Malignant Melanoma

A previously asymptomatic, largeblack plaque on a 65-year-old man'sscalp recently began to bleed. The lesionhad grown considerably since itfirst appeared as a small black macule3 years earlier.A clinical diagnosis of malignantmelanoma was confirmed by an incisionalbiopsy. An excisional biopsy ofthe 3.85-mm thick cancer was performedseveral days later. The patientrefused biopsy of clinically palpablelymph nodes in his neck.Common sites of melanomametastases include the nodes, lungs,liver, brain, and bone. This patientdied 8 months later with metastasesto his brain.(Case and photograph courtesy ofDr Reynold C. Wong.)