Management The entire cutaneous surface, including the scalp and mucous membranes, should be examined in each patient. Bright room illumination is important, and a 7x to 10x hand lens is helpful for evaluating variation in pigment pattern. A history of relevant risk factors should be elicited. Any suspicious lesions should be biopsied, evaluated by a specialist, or recorded by chart and/or photography for follow-up. Examination of the lymph nodes and palpation of the abdominal viscera are part of the staging examination for suspected melanoma. The patient should be advised to have other family members screened if either melanoma or clinically. | Chapter 083. Cancer of the Skin Part 4 Management The entire cutaneous surface including the scalp and mucous membranes should be examined in each patient. Bright room illumination is important and a 7x to 10x hand lens is helpful for evaluating variation in pigment pattern. A history of relevant risk factors should be elicited. Any suspicious lesions should be biopsied evaluated by a specialist or recorded by chart and or photography for follow-up. Examination of the lymph nodes and palpation of the abdominal viscera are part of the staging examination for suspected melanoma. The patient should be advised to have other family members screened if either melanoma or clinically atypical moles dysplastic nevi are present. The detection of early melanoma in relatives has been reported. Melanoma prevention is based on protection from the sun. Routine use of a broad spectrum UV-A UV-B sunblock with sun protection factor 15 use of protective clothing and avoiding intense midday ultraviolet exposure should be recommended. The patient should be educated in the clinical features of melanoma and advised to report any growth or other change in a pigmented lesion. Patient education brochures are available from the American Cancer Society the American Academy of Dermatology the National Cancer Institute and the Skin Cancer Foundation. Self-examination at 6- to 8-week intervals may enhance the likelihood of detecting change. The importance of routine follow-up visits for melanoma patients and patients with clinically atypical moles dysplastic nevi should be emphasized as these visits may facilitate early detection of new primary tumors. Precursor Lesions Clinically atypical moles also termed dysplastic nevi occur in certain families affected by melanoma. In some families melanomas occur nearly exclusively in the individuals with dysplastic nevi. In other families the nevi may not be present in all individuals with an increased risk of melanoma. The melanomas may arise in .
