Clinical practice guidelines for the diagnosis and management of melanoma: melanomas that lack classical clinical features

Victoria J Mar, Alex J Chamberlain, John W Kelly, William K Murray and John F Thompson
Med J Aust 2017; 207 (8): . || doi: 10.5694/mja17.00123
Published online: 9 October 2017


Introduction: A Cancer Council Australia multidisciplinary working group is currently revising and updating the 2008 evidence-based clinical practice guidelines for the management of cutaneous melanoma. While there have been many recent improvements in treatment options for metastatic melanoma, early diagnosis remains critical to reducing mortality from the disease. Improved awareness of the atypical presentations of this common malignancy is required to achieve this. A chapter of the new guidelines was therefore developed to aid recognition of atypical melanomas.

Main recommendations: Because thick, life-threatening melanomas may lack the more classical ABCD (asymmetry, border irregularity, colour variegation, diameter > 6 mm) features of melanoma, a thorough history of the lesion with regard to change in morphology and growth over time is essential. Any lesion that is changing in morphology or growing over a period of more than one month should be excised or referred for prompt expert opinion.

Changes in management as a result of the guidelines: These guidelines provide greater emphasis on improved recognition of the atypical presentations of melanoma, in particular nodular, desmoplastic and acral lentiginous subtypes, with particular awareness of hypomelanotic and amelanotic lesions.

  • Victoria J Mar1,2
  • Alex J Chamberlain1,2
  • John W Kelly1,2
  • William K Murray3
  • John F Thompson4,5

  • 1 Victorian Melanoma Service, Alfred Health, Melbourne, VIC
  • 2 Monash University, Melbourne, VIC
  • 3 Peter MacCallum Cancer Centre, Melbourne, VIC
  • 4 Melanoma Institute Australia, Sydney, NSW
  • 5 University of Sydney, Sydney, NSW



We thank Laura Wuellner, Jutta von Dincklage and Jackie Buck from the Cancer Council Australia Clinical Guidelines Network for their assistance in this work. Development of the new Clinical Practice Guidelines for the Diagnosis and Management of Melanoma was funded by Cancer Council Australia and Melanoma Institute Australia, with additional support from the Skin Cancer College Australasia.

Competing interests:

No relevant disclosures.


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