ekstremitetsperfusjon. Tidsskr Nor Legeforen 2021. doi:10.4045/tidsskr.21.0194 DOI  
  31. Sahin U, Oehm P, Derhovanessian E, et al. An RNA vaccine drives immunity in checkpoint-inhibitor-treated melanoma. Nature 2020; 585: 107-12. pmid:32728218 PubMed  
  32. Wernli KJ, Henrikson NB, Morrison CC etal. Screening for Skin Cancer in Adults: Updated Evidence Report and Systematic Review for the US Preventive Services Task Force. JAMA 2016; 316: 436-47. pmid:27458949 PubMed  
  33. Johansson M, Brodersen J, Gøtzsche PC, Jørgensen KJ. Screening for reducing morbidity and mortality in malignant melanoma. Cochrane Database of Systematic Reviews 2019, Issue 6. Art. No.: CD012352. DOI: 10.1002/14651858.CD012352.pub2. Accessed 21 April 2022. The Cochrane Library  
  34. Matsumoto M, Wack S, Weinstock MAet al. Five-Year Outcomes of a Melanoma Screening Initiative in a Large Health Care System. JAMA Dermatol. 2022 Apr 6:e220253. Epub ahead of print. PMID: 35385051 PubMed  
  35. O'Shea SJ, Davies JR, Newton-Bishop JA. Vitamin D, vitamin A, the primary melanoma transcriptome and survival. Br J Dermatol 2016; 175: 30-4. pmid:27667313 PubMed  
  36. Diehl JW, Chiu MW. Effects of ambient sunlight and photoprotection on vitamin D status. Dermatol Ther 2010; 23: 48-60. pmid:20136908 PubMed  
  37. Calomarde-Rees L, García-Calatayud R, Requena Caballero C et al. Risk Factors for Lymphatic and Hematogenous Dissemination in Patients With Stages I to II Cutaneous Melanoma. JAMA Dermatol 2019.0069. pmid:31042264 PubMed  
  38. Green AC, Baade P, Coory M et al. Population-based 20-year survival among people diagnosed with thin melanomas in Queensland, Australia. J Clin Oncol 2012; 30(13): 1462. pmid:22412152 PubMed  
  • Silje Folven Barlindhaug, spesialist i allmennmedisin, redaktør NEL

Tidligere fagmedarbeidere

  • Sylvi Torvund, spesialist i allmennmedisin, Nidarvoll legesenter, Trondheim
  • Kristin Ryggen, overlege, Hudavdelingen, Regionsykehuset i Trondheim