Talk:Melanoma/Archive 1

Archive 1

Research

Would like to discuss the possibility of adding a "Research" section to melanoma or to having a separate topic "Melanoma Research". Any thoughts? --Khaj 06:27, 25 July 2006 (UTC)

---

Sunlight is a controversial cause of melanoma is a color. Philiphughesmd 04:11, 9 December 2005 (UTC) Dr. Bernie Ackerman has written an entire book about the valueless sentinel lymph node biopsy. Philiphughesmd 04:14, 9 December 2005 (UTC)

I think it may be prudent to indicate that imiquamod and Moh's are not exactly first line or established treatments for melanoma. I've aimed to do so politely. Wide local excision remains the standard of care so the value of Moh's here is unclear. It is rarely appropirate to accept inadequate surgical resection of a cancer to minimise a scar. Will Blake 06:50, 29 May 2006 (UTC)

I have removed references to minimal deviation melanoma which is not a widely recognised subtype. Many feel it arises only when a pathologist is unwilling to commit to a benign or a malignant diagnosis. Hope no-one objects Will Blake 23:53, 29 May 2006 (UTC)

The following discussion is an archived debate of the proposal. Please do not modify it. Subsequent comments should be made in a new section on the talk page. No further edits should be made to this section.

The result of the debate was move. —Nightstallion (?) 13:58, 3 June 2006 (UTC)

Move: melanoma

I have asked to have this article moved to 'Melanoma' which is a more accurate, contemporary, precise and brief term. This is done on a consensus basis. Please record your feelings below. Any objectors? Will Blake 06:12, 29 May 2006 (UTC)

Although "melanosarcoma" may more accurately describe a malignant tumor of melanocytes, "melanoma" probably reflects common usage better. My understanding is that there are indeed benign tumors of melanocytes, but they are are far outnumbered by the malignant kind that common usage of "melanoma" has come to refer to the latter. -AED 06:13, 30 May 2006 (UTC)

This may indeed be confounding, but the medical jargon uses melanoma definitely for a malignant tumour (i.e. MesH definition. There are indeed various benign proliferations of melanocytes that and are given various names (ie "benign melanocytic lesions", various types of melanocytic naevi, mongolian spot, naevus of ota)--Dr. Friendly 21:55, 30 May 2006 (UTC)

The good doctor is correct, there are many benign tumours of melanocytes but none of them are ever refered to as melanoma. All the common naevi (junctional, compound, blue, spitz) are benign proliferations of melanocytes but the question is are they neoplasms or hamartomas? Thanks for your interest Will TALK 22:43, 30 May 2006 (UTC)

My vote should indicate that I certainly do not disagree that "melanoma" now almost always refers to malignant tumors and that other terms are now almost always refer to benign tumors. Given that we failed to be etymologically consistent with our use of Greek and Latin long ago, I don't quite agree that is more accurate to describe the malignant version as "melanoma". (Although it may appear as such to us now, the term "malignant melanoma" didn't come into being just for the sake of being redundant!) It is definitely the more contemporary use of the term, though. -AED 23:37, 30 May 2006 (UTC)

Your point is well made and correct Will TALK 23:55, 30 May 2006 (UTC)

Statements for or against

For

1. --Dr. Friendly 13:03, 29 May 2006 (UTC)
2. -AED 06:14, 30 May 2006 (UTC)
3. Rewster 06:24, 30 May 2006 (UTC)
4. JFW | T@lk 07:16, 30 May 2006 (UTC)

The above discussion is preserved as an archive of the debate. Please do not modify it. Subsequent comments should be made in a new section on this talk page. No further edits should be made to this section.

punch biopsy apperatus

I'm wondering, I've never seen the tool used for a punch biopsy. I'm thinking though, it sounds more like hole-puncher, than a small cookie-cutter. Do you think maybe that might be a better description of it?

Excision biopsies are done for melanomas. Snowman 07:44, 1 August 2006 (UTC)

Not necessarily, I work with Melanoma patients and their information on a daily basis and I've seen excisional bx's but just as if not more common are shave and punch biopsies followed by a Staged Mohs or Wide Local Excision once the diagnosis of Melanoma vs. other Nevus is confirmed. SLC1 01:49, 8 September 2006 (UTC)

They're definitely more similar to mini cookie-cutters than hole-punchers. Imagine a sharp-ended tube on a stick basically, with no corners. However, the indicated sizes (1mm-6mm) is incorrect, they're also available at least up to 8mm and I don't remember seeing a 1mm one. Can anyone verify and fix that? —Preceding unsigned comment added by 203.217.12.11 (talk) 03:23, 2 September 2008 (UTC)

They are round knives. Yes, they are available in 1 mm size - which is almost impossible to visualize and pickup. The smallest useful size for me is 1.5 mm. They are nice to use on cosmetically important area where a shave biopsy can not do (need dermis), but a larger full thickness (going down to the fat) biopsy is needed. I almost never use a 1 mm, as they are hard to handle. A punch biopsy or any full thickness biopsy will do in the diagnosis of a melanoma - assuming that the patient understand that a second larger "biopsy" might be required later for correct staging of the specimen. Very useful tool in the diagnosis of a large lentigo maligna or a large superficial spreading melanoma where excision on the day of the visit is impractical. You can do 6 or 7 random punches of a large lesion of the face to make sure you get the diagnosis the first time. It is not unusual to see a clashing of 2 or 3 distinct lesions on the face, and the random punches will make sure you are getting the right lesion.--Northerncedar (talk) 11:10, 22 May 2010 (UTC)

How does it happen?

Please tell us how melanoma happens in English, not in jargon.  How does normal suntanning (which can help prevent melanoma) suddenly cause the cancer?  The section Causes is too technical for lay people.  We are not doctors.  122.200.166.173 (talk) 11:50, 7 October 2010 (UTC)

We don't need to dumb it down to the point a 5 year old can read it. If that's your literacy level, perhaps you want to be reading simple.wikipedia.org instead. Having an "overview" for the causes section followed by rigorous medical treatment is probably more than appropriate. User:130.102.158.15 (talk) 06:57, 25 October 2010 (UTC)

The "In lay terms" section appears to be conjecture. Are there any references for the statements made in this section? Danensis (talk) 12:53, 13 October 2010 (UTC)

Agreed, "In lay terms" is just made up drivel, as far as I can tell. User:130.102.158.15 (talk) 06:57, 25 October 2010 (UTC)

Most of it seems accurate even if it is in 'lay terms', and if your concern is with the 'dubious' risk of artificial UV, here is a supporting article

Bennett, D. C. (2008), Ultraviolet wavebands and melanoma initiation. Pigment Cell & Melanoma Research, 21: 520–524[1] User:120.151.55.92 (talk) 12:54, 27 October 2010 (UTC)

Seriously? Inverse square law? What a load of rubbish. Someone please remove that and clean the whole section up. —Preceding unsigned comment added by 130.102.158.12 (talk) 23:30, 23 March 2011 (UTC)

The last entry in this thread is five years old. FYI, https://simple.wikipedia.org/wiki/Talk:Melanoma has but one paragraph and was 'simply' easy to understand. Thanks for the tip. Also, those wanting different source/information can now do a Google-search. It may yield some university basic info. -- AstroU (talk) 09:03, 9 February 2016 (UTC)

I think that it might be worth including:

• information on this break threw, Cloned immune cells treat skin cancer
• the origins of a melanocyte and the normal melanocyte
• some benign pigmented lesions

It helps to see the difference between benign and malignant pigmented lesions, but it is not always easy. Snowman 21:19, 2 August 2006 (UTC)

• the difficultly in diagnosis in children (Spitz naevus)

the histopathology is difficult. Snowman 21:19, 2 August 2006 (UTC)

• atypical presentation

Non-pigmented forms. The ulcer that does not heal. Subungual (under a finger or toe nail). Snowman 21:19, 2 August 2006 (UTC)

• premalignant or dysplatic forms
• large pigmented birth marks

all of the above would be more appropriate on the already existing melanocyte and nevus pages.--Khaj 10:25, 1 August 2006 (UTC)

The point is, I think certain large birth marks are more likely to undergo a mitotic change. Snowman 10:58, 1 August 2006 (UTC)

• photographs from light microscopy

of what? nevi or melanoma? Be specific.--Khaj 10:25, 1 August 2006 (UTC)

Lets say; various stages from dysplastic to metastatic melanoma.

• histological tissue preparation

there already is a histology page, there is nothing in histological preparation which is purely specific to melanoma.--Khaj 10:25, 1 August 2006 (UTC)

Special stains. Snowman 10:58, 1 August 2006 (UTC)

There are some melanoma histology pictures on wikicommons which could be used. --WS 18:48, 1 August 2006 (UTC)

• biopsy with adequate excision Snowman 13:38, 31 July 2006 (UTC)

again, be specific, biopsy of what? nevi or melanomas?--Khaj 10:25, 1 August 2006 (UTC)

The article page can be more specific than the discussion page. Snowman 10:58, 1 August 2006 (UTC)

In the UK the biobsy of a suspicious lesion should be done by a hospital specialist (dermatologist or possibly a surgeon). I think that a punch biosy should never by done (or in only rarely done on a large lesion) for a suspicious pigmented lesions, as the punch biosy itself my spread the mitotic cells following which a much larger area of excision is needed. Snowman 08:59, 3 August 2006 (UTC)

They should not be done, not because of spreading cells, but because accurate determination of depth of melanoma invasion is critical for treatment decisions and prognosis and this can not be reliably determined with a punch biopsy (PMID 15748548). The only exception is when the melanoma completely fits in the punch. --WS 15:16, 3 August 2006 (UTC)

Does anyone know PDF - images

Does anyone know how to extract images from a PDF file ? There's a wealth of melanoma photos that are said to be in PD but inside this PDF. Kpjas 08:22, 4 August 2006 (UTC)

These images may have a copyright and so can not be used on the wiki. Snowman 08:36, 4 August 2006 (UTC)

To be featured (to-do)

I think as a current MCOTW, we should improve it to become FA. In my opinion, what is needed:

• more images (I start to find some)
• longer history
• more references
• more external links

NCurse _work 11:41, 7 August 2006 (UTC)

Also need link or source for British study which suggests that melanoma is more common in indoor than outdoor workers. Figma 23:52, 7 August 2006 (UTC)

I started to add new references (finished at Prevention for today) and I added organizations links + Commons link. Question: should I create a gallery for the 4 histology images in commons? Maybe a histology section should be needed. NCurse _work 15:55, 8 August 2006 (UTC)

And I sent a letter to the American Academy of Dermatology to give us images. :) NCurse _work 16:08, 8 August 2006 (UTC)

Nice pictures, but are the captions correct? Snowman 12:30, 14 August 2006 (UTC)

Most of the captions are from their DermAtlas homepage. The original source. NCurse _work 12:37, 14 August 2006 (UTC)

Medical advice

This article page seems to provide medical advice more than once. Does the wiki give medical advice? Snowman 17:52, 8 August 2006 (UTC)

Seriously no! Where did you find these? Do you mean the Prevention section's Primary part? It has references. So that I wouldn't say this is a medical advice. But tell me your opinion please. NCurse _work 18:25, 8 August 2006 (UTC)

I inclination is to avoid advice at all costs, but I am not sure what the wiki policy is?

Any mole that is irregular in color or shape should be examined by a doctor to determine if it is a malignant melanoma. This is at the beginning of the diagnosis section. It does not appear to be contraversial, but it is medical advice. Perhaps is could be rephrased to something like Moles that are irregular in color or shape are suspicious of a malignant melanoma or a premalignant melanoma. This has changed the sentence from advice to a tutorial.

The prevention section says To prevent or detect melanomas (and increase survival rates), it is recommended that the public[17]. May be better to say recommended by "name-here" in "date-here" that the public..... I feel that the exact origin of the people with relatives sentence should be clear. Perhaps the whole section should be rephrased so that is is a tutorial rather than advice. Snowman 18:30, 9 August 2006 (UTC)

You're right. I made the change that you recommended ("Moles that are irregular..."). Otherwise, yes, all of that section should be rewritten. I'll try it. Maybe we should leave Melanoma MCOTW for an other week. NCurse _work 18:50, 9 August 2006 (UTC)

Melanoma has been choosen for MCOTW, and I expect that it will become an excellent article. I think that a tutorial style would be best for a featured article. I wonder if advice is different in Australia, England, USA, Scotland or Germany. I wonder it there are websites that can be linked for the primary and secondary prevention advice. There might be one for UK. Snowman 08:22, 10 August 2006 (UTC)

Should we move it to Peer? NCurse _work 17:57, 10 August 2006 (UTC)

Peer - What is that? Snowman 17:59, 10 August 2006 (UTC)

Sorry. Peer review of course. :) NCurse _work 18:13, 10 August 2006 (UTC)

What does that involve and why will that help? Snowman 18:18, 10 August 2006 (UTC)

See Wikipedia:Peer review --WS 22:06, 10 August 2006 (UTC)

When I change MCOTW, maybe this article could get a peer review. Why will that help? When I wanted Aortic dissection to be featured, peer review showed a lot of faults in the article. It could help because much more people use Peer review than MCOTW. But we can wait with that. NCurse _work 18:21, 10 August 2006 (UTC)

Of course it is also perfectly possible to have both at the same time. --WS 22:06, 10 August 2006 (UTC)

Thank you for pointing out the Wiki Peer review page. Melanoma is especially complex area in dermatology and histopathology. Snowman 08:58, 11 August 2006 (UTC)

Recent edits

NCurse please reign in your editing. Many of your changes are unnecessary and subtract from clarity. For example, you added a reference which was already existing (at the time of this writing references 8 and 9 are THE SAME, I noticed this because I wrote/edited much of the history section ... which you are editing to its detriment, please STOP). Despite your extensive efforts I think most of you're recent flood of changes are unnecessary. Khaj 09:23, 14 August 2006 (UTC)

Please tell me what and I fix my faults. Or comment here: Wikipedia:Peer review/Melanoma/archive1. Thanks! NCurse _work 09:32, 14 August 2006 (UTC)

Believe me I don't want to ruin the article. I try to make it better. NCurse _work 09:36, 14 August 2006 (UTC)

Citing slides you found in a pdf file on the internet is not a valid citation. Find alternative citations or remove them. Khaj 14:49, 14 August 2006 (UTC)

I removed them. NCurse _work 16:07, 14 August 2006 (UTC)

I see also that you reverted my reversions, WHICH I DISCUSSED ABOVE. As someone who has worked in melanoma research for six years it is REALLY FRUSTRATING to deal with someone like you. Why is it that I must pre-discuss every change WHEN YOU APPARANTLY DO NOT? It is very obvious why professionals in the biological sciences rarely donate their expertise here. You are an obvious sufferer of editcountitis. I am so frustrated with you that I am close to saying I that I give up ... you win ... at the moment it looks like this entry on Wikipedia is destined for the "please ignore" bin when I discuss further reading materials with my students. The poor english, the failure to understand what a citation really must provide, and the general bone-headedness of non-professional ham-fisted "contributors" in particular are extremely offputting. Khaj 17:06, 14 August 2006 (UTC)

First, please calm down. See that edit, it was an anonym edit, that's why I reverted it and told him on his talk page. If you edit something, regarding you're a specialist, I'd never revert it. I can't see why you create a war, I came here to improve the article, and I don't think that every of my edits were catastrophic. I accept that you know everything better in that topic, that's why I'd never revert your edit. Maybe the problem is your wikistress. Delete any of my edit, revert anything, I'm not interested, I'd never make a war (not like you). I've been able to learn here in wiki, everybody is as important and respected as much he works. Thanks... NCurse _work 21:31, 14 August 2006 (UTC)

Your last sentence is unfortunate. If everyone is given an equal voice in every article, then the truly knowledgeable drown in seas of mediocrity. Khaj 05:51, 15 August 2006 (UTC)

Khaj, I've been commenting/reviewing/etc on the peer review page, so it's possible that your objection is more to my suggestions than to NCurse's interpretations/implementations. In particular, I pointed out the awkward first sentence of the history section, which I've copyedited slightly; feel free to review it. The original wording, "While there is little serious doubt that melanoma is not a new disease..." contains weasel words that will get nitpicked if this article eventually becomes a featured article candidate.

Right, I'm going to explain this once, and then I want it reverted back. They are not "weasel words", they are an example of precise english. When there is no evidence for something then the possibility that general consensus is wrong remains open. In the case of melanoma there is no proof whatsoever (the evidence given is only suggestive and there is NO other evidence available) that melanoma was an affliction of antiquity. The evidence provided is merely suggestive. Pair this with the knowledge that nobody knows how melanoma occurs (we only know associations, e.g. sunlight) and the field remains open that the cause of melanoma is something particular to (relatively) modern times. However, rightly or wrongly, in scientific circles there is "no serious doubt" that melanoma did exist far longer than recorded history. Therefore, as a statement of fact concerning what researchers and clinicians think, those were not weasel words ... they were a statement of the uncertainty behind a generally accepted truism. Khaj 05:51, 15 August 2006 (UTC)

I hate quoting policy at people but you might want to have a look at WP:OWN. I understand your concerns regarding the integration of "normal" scientific uncertainty, but the original wording of that particular sentence is not only weak, but grammatically awkward. What do you think of "Although melanoma is unlikely to be a new disease,..."? (Additionally, given your expertise in the subject, this and related articles could surely use more attention than this single little clause is getting.) Opabinia regalis 06:56, 15 August 2006 (UTC)

Good link, perhaps you should read it yourself! Your alternative statement "Although melanoma is unlikely to be ..." itself begs for citation, what evidence is there for it to be unlikely? My version acknowledges the lack of strong evidence - there are no citations backing up your "unlikely to be new" position, it's a deficiency we will just have to accept, all we can point to is that nowhere (therefore "no") do you find scientific (therefore "serious") arguments against (therefore "doubt") the idea that melanoma has been around for a long time. Which version (yours or mine) is therefore weakest? The perception of grammatic awkwardness is just that, your perception only, read more review papers (read some of the ones in medical fields particularly). Given my expertise in this subject it WAS my original intention to devote more time to further areas, but as I worked on first the introduction (I did the first paragraph) and then started putting together the histories, this article had the extreme misfortune of becoming an MCOW. Like flies to honey well-meaning but essentially unqualified people started hashing in a flood of whatever data they could scrape together on the subject in the misguided belief that quantity equals quality. Now this article has become a mountain of confusion (the second paragraph of the introduction is hilarious from the perspective of someone who's work revolves around pigmented cells, it reads as if humans are either white or black and fails to acknowledge the spectrum which is reality - and that is just the LANGUAGE used). Therefore, I currently restrict myself to the sections I have worked on. When the dust dies down, and when time permits, I intend to do more. But the history section is something of a test case for me, if I don't get properly reasoned arguments behind changes which are made, then I don't see the point in devoting time to the other areas. Khaj 08:11, 15 August 2006 (UTC)

It strikes me as strange that you would think "it is unlikely that..." is any more or less in need of citation than "there is no serious doubt that..." when both are essentially fudges for the same thing. Rather than arguing about the specific wording of a largely extraneous sentence, why not just start with something like "Although evidence of melanoma in antiquity is scarce, a 1960s examination of nine Peruvian Inca mummies carbon dated to be approximately 2400 years old showed apparent signs of melanoma: melanotic masses in the skin and diffuse metastases to the bones."

It's bloody frustrating to go to the trouble of carefully explaining word choice to someone who then just brushes it all off as a "fudge". What gives you, as a rank outsider, the authority to summarily dismiss an insider's viewpoint? Khaj 13:24, 16 August 2006 (UTC)

However carefully each individual word was or was not chosen, the end product is still grammatically awkward. This particular discussion is about wording, not content. Opabinia regalis 01:13, 17 August 2006 (UTC)

As for the introduction, the paragraph you object to contains three sentences, each with its own reference. The reference I was able to access explicitly made reference to increased susceptibility in white people. So if you object to such classifications, I don't think we're the people to take it up with.

But you're the people editing this article into trash! Whom else can one "take it up with"? Khaj 13:24, 16 August 2006 (UTC)

The people who wrote a paper about melanoma incidence and classified their subjects by race? Since that seems to be what you object to in that paragraph. Racial classification may not be overly useful from the perspective of figuring out what individual cells are doing, but it's certainly useful from a practical, clinical perspective. Most people classify themselves by race, so reporting statistics on that variable seems reasonable for an article directed to nonspecialists. Opabinia regalis 01:13, 17 August 2006 (UTC)

The remainder of your commentary is probably best addressed elsewhere, such as individual user talk pages or with the other MCOTW participants. From what I can tell they're a pretty organized bunch. Opabinia regalis 00:18, 16 August 2006 (UTC)

Unlike you? Is that some sort of admission? If melanoma research wasn't my livelihood I would certainly just forget about this and walk away. But you're screwing with what students think is a learning resource. Khaj 13:24, 16 August 2006 (UTC)

Did you read the following text at the bottom of the editing page: If you don't want your writing to be edited mercilessly or redistributed by others, do not submit it.? It is great to have an expert onboard here, but that won't mean that no one will edit anything you wrote anymore. We are all trying to improve this (and other) article, but there is no guarantee that every edit will actually be an improvement or is 100% accurate. This is something you will have to live with and keep in your mind when you use wikipedia as a learning resource. --WS 14:47, 16 August 2006 (UTC)

Equally, something you will have to live with is someone compelled to argue their case. I did read that part and I have asked myself whether I should just "drop it". The answer, from the viewpoint of someone who has a vested interest in the development of understanding concerning this single article, is that I can not. It is interesting that I'm arguing against edit-scorekeepers and trophy hunters on what they perceive to be a trivial matter, but until I get a reasoned argument against something I have gone to the trouble to carefully explain I'm not prepared to give ground. Khaj 01:06, 17 August 2006 (UTC)

That is why these talk pages exist and there is nothing wrong with that. Also the first response from NCurse was: Please tell me what and I fix my faults. So I would suggest ending this discussion and start a new discussion here if edits show up which you are not happy or if they are still in the article. --WS 01:21, 17 August 2006 (UTC)

Images

Incidentally, the new images are great! I didn't look in detail at the license/reproduction requirements, but if it's allowed it might be useful to simplify the captions. Casual readers will not know that what they're looking at is a "violaceous nodule". Opabinia regalis 01:00, 15 August 2006 (UTC)

I've uploaded all the four images from DermAtlas with Withpermission and Fair use in|Melanoma templates and with link to the site's disclaimer. I asked the community about that in the Village Pumb (assistance) and they said it is ok. Anyway Khaj: I still hope that we can work together. NCurse _work 07:37, 15 August 2006 (UTC)

Oh, I'm sure the licenses are fine - I was wondering if the license required duplication of the captions along with the images. The caption of Image:Superficial_spreading_melanoma_1_060619.jpg in particular is not written for non-experts. Opabinia regalis 23:57, 15 August 2006 (UTC)

Important update?

Gene trial cures 2 of cancer

Summary: Government scientists turned regular blood cells into tumor attackers that wiped out all signs of cancer in two men with advanced melanoma. The striking finding, unveiled Thursday, marks an important step in the quest for gene therapy for cancer. But the genetically altered cells didn't help 15 other melanoma victims. So scientists are trying to strengthen the shots.

Epidemiology

Why is this paragraph duplicated exactly here when it already appears in the introduction?

"Melanoma of the skin accounts for 160,000 new cases worldwide each year, and is more frequent in white men.[3] It is particularly common in white populations living in sunny climates.[11] According to the WHO Report about 48,000 deaths worldwide due to malignant melanoma are registered annually.[5]"

TimothyPilgrim 13:33, 20 October 2006 (UTC)

I removed it, left the original paragraph in the lead. NCurse _work 19:49, 27 October 2006 (UTC)

There is some evidence that Vitamin D (including from sun exposure) may be protective. Also, there are studies showing that dietary omega-6/omega-3 imbalance contributes to susceptibility to melanoma. http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1567907 --Chave (talk) 15:10, 21 August 2008 (UTC)

Natural history?

Dear all

I think a short section on the naural history of the malignant melanoma - in situ/invasive radial/vertical growth phase would be good - as I find people even with medical background find difficult to understand the concept. Thic could help to understand the difference between the prognosis of a thin and a thick melanoma - not just give the numbers. I was thinking to include something along these lines below:

Natural history of malignant melanoma

The malignant melanoma starts as a proliferation of melanocytes, which is limited to the dermo-epidermal junction. This is also referred as radial growth phase - the tumour cells grow alongside the junction. At this phase the tumour does not have invasive potential, and the thickness of the lesion is less than 1 mm.

When the tumour cells start to move in a different direction - vertically up into the epidermis and into the papillary dermis, the behaviour of the cells changes dramatically.

The next step in the evolution is the invasive radial growth phase, which is a confusing term, however it explains the next step in the process of the radial growth, when individual cells start to acquire invasive potential. This step is important - from this point on the melanoma is capable of making a metastasis. The Breslow depth of the lesion is usually less than 1 mm, the Clark's level is usually 2.

The following step in the process is the invasive melanoma - the vertical growth phase. The tumour attained invasive potential, which is shown by the mitotic activity of the tunour cells. The metastatic cells are getting into the bloodstreem by invasion of the lymphatics and small blood vessels. The tumour thickness is usually more than 1 mm, and the tumour involves the deeper parts of the dermis.

The host elicits an immunological reaction against the tumour, which is judged by the presence and activity of the TILs (tumour infiltrating lymphocytes). These cells sometimes completely destroy the primary tumour, this called regression, which is the latest stage of the melanoma development. In certain cases the primary tumour is completely destroyed and only the metastatic tumour is discovered.

What do you think?

best wishes, Las

Laciga 00:39, 28 November 2006 (UTC)

Seems to be a good start. But the name of the section is not the best. I'll suggest a new one. Be bold to insert the text. NCurse _work 05:29, 28 November 2006 (UTC)

History section

It says "American physician, Dr. Roger Turkington, discovered the human melanoma gene." No references are cited and what exactly is "the human melanoma gene" anyway? IIRC there is no such thing. 130.60.28.29 15:57, 12 January 2007 (UTC)

Veterinary

I've put a little bit in about equine melanomata, since there didn't seem to be anything available yet, and this article is sufficiently detailed that a separate page doesn't seem justified at this point. (Dlh-stablelights 13:44, 9 June 2007 (UTC))

Why not go ahead and put in a special section for every species? Melanoma isn't restricted to horses and men. While many animals seem unsusceptible (e.g. mice), many animals are as susceptible as horses (e.g. pigs). I think the answer here is to NOT HAVE SPECIES-SPECIFIC SECTIONS. No wonder this article is such a disaster.130.60.28.29 (talk) 15:54, 27 November 2007 (UTC)

Website Directory

Is there any reason for the growing directory of only vaguely useful websites? Most are are just info-pages from commercial services; and all that information should be incorporated into the article. 218.111.148.233 08:19, 4 November 2007 (UTC)

Genetics section.

Quote: In the future, however, physicians will hopefully be able detect melanomas based on a patient’s genotype, not just his or her phenotype. It is my understanding that one cannot detect a melanoma based on a whole body genotype- one can only detect pre-dispositions/risk factors. The only way to achieve a genotype diagnosis is to genotype the cancer cells specifically. Useful in confirmation of a suspected melanoma, but hardly useful in scanning. —Preceding unsigned comment added by 121.208.80.102 (talk) 12:43, 6 November 2007 (UTC)

Readability

In my opinion, this article is unhelpful to the average person seeking information about melanoma. It seems geared to grad students in biochemistry. I suggest some of the excessive, highly-technical medical language be toned down. Grumpy otter (talk) 20:52, 23 January 2008 (UTC)

I have to agree, this information is presented at a very technical level. The entry seems more appropriate to a medical book, then wikipedia. 12.4.17.250 (talk) 20:10, 24 September 2009 (UTC)

Medical approach

I think the article could benefit from a more medical approach. Prevalence and incidence rates should be included. It should be stated that there is no medical proof that nevus trauma causes melanoma. Furthermore, the article should demystify the malignant melanoma: it is one of the most curable cancers in the US (after seminoma, thyroid cancer and prostate cancer). It is not as lethal as you might think after reading popular health magazines.

Sunscreen

As far as I understand it, the routine use of sunscreen is still routinely advocated by mainstream medicine as an anti-melanoma measure; see this for instance. While I understand that sometimes mainstream medicine gets it wrong, we should make clear what the majority medical view is - which is still, strongly, in favour of sunscreen use as far as I know. --Robert Merkel (talk) 04:05, 24 April 2008 (UTC)

AHRQ does not agree. At the Agency for Healthcare Research and Quality (AHRQ) Home Page (The Agency for Healthcare Research and Quality (AHRQ) is the lead Federal agency charged with improving the quality, safety, efficiency, and effectiveness etc etc) In Recommendations and Rationale, Counseling to Prevent Skin Cancer, U.S. Preventive Services Task Force (USPSTF) at http://www.ahrq.gov/clinic/3rduspstf/skcacoun/skcarr.htm the following is the summary of their recommendation on counseling for behavior changes to prevent melanoma:

The U.S. Preventive Services Task Force concludes that the evidence is insufficient to recommend for or against routine counseling by primary care clinicians to prevent skin cancer.

Rating: I Recommendation.

Rationale: The USPSTF found insufficient evidence to determine whether clinician counseling is effective in changing patient behaviors to reduce skin cancer risk. Counseling parents may increase the use of sunscreen for children, but there is little evidence to determine the effects of counseling on other preventive behaviors (such as wearing protective clothing, reducing excessive sun exposure, avoiding sun lamps/tanning beds, or practicing skin self-examination) and little evidence on potential harms.

Clinical Considerations: Using sunscreen has been shown to prevent squamous cell skin cancer. The evidence for the effect of sunscreen use in preventing melanoma, however, is mixed. Sunscreens that block both ultraviolet A (UV-A) and ultraviolet B (UV-B) light may be more effective in preventing squamous cell cancer and its precursors than those that block only UV-B light. However, people who use sunscreen alone could increase their risk for melanoma if they increase the time they spend in the sun. —Preceding unsigned comment added by Chave (talk • contribs) 14:47, 21 August 2008 (UTC)

Are we doctors?

"It is not adequate that a dermatologist has a dermatoscope in his or her office, it should be a routine part of the skin exam that the instrument is used."

Since we are not doctors, how do we know when to use a dermatoscope over them? Seemed a little wonky and wanted other input before changing.Sheepeh (talk) 03:31, 31 December 2008 (UTC)

Thanks - Seems highly skewed view that the device should be used (vs other techniques such as computer image analysis) - dermatoscope website is not independant source for this view and whole inclusion seemed undue weight - I've hacked[2] it down to a more sensible size removing what was in effect commercial plugging. I'm not sure if any UK dermatologists routinely use such devices (vs clinicial inspoection and biopsy if any doubt). David Ruben ^Talk 17:23, 1 January 2009 (UTC)

Causes of Melanoma "In lay terms"

I removed this section because it was incorrect. The ideas it contained were not cited and are not generally accepted by melanoma cancer biologists.Biochemallurgist (talk) 21:48, 21 November 2010 (UTC)

I undid your edit because you are not correct. You have 19 edits on this page in the 47 hours from November 21. You have no user page, and no talk page. If you have problems with a section, you don't delete, you fix. 122.200.166.177 (talk) 00:20, 28 November 2010 (UTC)

"In lay terms: Content made generalizations that are not supported by data. I edited the text to remove unsupported claims, and to explain that melanoma doesn't always result from UV exposure." (Revision as of 18:10, 30 November 2010, Blindh/talk) Perhaps people should learn to do real research before imposing their pet beliefs on others. I'm not going to revert this unwarranted edit, but check this info out:

http://www.youtube.com/watch?v=eeXtGHSt-5o

Skin Cancer/Sunscreen - the Dilemma::

UCSD School of Medicine and GrassrootsHealth:: Edward Gorham, PhD::

Series: Vitamin D Deficiency - Treatment and Diagnosis [2/2009] [Health and Medicine] [Professional Medical Education] [Show ID: 15770]::

LICENSE: Creative Commons (Attribution-Noncommercial-No Derivative Works)

The fact is that Melanoma always results from UV exposure and usually results in a place that never saw the sun. Further, melanoma does not result from UV damage to a melanocyte or melanin. 122.200.166.53 (talk) 07:51, 21 January 2011 (UTC)

I have reverted the edit made by User:Blindh on 18:10, 30 November 2010, to bring the section back to some factuality. All material in this section has been sourced from allied/related articles in Wikipedia. However, since Wikipedia is only a third-class reference, the sources should probably not be cited. As well, the whole article should be substantially re-arranged to present some logical order of reference, as it is currently a dog's breakfast with bits all over the place. 122.200.166.232 (talk) 02:24, 24 January 2011 (UTC)

melanoma and cancer stem cells

There may be no subpopulation of melanoma cancer stem cells, See [3] Rod57 (talk) 14:33, 4 December 2010 (UTC)

I added a section about stem cells and melanoma for my Biology of Stem Cells class. There is evidence that the stem cells in hair follicle stem cell niches play a major role in melanoma. — Preceding unsigned comment added by Lpitzer (talk • contribs) 16:55, 24 December 2016 (UTC)

Grammatical changes

All I have done is make sorely-needed grammatical changes. Do not understand whole-sale reverts. YMMV, but this needs to be discussed in more detail HERE before doing such reverts. 23:30, 17 January 2011 (UTC) — Preceding unsigned comment added by Jackfirst (talk • contribs)

"Melanoma" vs "Malignant Melanoma" ?

Recent edits by 184.58.124.224 indicate this user is adamant about removing the word 'malignant' in front of 'melanoma,' citing it as redundant. While I can understand this view, since common reference to melanoma most always means malignancy, the actual term 'malignant melanoma' is used extensively in the literature, books, journal papers, etc. Terms like 'premalignant melanoma' and 'benign melanoma' are also sometimes used. I have left this user's changes to the text, but what is the proper convention here? 98.109.174.254 (talk) 21:02, 21 January 2011 (UTC)

More cause of Melanoma "in lay terms"

Hi WhatamIdoing and MastCell -

This is my evidence chain:

Indirect DNA damage (Note: the first para of the lede is very badly written, it is not intuitive.) Indirect DNA damage occurs when a UV-photon is absorbed in the human skin by a chromophore that does not have the ability to convert the energy into harmless heat very quickly.[2] From the image "File:Indirect DNA damage.png" Indirect DNA damage: The chromophore absorbs UV-light ( * denotes an excited state), and the energy of the excited state is creating singlet oxygen (1O2) or a hydroxyl radical (•OH), which then damages DNA through oxidation.[1]

At Location of the damage Direct DNA damage is confined to areas that can be reached by UV-B light. In contrast free radicals can travel through the body and affect other areas - possibly even inner organs. The traveling nature of the indirect DNA damage can be seen in the fact that the malignant melanoma can occur in places that are not directly illuminated by the sun—in contrast to basal-cell carcinoma and squamous cell carcinoma, which only appear on directly illuminated locations on the body.[citation needed]

Direct DNA damage Direct DNA damage can occur when DNA directly absorbs the UV-B-photon. UVB light causes thymine base pairs next to each other in genetic sequences to bond together into thymine dimers, a disruption in the strand, which reproductive enzymes cannot copy. It causes sunburn and it triggers the production of melanin.[1] From the image "File:Direct DNA damage.png" Direct DNA damage: The UV-photon is directly absorbed by the DNA (left). One of the possible reactions from the excited state is the formation of a thymine-thymine cyclobutane dimer (right). The direct DNA damage leads to sunburn, causing an increase in melanin production, thereby leading to a long-lasting tan. However, it is responsible for only 8% of all melanoma.

Melanin Production of melanin is stimulated by DNA damage induced by UVB-radiation,[1] and it leads to a delayed development of a tan. ... This property enables melanin to dissipate more than 99.9% of the absorbed UV radiation as heat[3] (see photoprotection). This prevents the indirect DNA damage that is responsible for the formation of malignant melanoma and other skin cancers.

There were obviously many other pathways, but they all led back to these three. 122.200.166.100 (talk) 01:47, 26 January 2011 (UTC)

I think I see how you've ended up with this idea, and I certainly believe that UV-B is the major cause. The first loophole is that free radicals can be caused by a variety of processes, not merely the UV light mentioned in the other article. If melanoma can be caused by free radicals, then it can be caused by free radicals that are not created from UV light. (For example, every time you catch a cold, your immune system starts producing relatively large quantities of free radicals to dump on infected cells.)

I have generally not found it a good idea to rely too heavily on other Wikipedia articles when sorting these things out. For one thing, you never know if the person writing it quite got all the details out straight (or if someone has "fixed it" since then), and for another, just because it seems to me that something must be so, doesn't mean that it really is so.

I think that what we want is a paper or book written by an expert who says "(fill in the blank) causes melanoma", rather than trying to piece it together ourselves. (Besides, then if it's wrong, it's the expert's fault, not ours.) I don't think it will be difficult to find decent sources, but I'm out of time for today. (The tax paperwork is calling... ugh!) WhatamIdoing (talk) 03:08, 26 January 2011 (UTC)

My sympathies over the tax paperwork -- fortunately, here in Oz we only have one set to deal with...

OK!!!! I have found a credible alternate cause!!!!: PMID 9920435:

"The other factor operating appears to be skin temperature. For melanoma, it is postulated that the latter factor by itself may suffice to account for the observed variation with latitude. The higher incidence of melanoma in the higher social classes and its increasing incidence with age may be readily explained by the hypothesis that melanoma incidence increases with increase in skin temperature."

I actually started this mess because I needed to find an intelligible treatment of the causes of melanoma. Then I found I could not understand anything in the articles. I do like your thinking on non-UV free radicals :) 122.200.166.108 (talk) 03:27, 26 January 2011 (UTC)

So far, then, we've got genetics (familial/inherited melanoma), UV light (for non-Hispanic white people), and maybe skin temperature—although it sounds like the author proposes skin temperature as something that makes UV light exposure more dangerous, not as a problem all by itself. (If you work in a bakery or a steel mill, your skin temperature will be higher than average, but I don't believe he thinks you'll get melanoma as a result.)

At the next level down, ISBN 9781588294593 (p 441) suggests that the underlying problem is a genetically caused weak repair system for DNA damage. This would explain genetics (obviously) and UV light (causes DNA damage) and non-UV light sources (because any type of DNA damage is relevant, no matter what the cause). WhatamIdoing (talk) 06:39, 27 January 2011 (UTC)

"genetics (familial/inherited melanoma)" <-> "'genetically caused weak repair system for DNA damage"? I'm being deliberately obtuse here, as leaping to conclusions usually is a dead end... So now all we need is to get that lot into the "Causes" section without appearing to dream it up on the fly. I can have a burl, but not for a couple of weeks as I'll be working very far from computers and the internet. 122.200.166.249 (talk) 07:28, 27 January 2011 (UTC)

It's a little confusing, isn't it? But they seem to think that there's basically a "melanoma gene" (or several), and that causes specifically melanoma (in some of the people who have the gene). But then there seem to be people who don't have a specific risk for melanoma, but instead have a risk for all sorts of cancers. They might get melanoma, if they get the "right" (or wrong!) sort of DNA damage in the right kind of cell, but if they get a different type of DNA damage (say, in a different kind of cell), then they might get some other type of cancer (whereas a person with a better DNA repair system might just fix the damage and not get cancer at all).

You might also like to have a look at http://www.ncbi.nlm.nih.gov/books/NBK20896/ It's the melanoma chapter from a textbook for medical school classes on cancer (and free online). I haven't gotten very far with it, but it might have some more information.

I'd be happy to see you have a go at it. WP:There's no deadline, so it can wait until you're back and have some time. WhatamIdoing (talk) 21:27, 31 January 2011 (UTC)

I hope I can add perspective concerning the cause of melanoma. The UV light striking exposed skin results in that skin producing "Melanocytes: make melanin!" hormones that then circulate within the body. When they reach unexposed skin, they can tend to push melanocytes there into malignancy. The process could be similar to how estrogen can increase breast cancer risk.Joseph Meisenhelder (talk) 14:19, 25 April 2013 (UTC)

vemurafenib and Yervoy

AP (June 5, 2011). "Studies Find New Drugs Boost Skin Cancer Survival". New York Times. --Javaweb (talk) 14:54, 5 June 2011 (UTC)Javaweb

"New Promise Shown in Treatments for Melanoma, Breast Cancer". PBS News Hour. June 6, 2011. PBS. {{cite episode}}: External link in |transcripturl= (help); Unknown parameter |transcripturl= ignored (|transcript-url= suggested) (help) --Javaweb (talk) 22:43, 7 June 2011 (UTC)Javaweb

I was under the impression that 'further reading' could be used for ...

Following reverted in this edit → http://en.wikipedia.org/w/index.php?title=Melanoma&action=historysubmit&diff=465081686&oldid=465081098

Perrone, Matthew (7 Nov 2011), Associated Press (ed.), "New device uses light to screen for melanoma", R&D Magazine, Advantage Business Media, rdmag.com, retrieved 10 Dec 2011 {{citation}}: Unknown parameter |coauthors= ignored (|author= suggested) (help)

--User:Ceyockey (talk to me) 03:28, 20 December 2011 (UTC)

Please read WP:MEDRS regarding what are appropriate sources. Wikipedia:Further_reading also gives an overview of this sections us.--Doc James (talk · contribs · email) 03:33, 20 December 2011 (UTC)

I am familiar with reliable source requirements and the source I cited would be considered reliable in general; it is quite unfortunate that we are moving (have moved) to a "what's reliable here is not reliable there" fragmentation of sourcing guidelines as I think this impedes the mission of the encyclopedia as a whole — but enough on that matter as I don't want to debate the notion of guideline being applied as policy or other broad controversial areas here. I actually thought that the removal was more about the function / content of the 'further reading' section than the source being called into question. --User:Ceyockey (talk to me) 14:03, 21 December 2011 (UTC)

==Further reading== entries are not required to be reliable sources. The MEDRS guideline does not apply. WhatamIdoing (talk) 23:10, 3 January 2012 (UTC)

High incidence of melanoma in Texas, florida, Italy

Why the revert of my edit about the high incidence of melanoma in southern italy. Dammit, that is what it is, the literature reflects it, and I have the tickets to Italy (where I attend international skin cancer conferences) to prove it. Also, there is not a particularly high incidence of melanoma in "Northern Europe". What there is is a high incidence in areas of historical migration of northern europeans into southern climes. Classic example is Sicily, with its large Norman component to the gene pool. Other examples are Texas and Australia. And yes, I know experts don't count for much here, except we do know the literature. Drjames1 (talk) 20:40, 29 February 2012 (UTC)

I Take it back. the increasing incidence of melanoma seen with decreasing altitude seen in european immigrant lands such as australia and texas in not seen in Europe itself, at lest not lately. Just the opposite, in fact. Reason is that in Europe populations haven't moved around as much. Drjames1 (talk) 21:50, 29 February 2012 (UTC)

Offhand, I'd guess that this reversion is about the location of the text rather than its contents. By adding your new sentence in between the old sentence and the old reference, it makes it look like the old sentence is uncited and your new sentence is supported by the old reference. WhatamIdoing (talk) 00:54, 1 March 2012 (UTC)

Request for input

Solicit input on bio of pioneering melanin researcher Peter Proctor. Nucleophilic (talk) 13:39, 6 May 2012 (UTC)

mention of good prognosis if detected early

Hi,

I would recommend to mention that a locally excised melanoma has a good prognosis. In the second paragraph: "Melanoma is less common than other skin cancers. However, it is much more dangerous if it is not found early. It causes the majority (75%) of deaths related to skin cancer.[3]" I would put before mentioning the mortality rate, something like "Has a good prognosis if detected early" "Can be removed completely if detected early". That would be helpful for all the people that read article because being delivered the diagnose. — Preceding unsigned comment added by Jadram2011 (talk • contribs) 14:01, 23 July 2012 (UTC)

Needs update now Vemurafenib has FDA approval

Vemurafenib (already mentioned in Research) could now also be mentioned in the Adjuvant/chemo section and more emphasis on the V600E BRAF mutation.

Vemurafenib says Vemurafenib received FDA approval for the treatment of late-stage melanoma on August 17, 2011, Health Canada approval on February 15, 2012 and on February 20, 2012, the European Commission approved vemurafenib as a monotherapy for the treatment of adult patients with BRAF V600 mutation positive unresectable or metastatic melanoma, the most aggressive form of skin cancer. - Rod57 (talk) 03:44, 17 December 2012 (UTC)

Now dabrafenib also has FDA approval does anyone object to moving the BRAF section from Research into Treatment ? - Rod57 (talk) 13:06, 22 August 2014 (UTC)

Now (Sept 2014) Pembrolizumab also has FDA approval it could be mentioned under Immunotherapy ? - Rod57 (talk) 19:32, 7 September 2014 (UTC)

Cutaneous melanoma - rename ?

This page could be renamed "Cutaneous melanoma". Melanoma can be observed in numerous extra-cutaneous localization. What do you think to rename the page? patho (talk) 15:07, 7 February 2014 (UTC)

Bad idea IMO without a very careful 2 or 3-way split (including the talk page). Better to cover non-cutaneous melanoma in this article ? - Rod57 (talk) 11:38, 5 July 2016 (UTC)

Not supportive. Other types can be discussed here. Doc James (talk · contribs · email) 15:07, 5 July 2016 (UTC)

Surgery

The first paragragh of the Surgery section describes the standard practices of excision but at the end it says "This is a common pattern of treatment failure in melanoma", without explaining why or how, the reason that I find it a bit confusing. Can someone with the knowledge of the subject matter can have a look at it. -- SMS ^Talk 21:41, 16 April 2014 (UTC)

Review

... of the management in the British Medical Bulletin doi:10.1093/bmb/ldu019 JFW | T@lk 15:57, 4 September 2014 (UTC)

Why does "melanocarcinoma" redirect here?

Not mentioned in article; what does it mean? Equinox (talk) 23:16, 9 August 2015 (UTC)

Historical term used to mean melanoma. [4] Doc James (talk · contribs · email) 05:02, 10 August 2015 (UTC)

Sunscreen

Ingredients in some sunscreens are not 'titanium' and 'zinc'; they are 'titanium dioxide' and 'zinc oxide'. 71.139.163.243 (talk) 03:50, 30 October 2015 (UTC)

I have fixed the text accordingly. Thanks for pointing it out. Deli nk (talk) 12:09, 30 October 2015 (UTC)

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New NEWS today, for future editing (maybe)

This article has HIGH VISIBILITY; what do you think??

Headline-1: Bananas May Help Detect, Cure Skin Cancer

• http://news.discovery.com/human/health/bananas-may-help-detect-cure-skin-cancer-160208.htm

QUOTE: "Girault believes the scanner could be used one day to destroy tumors, hopefully rendering biopsies and even chemotherapy unnecessary.

“Our initial laboratory tests showed us that our device could be used to destroy the cells,” he said.

The research was published in the German science journal Angewandte Chemie." -- AstroU (talk) 09:11, 9 February 2016 (UTC) -- PS: FYI for future WP discussion/editing.

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Causes > UV > possible link to ozone depletion

https://www.ncbi.nlm.nih.gov/pubmed/2367555 et al. Cliffewiki (talk) 14:04, 4 October 2017 (UTC)

Research: Mensacarcin

In this edit I added a short snippet including a citation, linking to mensacarcin. User Jytdog reverted this edit. While I added the sentence to a wrong section, there is no reason to delete it: The citation is from a high-level, peer-reviewed journal, the research is convincing. And the agent certainly is of high interest under the viewpoint of research. I will add it again to the Research section, slightly lengthened. Tomdo08 (talk) 02:10, 17 January 2018 (UTC)

Thanks for opening a discussion. MEDRS is more than just "high-level, peer-reviewed journal". Please read WP:MEDRS. If you don't understand it after you read it, please ask. You also might want to read WP:Why MEDRS? (just the summary section, it is too long) Thanks. Jytdog (talk) 04:04, 17 January 2018 (UTC)

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Biopsy section

It happens quite often that conclusions of original articles pertaining to the safety of biopsies are inadvertently mis-represented in the articles quoting them; this is the case of this article on melanoma. That causes much harm. The wording of the Abstract of this article, although technically flawless, is gravely misleading, because it requires not an average, but especially high degree if attention to hidden details. Unfortunately for melanoma sufferers, this article has been referenced in this Wikipedia article by someone who evidently had only a normal degree of attention to details.

Let us discuss the crucial declaration of this Wikipedia article: "Incisional biopsies such as punch biopsies are usually contraindicated in suspected melanomas, because of the possibility of sampling error or local implantation causing mis- estimation of tumour thickness. However, fears that such biopsies may increase the risk of metastatic disease seem unfounded.[55][56]" (Wikipedia's reference numbers). This is what the misleading wording of the original article SEEMS to say.

Even the title "Is incisional biopsy of melanoma harmful?" is inconsistent with the content. Reassuringly but incorrectly, that title's question is answered negatively in the Abstract's Conclusions: "The concern that incomplete excision of primary melanomas may result in an increased incidence of SLN (Sentinel Lymph Node) micrometastases, artifactual or real, is unfounded." Where is the misleading?

This misleads to read that it is a general conclusion, while in reality the harm of the incisional biopsy was discussed only comparing to excisional biopsy and punch biopsy; see the Abstract's Background: "The aim of this study was to evaluate the difference (...) for patients who undergo excisional versus incisional versus shave biopsy."

The idea of comparing the harm of biopsies to non-biopsying diagnostic methods did not seem to cross the Authors' minds; possibly because of the wrong "obviousness" that cancers and suspected cancers have to be biopsied.

The Authors of the original article are guilty of the lethal harm: When meaning to say that incisional biopsies are not more harmful than excisional and shave- types, their inconsistent wording misleading readers to think that incisional biopsies are harmless - which is inconsistent with the data of their own article, showing 20% of that increase. Biopsies do increase the incidence of metastasis (see Fig. 3 in Reference 56 in this Wikipedia's article on melanoma). For melanoma, metastasis is lethal in 90%, and this is what this misrepresentation is leading the Wikipedia's reading melanoma sufferers, and their doctors, into.

Let us "nail this down": In the Abstract's "Results" section, we read:

• About 20% of the biopsied melanoma patients (345 of 1760 patients) developed metastasis.
• This metastasis rate and the survival rate were the same for excisional, incisional, or shave biopsies.
• But in the "Conclusions" we read:

"The concern that incomplete excision of primary melanomas may result in an increased incidence of SLN (sentinel lymph node) micrometastases, artifactual or real, is unfounded." Does this conclusion match the two foregoing facts? All those 1760 patients were biopsied. This lack of the non-biopsy reference made Authors think that the metastasis of those 345 patients had nothing to do with the biopsies.

HOW DEADLY MISLEADING!

The Authors mean: Don't worry which kind of biopsy we will apply to you, they all are harmful to the same (20%) degree.

The readers read: All biopsies of melanoma are harmless.

This misleading is not intentional. But this does not help those who have died because they trusted such assurances.

The other Wikipedia's Reference [56] is very misleading too, albeit in a different way; I can expand on that.

Jerry Czarnecki, [email redacted: we post in public here and this page will be copied to many other websites and there is no reason to expose account to spam] — Preceding unsigned comment added by 97.93.71.22 (talk) 03:06, 18 February 2018 (UTC)

Thanks for your note. Just want to acknowledge that this is something you are clearly passionate about.

The two refs you note that the article currently cites are PMID 16307945 which is a thirteen year old review, and PMID 24665419 which is a three year old primary source. We should not be using the latter at all, as it is a primary source. The review is the kind of source we use, but it is too old by now.

We generally source content about health in Wikipedia to a) recent reviews in good quality journals, or b) statements by major medical or scientific bodies. If you are aware of such a source that discusses biopsies, please bring it.

In the meantime I am looking for such sources, and will update the article based on what they say.

That is all we do here - summarize what reliable sources say. More anon... Jytdog (talk) 03:40, 18 February 2018 (UTC)

I did a search, here:

PMID 28114438 (review from 2017 in JAMA Facial Plast Surg.) says "The ideal biopsy of a lesion of clinical suspicion for melanoma consists of an excisional biopsy with a narrow (1-3 mm) margin of clinically normal skin...Although excisional biopsy of a lesion suspicious for melanoma is ideal, sometimes it is impractical or inappropriate....Incisional biopsies do not increase the risk of metastasis".

PMID 28195451 is another recent review; I don't have access to it and have requested it from my library.

PMID 27580240 is another recent review from a good journal. It reports that "Molenkamp et al. investigated the impact of initial diagnostic biopsy type (wide excisional biopsy [reference group], narrow excisional biopsy, excisional biopsy with positive margins and incisional biopsy) on survival outcomes.[23] Multivariate analysis showed that biopsy type had no effect on either DFS (HR: 0.47–0.71; P > 0.10) or OS (HR: 0.74–0.75; P > 0.41) among patients who had their primary tumour re-excised and had also undergone SLNB." It didn't comment further on that, and was concerned with other issues.

PMID 26901103 is a recent Swiss guideline on diagnosis and treatment of melanoma. it simply says: "Diagnosis should be based on a full thickness excisional

biopsy with a small side margin."

That is as far back as i went. I will check clinical guidelines from medical societies tomorrow... Jytdog (talk) 04:36, 18 February 2018 (UTC)

New Research - Blood test for Melanoma detection

Hi guys, I read this week in the news about this study and since I havent found a quality secondary source I wanted to ask for help in either finding this kind of reference or your opinions towards maybe including this in another part of the melanoma article.

My initial added content which was correctly and kindly reverted for lacking secondary reference reads: In July 2018, a study revealed an experimental blood test that could detect melanoma skin cancer early. The study, published in the journal Oncotarget, was able to identify people with melanoma with 79% accuracy and people without a melanoma with 84% accuracy. Further research will be made in order to achieve a 90% accuracy in detection, which will allow to be valued by clinicians.

This inclusion, altough still in development, have a huge potential toward earlier detection. As I live in a caribbean island where many specialist such as dermatologist are in shortage, it gave me hope to see a study that gave new possibilities to a blood test that can help screen potential cases. I hope this development results in success so that it can be used in clinical settings and thus save countless lives. Thanks once again for your support.

Greetings from Puerto Rico. --Edwin. Efeliciano_ms (talk) 01:35, 20 July 2018 (UTC) Efeliciano ms (talk) 01:37, 20 July 2018 (UTC)

It appears to be a bit of early stage research. Will this turn into a useful diagnostic test? Hard to say yet. Doc James (talk · contribs · email) 06:34, 20 July 2018 (UTC)

References

Lancet seminar

doi:10.1016/S0140-6736(18)31559-9 JFW | T@lk 12:17, 14 September 2018 (UTC)

Queen's University Student Editing

Hello, we are a group of medical student's from Queen's University. We are working to improve this article over the next month and will be posting our planned changes on this talk page. We look forward to working with the existing Wikipedia medical editing community to improve this article and share evidence. We welcome feedback and suggestions as we learn to edit. Thank you. TheGrumpyGerman (talk) 18:11, 1 October 2018 (UTC)

Nothing is posted User:TheGrumpyGermanDoc James (talk · contribs · email) 19:31, 6 November 2018 (UTC)

@Dawnarmstrong4, Kookaburra123, QmedV, TheGrumpyGerman, and Vincentso94: Can you please share your proposed changes here on the article talk page? More info of sharing on the talk page: https://en.wikipedia.org/wiki/User:JenOttawa/Talk_Page_Template.

Thanks JenOttawa (talk) 13:44, 7 November 2018 (UTC)

@Dawnarmstrong4, Kookaburra123, QmedV, TheGrumpyGerman, and Vincentso94: I moved your suggestions down to the bottom of the page so we can easily find them. Thanks for updating this! We may still be missing a few suggestions. JenOttawa (talk) 16:16, 8 November 2018 (UTC)

Suggestions for the article page

"Hello, we are a group of medical students editing this page as part of our class assignment. We have compiled a list of suggestions to improve this article and would appreciate community feedback before we proceed with these edits. Here is a list of our suggestions:

1. We propose to insert the following content into the Melanoma #Diagnosis section regarding updating the laboratory tests to include SOX10 and updating S100B information and can be found in the following sandbox: https://en.wikipedia.org/wiki/User:TheOccasionalHiker/sandbox

2. We propose to add the following content into the Melanoma#Prevention section regarding the risk of UV nail lamps and further promoting sunscreen application. The proposed change can be found at https://en.wikipedia.org/wiki/User:Metrobooomin/sandbox

3. We propose to make changes to the Melanoma #Treatment section, mainly pertaining to the subheading immunotherapy/chemotherapy and creating a subheading of Small-Molecule Targeted Therapies. The changes can be found in the following user sandboxes. Immunotherapy: https://en.wikipedia.org/wiki/User:Vincentso94/sandbox Chemotherapy: https://en.wikipedia.org/wiki/User:Kookaburra123/sandbox Small Molecule Targeted Therapies: https://en.wikipedia.org/wiki/User:TheGrumpyGerman/sandbox

4. We propose to make changes to the Melanoma#Staging section where we integrate the American Joint Committee on Cancer staging guidelines. The proposed changes can be found at https://en.wikipedia.org/wiki/User:Dawnarmstrong4/sandbox — Preceding unsigned comment added by TheOccasionalHiker (talk • contribs) 17:25, 8 November 2018 (UTC)

5. We propose to make changes to the Melanoma #Cause section. -We would like to add the following sentences to the “Cause” section:

1)Melanoma can also occur in skin areas with little sun exposure (ie. inside the mouth). -2)People with Atypical mole syndrome (also known as dysplastic nevus syndrome or familial atypical multiple mole melanoma (FAMMM))are at increased risk for the development of melanoma.

We propose making the following changes to the #Genetics section: -I would like to add the acronym commonly used to describe familial melanoma. Where familial melanoma was first mentioned in the genetics section I added the acronym FAMMM in brackets. I defined this acronym earlier in the article under the cause section. -FAMMM is typically characterized by having 50 or more combined moles in addition to a family history of melanoma. It is transmitted autosomal dominantly and associated with the CDKN2A mutation. Those with FAMMM do have an increased life-time risk of melanoma.

Thank you for sharing suggestions # 5. I made some adjustments to the citations and text. JenOttawa (talk) 17:58, 12 November 2018 (UTC)

Thank you for taking the time to read and critique our suggestions. We would appreciate and welcome any feedback or suggestions that you may have regarding our proposed changes. TheOccasionalHiker (talk) 03:38, 8 November 2018 (UTC)

References

2nd sentence too long

The 2nd sentence currently reads: Melanomas typically occur in the skin, but may rarely occur in the mouth, intestines, or eye. It is too long to be this early in the article. I suggest abbreviating it to Melanomas typically occur in the skin. The caveat word typically signals sufficiently that there are also other possibilities, so noone is fooled by this omission. Readers typically spend very little time on each article and typically start at the top. Therefore, we exert ourselves to be very compact in the intro, and especially in the beginning of the intro. The info that I suggest is removed here in the intro should of course be present in some other part of the article. (Which I also trust it is.) --Ettrig (talk) 08:14, 2 February 2019 (UTC) Oops, I checked for handling this info in the rest of the article, and it is not sufficiently treated there. I am trusting that this is true and important, since it is mentioned in the 2nd sentence. In that case it should be fully spelled out in the article. But it is not. The word intestine does not occur anywhere else in the article. The first sentence in Signs and symptoms seems to presume that melanoma occurs only in the skin. I think this would be an OK place to describe where in the body melanoma occurs. (Maybe it would be even better to add an earlier paragraph that describes what the illness is constituted of, for example its mechanisms.) --Ettrig (talk) 08:25, 2 February 2019 (UTC)

Gene mutations and copy number alterations

I would complement the nicely-written section on Pathophysiology with results from TCGA studies on recurrent genomic alterations in melanoma. For example, the notion that BRAF V600 is the most common mutation in melanoma would give context to BRAF inhibitors mentioned later Tave15 (talk) 09:17, 9 April 2019 (UTC)