Melanoma strikes hard

Gary, a healthy, 34-year-old, fair-headed man, presented to his GP after his wife noticed a mole on his back that seemed to have darkened, sometimes leaving spots of blood in their bed.

Biopsy confirmed a clinical diagnosis of melanoma.

A surgeon excised the mole and surrounding tissue, closing the defect with a split skin graft. Histology showed an ulcerated 2.1mm deep tumour with lymphatic invasion but clear margins of at least 2cm. There was no other clinical evidence of disease. Chest X-ray was normal.

Depth of tumour invasion (Breslow thickness) is a better prognostic