Clinical Diagnosis Of Melanoma Research Articles

Growth rate of indeterminate choroidal lesions prior to melanoma diagnosis.

Small choroidal melanocytic lesions have a low rate of metastasis and can be reasonably managed with surveillance until they demonstrate evidence of growth or clinical risk factors for melanoma. However, even choroidal nevi are not stationary, with many exhibiting slow growth over time. We sought to quantify the growth rates of indeterminate choroidal lesions that were initially observed prior to a clinical diagnosis of melanoma. A single-center retrospective study was performed of patients diagnosed with choroidal melanoma based upon clinical characteristics who were initially followed for indeterminate lesions over at least 6 months. Subjects were included if they had a minimum of two B-scan ultrasound measurements prior to the visit at which melanoma was diagnosed. Demographic and tumor characteristics were collected from the medical record. Growth rates were calculated as the change in lesion thickness in mm per month and were recorded at 6-month intervals; ultrasound measurements less than 1 month apart were excluded. The characteristics of indeterminate lesions with faster versus slower growth rates prior to melanoma diagnosis were compared. Fifty-four patients met inclusion criteria. The mean age at melanoma diagnosis was 67.4 years, and 53.7% were female. Subjects had a median of four B-scan ultrasound measurements prior to melanoma diagnosis (range 2-19) and were followed for a median of 40.6 months (range 9.9-138.0 months). The mean lesion thickness was 1.4 mm (range 0.5-2.2 mm) at presentation, and increased to 2.3 mm (range 1.5-5.7 mm) at melanoma diagnosis. The mean growth rate did not exceed 0.021 mm/month (95% CI: 0.004-0.039; equivalent to 0.25 mm/year) for indeterminate lesions, but increased to 0.057 mm/month (95% CI: 0.043-0.071 mm/month; equivalent to 0.68 mm/year) at the time of melanoma diagnosis. Rapidly growing lesions had a greater tumor thickness and shorter duration of observation at the time of melanoma diagnosis. For most indeterminate choroidal lesions eventually diagnosed as melanoma, the lesion thickness was relatively stable for a period of time, then rose significantly between the penultimate visit and the final visit. These findings confirm the recommendation for continued monitoring of suspicious choroidal lesions, as the growth rate may accelerate just prior to melanoma diagnosis. Lesions with a mean growth rate of up to 0.25 mm/year were observed, whereas lesions clinically determined to have transformed into melanoma demonstrated a mean growth rate of 0.68 mm/year. These values provide a baseline for future studies and potential therapies directed at stabilizing or reducing the growth of indeterminate choroidal lesions or small choroidal melanomas. Limitations of this study include its retrospective nature and reliance on clinical diagnostic criteria.

Management of melanoma of the foot in our subregion: Is preliminary biopsy always required?

Background: Majority of patients with melanoma of the foot in our subregion present late. After preliminary excision biopsy for these patients, many of them do not come back for further excision when there is an indication to do so following biopsy result. A better result could be achieved by using wider margins for excision biopsy in patients with low socio-economic status. Objectives: We assessed the role of excision of melanoma of the foot without preliminary biopsy as an option in the management of melanoma of the foot in our subregion. Materials and Methods: This was a 5-year retrospective review of patients with melanoma of the foot that presented to a tertiary health institution in Nigeria from December 1, 2014 to November 30, 2019. Results: Half of the patients with lesions that have not advanced locally (35.3%) had wide local excision with 2–3 cm margin without preliminary biopsy, relying on clinical diagnosis of melanoma. Another 35.3% of same number as those mentioned above were managed by doing a preliminary biopsy. Incision biopsy was employed for those with distant metastasis or lesions where amputation of any form was indicated (29.4%). Conclusion: Melanoma of the foot can be diagnosed clinically with a high degree of accuracy in majority of patients. Preliminary biopsy is essential for lesions requiring amputation or very large lesions. For small lesions, excision biopsy with wider margins than is used for preliminary biopsy is beneficial especially for poor patients who tend to delay having a second surgery that is definitive due to financial constraint, ignorance, or other reasons.

A classification method for multi-class skin damage images combining quantum computing and Inception-ResNet-V1

Melanoma is a high-grade malignant tumor. Melanoma and mole lesions are highly similar and have a very high mortality rate. Early diagnosis and treatment have an important impact on the patient’s condition. The results of dermoscopy are usually judged visually by doctors through long-term clinical experience, and the diagnostic results may be different under different visual conditions. Computer-aided examinations can help doctors improve efficiency and diagnostic accuracy. The purpose of this paper is to use an improved quantum Inception-ResNet-V1 model to classify multiple types of skin lesion images and improve the accuracy of melanoma identification. In this study, the FC layer of Inception-ResNet-V1 is removed, the average pooling layer is the last, SVM is used as the classifier, and the convolutional layer is quantized. The performance of the model was tested experimentally on the ISIC 2019 dataset. To prevent the imbalance of the sample data set from affecting the experiment, the sample data is sampled with weight. Experiments show that the method used shows excellent performance, and the classification accuracy rate reaches 98%, which provides effective help for the clinical diagnosis of melanoma.

Surface-Enhanced Raman Scattering Biosensor Based on Self-Assembled Gold Nanorod Arrays for Rapid and Sensitive Detection of Tyrosinase

Tyrosinase (TYR) is a key rate-limiting enzyme of melanin and a biomarker for melanoma diagnosis. Therefore, detection of TYR in biological samples is essential for the clinical diagnosis of melanoma. A novel portable surface-enhanced Raman scattering (SERS) sensor is proposed to detect TYR activity. It is based on dopamine (DA)-functionalized Au nanorod (Au NR) arrays as the capture substrate and 4-mercaptophenylboronic acid (4-MPBA)-modified silver nanoparticles (Ag NPs) as the SERS probe. In this case, the Au NR arrays are modified with 3,3′-dithiodipropionic acid di(N-succinimide ester) (DSP) to capture DA. In the presence of TYR, DA is oxidized to dopaquinone (DQ), which resulted in a decrease in the concentration of SERS probes further adsorbed onto the arrays. The activity of TYR is detected by changes in the intensity of the phenylboronic acid signal. Furthermore, this detection system has a wide linear detection range and high sensitivity that can effortlessly evaluate a linear range of 0.0001–100 U/mL of TYR activity. More significantly, the presented SERS sensor can perform well on both the determination of TYR activity in serum and the assessment of TYR inhibitors, which offers new opportunities for diagnosis of melanoma and other TYR-related diseases under complex biological conditions.

Diffusion-Weighted Imaging Combined with Perfusion-Weighted Imaging under Segmentation Algorithm in the Diagnosis of Melanoma.

This study is aimed at exploring the value of magnetic resonance diffusion-weighted imaging (DWI) combined with perfusion-weighted imaging (PWI) for diagnosing melanoma under a three-dimensional (3D) hybrid segmentation algorithm. 40 patients with melanoma were collected as research objects and subjected to magnetic resonance imaging (MRI) examination. A segmentation model was constructed and the original images were input. The noise contained in the images was preprocessed and normalized, and the mixed level set segmentation was performed after linear fusion of the images. Imaging findings were analyzed to find that the combined diagnosis of DWI and PWI with a 3D hybrid segmentation algorithm had the advantage of being clear and accurate. 10 primary cases were detected, which occurred in the cerebral meninges; 30 cases of metastases occurred inside the skull, mostly adjacent to the surface of the brain. The typical T1-weighted imaging (T1WI) and T2-weighted imaging (T2WI) of melanoma showed high signal and low signal, respectively, and the enhanced scan showed obvious enhancement. Atypical melanoma was manifested variously in MRI; a few had cystic necrosis, and an enhanced scan of the solid area revealed significant enhancement. Patients with multiple metastatic melanomas mainly showed low signal on DWI, and patients with primary or single metastatic melanoma mainly showed high signal or mixed high signal. Patients with perfusion imaging showed high perfusion on PWI. The 3D hybrid segmentation algorithm helped to improve the accuracy of DWI combined with PWI in the diagnosis of melanoma. This work provided a certain reference for the clinical diagnosis of melanoma.

Evolution of the Clinical, Dermoscopic and Pathologic Diagnosis of Melanoma.

The conventional narrative states that the steadily rising incidence of melanoma among fair-skinned Caucasian populations during the last decades is caused by excessive UV-exposure. There is, however, no doubt that other factors had a significant impact on the rising incidence of melanoma. Pre-1980s the clinical diagnosis of melanoma was based on gross criteria such as ulceration or bleeding. Melanomas were often diagnosed in advanced stages when the prognosis was grim. In the mid-1980s education campaigns such as the propagation of the ABCD criteria, which addressed health care professionals and the public alike, shifted the focus towards early recognition. Dermatoscopy, which became increasingly popular in the mid-1990s, improved the accuracy for the diagnosis of melanoma in comparison to inspection with the unaided eye, especially for flat and small lesions lacking ABCD criteria. At the same time, pathologists began to lower their thresholds, particularly for the diagnosis of melanoma in situ. The melanoma epidemic that followed was mainly driven by an increase in the number of in situ or microinvasive melanomas. In a few decades, the landscape shifted from an undercalling to an overcalling of melanomas, a development that is now met with increased criticism. The gold standard of melanoma diagnosis is still conventional pathology, which is faced with low to moderate interobserver agreement. New insights in the molecular landscape of melanoma did not translate into techniques for the reliable diagnosis of gray zone lesions including small lesions. The aim of this review is to put our current view of melanoma diagnosis in historical context and to provide a narrative synthesis of its evolution. Based on this narrative I will provide suggestions on how to rebuild the trust in melanoma diagnosis accuracy and in the benefit of early recognition.

Asymmetry analysis of melanoma based on ABCD rule

Malignant melanoma is a malignant tumor that is extremely harmful and prone to lymphatic metastasis. If it cannot be diagnosed and effectively treated at an early stage, it will cause irreversible consequences. There is a lot of evidence that if you can get the exact treatment in the early stage, it can effectively improve the recovery rate. At this stage, clinical diagnosis of melanoma is mainly performed manually, which has defects such as low overall efficiency. This article is based on ABCD rule, combined with the clinical features of melanoma in dermoscopic images, to determine the benign and malignant melanocytes. Firstly, the image processing technology and pattern recognition technology are used to acquire and preprocess the dermoscopic image, and the image feature points are extracted. Then, the microscopic asymmetry and macroscopic asymmetry of the image were analyzed. Finally, the symmetry score was calculated by TDS to judge the benign and malignant of melanocytes. It is expected to assist dermatologists in diagnosing melanoma, provide timely feedback information to patients and provide targeted treatment for patients, improve the efficiency and accuracy of medical clinical diagnosis, achieve the purpose of curing, and reduce the harm of melanoma to human health.

Malignant Melanoma of Gingiva

A 57-year-old Senegalese woman consulted to us for a pigmented mass inside the oral cavity evolving since 10 months. She had history of repetitive traditional tattoousing thorns on the gingiva. Intraoral examination showed a large pigmented tumour extending from the right maxillary gingiva to the left maxillary gingiva. It was 7 × 4 cm in size, firm in consistency with slight bleeding on touch. The patient also presented sub-mandibular lymphadenopathies and significant weight loss. An incisional biopsy with histopathological examination confirmed the clinical diagnosis of malignant melanoma. Biological examinations revealed anaemia at 6.9 g/dl and hypoalbuminemia at 23 g/l. HIV serology was negative. The patient dies after 2 weeks prior to any therapeutic perspective.

PET Imaging of Melanoma Using Melanin-Targeted Probe.

Melanin exists in the most of melanoma lesions. Melanin plays an important role in melanoma progression, metastasis, therapy response, and the overall survival of patients. Therefore, melanin is a critical target for melanoma diagnosis and therapy. Many melanin targeting probes, such as radioisotope-labeled benzamide analogs, have been developed for melanoma diagnosis using positron emission tomography (PET). The N-(2-(diethylamino)-ethyl)-18F-5-fluoropicolinamide (18F-P3BZA) probe is one of the benzamide analogs and has been preliminarily tested for clinical diagnosis of melanoma in our recent studies. It has shown high specificity and favorable in vivo performance for PET of melanoma. Herein, we describe the detailed synthesis protocol of 18F-P3BZA and PET/CT imaging procedure for animal models and patients.

Optical Radiomic Signatures Derived from Optical Coherence Tomography Images Improve Identification of Melanoma.

The current gold standard for clinical diagnosis of melanoma is excisional biopsy and histopathologic analysis. Approximately 15-30 benign lesions are biopsied to diagnose each melanoma. In addition, biopsies are invasive and result in pain, anxiety, scarring, and disfigurement of patients, which can add additional burden to the health care system. Among several imaging techniques developed to enhance melanoma diagnosis, optical coherence tomography (OCT), with its high-resolution and intermediate penetration depth, can potentially provide required diagnostic information noninvasively. Here, we present an image analysis algorithm, "optical properties extraction (OPE)," which improves the specificity and sensitivity of OCT by identifying unique optical radiomic signatures pertinent to melanoma detection. We evaluated the performance of the algorithm using several tissue-mimicking phantoms and then tested the OPE algorithm on 69 human subjects. Our data show that benign nevi and melanoma can be differentiated with 97% sensitivity and 98% specificity. These findings suggest that the adoption of OPE algorithm in the clinic can lead to improvements in melanoma diagnosis and patient experience. SIGNIFICANCE: This study describes a noninvasive, safe, simple-to-implement, and accurate method for the detection and differentiation of malignant melanoma versus benign nevi.

A unifying approach to the clinical diagnosis of melanoma including "D" for "Dark" in the ABCDE criteria.

Current clinical approaches to melanoma diagnosis have not been associated with a decrease in mortality from this cancer. The components of the new approach presented are, first, a screening examination to look for any lesion that stands out because of being dark, different, or changing; second, when a single lesion is recognized to be of concern for any reason, that lesion is then evaluated in more detail utilizing the ABCDE criteria, with the “D” signifying “Dark” and not “6 mm Diameter” in this mnemonic; and, third, additional discussion of the “ugly duckling” sign and of the recognition of nodular melanomas. Since the Georgia Society of Dermatology and Dermatologic Surgery was the first state or national society to endorse this approach, I refer to it as the Georgia approach.

Histopathologic correlation of high-risk MelaFindTM lesions: a 3-year experience from a high-risk pigmented lesion clinic.

A significant number of pigmented lesions are biopsied to rule out melanoma, but most will be benign. MelaFindTM is a highly sensitive, noninvasive computer-assisted system to aid in clinical diagnosis of melanoma. A total of 140 high-risk patients were followed by one expert dermatologist. Biopsies were blindly and independently evaluated by two dermatopathologists and given histologic severity scores (HSS, 0-12) based on the histologic features of melanoma/dysplastic nevi and compared to pathologic diagnoses and MelaFindTM scores. MelaFindTM reduced the biopsy number of clinically ambiguous lesions (923 scanned to 253 biopsied, 73% reduction). Biopsied cases were usually benign (135/253, 53.4%, HSS = 2.8-3.2). Dysplastic nevi with varying degrees of atypia were observed next most commonly (80/253, 31.6%, HSS = 4.7-5.2 for mild dysplasia and 7-7.6 for moderate to severe dysplasia). Melanomas comprised 11/253 (4.3%) of biopsies (HSS = 9.3-10.7). Twenty-four cases were given miscellaneous diagnoses not within the dysplastic nevus-melanoma spectrum (9.5%, HSS = 1.3). Dermal fibrosis was the most commonly identified worrisome histologic feature (177/253, 70%), closely followed by other known atypical features. Nonthreatening histologic features in benign lesions with high MelaFindTM disorganization scores were common. The HSS differed significantly depending on pathologic diagnosis severity, while the MelaFindTM score did not (benign = 2.2; mildly atypical = 4.8; moderately to severely atypical = 2.3; in-situ or invasive melanoma = 3.1). MelaFindTM unequivocally reduced the number of biopsies, but banal lesions had histologic attributes resulting in high-risk MelaFindTM scores, and MelaFindTM does not correlate with degree of cytologic atypia. Knowledge of these limitations should increase bidirectional confidence when making clinicopathologic correlations in high-risk patients.

Improving clinical diagnosis of early-stage cutaneous melanoma based on Raman spectroscopy

BackgroundClinical diagnosis of early melanoma (Breslow thickness less than 0.8 mm) is crucial to disease-free survival. However, it is subjective and can be exceedingly difficult, leading to missed melanomas, or unnecessary excision of benign pigmented skin lesions. An objective technique is needed to improve the diagnosis of early melanoma.MethodsWe have developed a method to improve diagnosis of (thin) melanoma, based on Raman spectroscopy. In an ex vivo study in a tertiary referral (pigmented lesions) centre, high-wavenumber Raman spectra were collected from 174 freshly excised melanocytic lesions suspicious for melanoma. Measurements were performed on multiple locations within the lesions. A diagnostic model was developed and validated on an independent data set of 96 lesions.ResultsApproximately 60% of the melanomas included in this study were melanomas in situ. The invasive melanomas had an average Breslow thickness of 0.89 mm. The diagnostic model correctly classified all melanomas (including in situ) with a specificity of 43.8%, and showed a potential improvement of the number needed to treat from 6.0 to 2.7, at a sensitivity of 100%.ConclusionThis work signifies an important step towards accurate and objective clinical diagnosis of melanoma and in particular melanoma with Breslow thickness <0.8 mm.

BRAF G596R mutation in a slow-progressing melanoma

More than 50% of melanomas harbor a single V600E point mutation in the kinase domain of the BRAF gene, resulting in constitutive activation of the MAP kinase pathway. The kinase loop in BRAF begins with Asp-Phe-Gly (DFG; codons 594-596). Mutations in this region are rare, and the effect on tumorigenesis or progression is unknown. We present a slow- progressing metastatic melanoma with a p.G596R (c.1786G.C) mutation in an 84-year-old female. This mutation has only been reported in two cases of melanoma in the current literature, with no clinical information available. Mutations in the DFG motif are considered low-activating through indirect binding and allosteric activation of the CRAF protein. Our patient has carried a clinical diagnosis of melanoma for over 25 years, suggesting that the G596R mutation may be associated with her indolent clinical course. It is unknown whether patients carrying this mutation will benefit from vemurafenib therapy. Our patient declined medical treatment.

Handheld photoacoustic probe to detect both melanoma depth and volume at high speed in vivo.

We applied a linear-array-based photoacoustic probe to detect melanin-containing melanoma tumor depth and volume in nude mice in vivo. This system can image melanomas at five frames per second (fps), which is much faster than our previous handheld single transducer system (0.1 fps). We first theoretically show that, in addition to the higher frame rate, almost the entire boundary of the melanoma can be detected by the linear-array-based probe, while only the horizontal boundary could be detected by the previous system. Then we demonstrate the ability of this linear-array-based system in measuring both the depth and volume of melanoma through phantom, ex vivo, and in vivo experiments. The volume detection ability also enables us to accurately calculate the rate of growth of the tumor, which is an important parameter in quantifying the tumor activity. Our results show that this system can be used for clinical melanoma diagnosis and treatment in humans at the bedside. Linear-array-based PA images of melanoma acquired in vivo on day 3 (a) and day 6 (b).

The role of dermoscopy and digital dermoscopy follow-up in the clinical diagnosis of melanoma: clinical and dermoscopic features of 99 consecutive primary melanomas.

Background:Early recognition is the most important intervention to improve melanoma prognosis.Objective:To report the value of dermoscopy and digital dermoscopy in the clinical diagnosis of malignant melanoma (MM).Methods:Retrospective analysis of 99 consecutive primary MMs diagnosed between 2010 and 2013. The MMs were divided into 3 groups: 1) the MM was the reason for consultation (MMC), 2) the MM was detected during routine control of nevi (MMRC), and 3) the MM was detected due to changes observed during digital dermoscopy follow-up (MMDFU). Clinical, dermoscopic and histologic features were assessed.Results:A total of 99 MMs were diagnosed in 89 patients (55% male) with a mean age of 50.8 (18-93) years. Of all the MMs, 35 were the reason for patient consultation (MMC), 52 were detected during routine control of nevi (MMRC) and 12 were diagnosed due to changes observed with digital dermoscopy (MMDFU). On clinical examination, 74.2 % of MMC met the 4 ABCD criteria, while only 30.7 % of MMRC and 8.3 % of MMDFU. Most MMC were correctly classified as malignant according to dermoscopy, but 44.2% of MMRC and only 16.7% of MMDFU. 22.9% of MMC, 50% of MMRC and 58.3% of MMDFU were in situ. Mean Breslow thickness was significantly lower in the MMDFU group (0.52 mm) than in the MMRC and MMDFU groups (0.77 and 1.43 mm respectively).Conclusions:The use of dermoscopy and digital dermoscopy allows the detection of MMs in early stages, even in the absence of specific criteria for malignancy.

Automatic diagnosis of melanoma using machine learning methods on a spectroscopic system.

BackgroundEarly and accurate diagnosis of melanoma, the deadliest type of skin cancer, has the potential to reduce morbidity and mortality rate. However, early diagnosis of melanoma is not trivial even for experienced dermatologists, as it needs sampling and laboratory tests which can be extremely complex and subjective. The accuracy of clinical diagnosis of melanoma is also an issue especially in distinguishing between melanoma and mole. To solve these problems, this paper presents an approach that makes non-subjective judgements based on quantitative measures for automatic diagnosis of melanoma.MethodsOur approach involves image acquisition, image processing, feature extraction, and classification. 187 images (19 malignant melanoma and 168 benign lesions) were collected in a clinic by a spectroscopic device that combines single-scattered, polarized light spectroscopy with multiple-scattered, un-polarized light spectroscopy. After noise reduction and image normalization, features were extracted based on statistical measurements (i.e. mean, standard deviation, mean absolute deviation, L 1 norm, and L 2 norm) of image pixel intensities to characterize the pattern of melanoma. Finally, these features were fed into certain classifiers to train learning models for classification.ResultsWe adopted three classifiers – artificial neural network, naïve bayes, and k-nearest neighbour to evaluate our approach separately. The naive bayes classifier achieved the best performance - 89% accuracy, 89% sensitivity and 89% specificity, which was integrated with our approach in a desktop application running on the spectroscopic system for diagnosis of melanoma.ConclusionsOur work has two strengths. (1) We have used single scattered polarized light spectroscopy and multiple scattered unpolarized light spectroscopy to decipher the multilayered characteristics of human skin. (2) Our approach does not need image segmentation, as we directly probe tiny spots in the lesion skin and the image scans do not involve background skin. The desktop application for automatic diagnosis of melanoma can help dermatologists get a non-subjective second opinion for their diagnosis decision.

Handheld photoacoustic microscopy to detect melanoma depth in vivo.

We developed handheld photoacoustic microscopy (PAM) to detect melanoma and determine tumor depth in nude mice in vivo. Compared to our previous PAM system for melanoma imaging, a new light delivery mechanism is introduced to improve light penetration. We show that melanomas with 4.1 and 3.7 mm thicknesses can be successfully detected in phantom and in in vivo experiments, respectively. With its deep melanoma imaging ability and handheld design, this system can be tested for clinical melanoma diagnosis, prognosis, and surgical planning for patients at the bedside.

Angles and geometric shapes, but not lines, in melanocytic lesions may be helpful in the clinical diagnosis of melanoma.

Geometric shapes have been suggested to be found in malignant melanomas. We have observed a number of melanomas presenting with linear and incomplete angulated figures. To verify the assumption that geometric shapes, a linear border and/or incomplete angulated figures may indicate a potential melanoma. Patients with surgically removed melanocytic lesions were admitted to the study. We evaluated the presence of a sharp linear demarcation, the presence of contiguous lines resulting in the formation of angle/s and the presence of complete geometric figure. We distinguished the obtained results into melanoma and benign melanocytic naevi. A total of 471 melanomas and 1979 melanocytic naevi were collected. Linear borders, angles and geometric figures were observed in 42 melanomas and in 75 benign melanocytic naevi. Angles with incomplete geometric configuration were observed in 21 melanomas and in 37 benign naevi (21/471 vs. 37/1979, 4.24% vs. 1.87%; P<0.0016); complete even if irregular geometrical figures in 12 melanomas and 17 naevi (12/471 vs. 17/1979, 2.54% vs. 0.85%; P<0.005). The presence of line(s) did not significantly differed in the two considered groups. Melanocytic lesions with angulated shapes and complete geometrical configurations might indicate a suspect melanoma. Only sharp linear demarcation of the lesion do not seem to be significantly associated with melanoma suspicion.

MELANOMA CUTÂNEO PRIMÁRIO: COMPLICAÇÃO DE TRATAMENTO COM INFLIXIMAB?

Doente do sexo masculino, com 58 anos de idade, observado na Consulta de Dermatologia por lesão heterogeneamente pigmentada, circular, com 15mm de maior diâmetro, localizada à parede abdominal. O doente afirmava ter nessa localização um “sinal com mais de 30 anos”, que no entanto tinha “começado a crescer” desde há 3 anos. A lesão foi submetida a excisão cirúrgica sob anestesia local, cujo estudo histológico confirmou o diagnóstico clínico de Melanoma Maligno com 0,65 mm de espessura. Na sua história clínica destacava-se o seguimento na consulta de Gastroenterologia dos CHUC por colite ulcerosa, tendo iniciado, por falência da terapêutica prévia (5-ASA, corticosteroides, azatioprina) tratamento com Infliximab 5mg/Kg endovenoso há 3 anos. Perante o diagnóstico de Melanoma Maligno foi efetuado alargamento das margens de excisão e estabelecido contacto com o Gastroenterologista assistente, tendo sido suspensa a terapêutica com Infliximab.Conclusão: O nosso caso realça a necessidade de uma observação dermatológica completa antes do início da terapêutica anti-TNF-α bem como da realização de consultas de follow-up regulares.