Malignant melanoma partly evolves from moles (especially junctional and compound nevi), while another portion originates from the skin or on the basis of freckles. Patients can be of any age, but it is more common in the elderly. The prognosis for female patients is better than for male patients, though the malignancy of melanoma can worsen during pregnancy. The exact cause of moles transforming into melanoma remains unclear, with trauma or various external stimuli often considered contributing factors. Although malignant melanoma is a highly aggressive tumor that develops rapidly and metastasizes widely, its biological behavior can vary significantly. The lesion may remain dormant for years or grow slowly, or it may enlarge rapidly and metastasize within a short period.

bubble_chart Clinical Manifestations

Eyelid melanoma often occurs in the inner and outer canthus and the eyelid margin, then spreads to both the eyelid and conjunctiva. The initial stage [first stage] may appear as a black mole or melanin nodules of varying sizes and uneven surfaces, with uneven pigment distribution or even no pigment (amelanotic melanoma). Around larger nodules, smaller nodules may be distributed, with diffuse nearby pigmentation and vascular engorgement. If the surface ulcerates, it easily forms an ulcer, or it may rapidly grow into a massive tumor within a short period. Some cases develop into cauliflower-like masses, which can be misdiagnosed as squamous cell carcinoma. The disease course can be as short as one or two months, developing into a massive tumor, or as long as several decades, with the latter often evolving from a mole.

The clinical features of melanoma are crucial. Any hairless mole that suddenly enlarges rapidly, significantly darkens in color, or develops new pigmented areas outside the original dark region should be considered a potential sign of malignant transformation, indicating rapid tumor spread along the epithelial layer. Papillary or nodular growth on the tumor surface, the appearance of satellite nodules, unexplained bleeding, or surface ulceration are further evidence of malignancy and should not be overlooked. Extensive destruction leads to massive tissue necrosis and shedding, severely affecting the eyelid, conjunctiva, and eyeball. However, in most cases, widespread metastasis occurs early, spreading directly via local lymphatic ducts or metastasizing to the brain, liver, or even nearly all internal organs via the bloodstream. Patients may die rapidly within a short period.

1. Patients with malignant melanoma are generally older in age, and melanoma is rare in young adults or children. For most tumors, age only holds statistical significance, but in cases of melanoma, age sometimes becomes one of the important diagnostic criteria.

2. Generally, the surface of a mole is relatively smooth, while the surface of melanoma tends to be rough. If a previously smooth black mole suddenly becomes rough or nodular, attention should be paid. Moles can be very dark in color, while melanomas may appear light or even non-pigmented. If the pigmentation is uneven, irregularly distributed, and the lesion area is rich in blood vessels, with peripheral satellite nodules or pigment dispersion, vigilance should be heightened.

In terms of texture, moles are soft and flexible, while melanomas are hard and brittle. Because melanoma epidermal cells can self-dissolve and ulcerate, the surface often develops fissures or ulcers, which is a manifestation of its malignant nature. Even if an ulcer has not yet formed, unexplained bleeding is also a dangerous signal.

Hairy moles are intradermal nevi and generally rarely undergo malignant transformation. However, if the hair on a mole falls out on its own, it suggests active changes at the dermoepidermal junction of the hair follicle, indicating a potential risk of malignant transformation. Such moles should be monitored closely or excised for biopsy.

3. Ulcer formation is one of the key clinical features distinguishing melanoma from moles, and it also carries prognostic significance. Ulcerated melanomas have a worse prognosis than non-ulcerated ones.

bubble_chart Treatment Measures