It Doesn't Hurt, So It Must Not Be Serious

TAKE-HOME LEARNING POINTS
• Although the classic melanoma is black and essentially flat, it can present in many other forms, including an amelanotic version, the color of which can be pink, blue, white or even skin-colored.

• Infrequently, melanoma presents initially in metastatic form, having spread from an unknown or obscure primary lesion.

• Immune response to a cutaneous melanoma can result in partial or even total destruction of the lesion, a process termed regression.

• Predictors of a relatively poor prognosis for melanoma include: the aforementioned regression, vertical thickness (Breslow depth), mitotic rate, vascular invasion, and the presence of ulceration.

• New masses in known nodal locations require examination of surrounding skin to detect or rule out suspicious lesions.