Amelanotic melanomas and melanomas arising in fair-skinned individuals are very difficult to detect, as they fail to show many of the characteristics in the ABCD rule, break the "ugly duckling" sign, and are hard to distinguish from acne scarring, insect bites, dermatofibromas, or lentigines. Biopsy
Following a visual examination and a dermatoscopic exam, or in vivo diagnostic tools such as a confocal microscope, the doctor may biopsy the suspicious mole. A skin biopsy performed under local anesthesia is often required to assist in making or confirming the diagnosis and in defining severity. Elliptical excisional biopsies may remove the tumor, followed by histological analysis and Breslow scoring. Incisional biopsies such as punch biopsies are usually contraindicated in suspected melanomas, because of the possibility of sampling error or local implantation causing misestimation of tumour thickness. However, fears that such biopsies may increase the risk of metastatic disease seem unfounded.Total body photography, which involves photographic documentation of as much body surface as possible, is often used during follow-up for high-risk patients. The technique has been reported to enable early detection and provides a cost-effective approach (with any digital camera), but its efficacy has been questioned due to its inability to detect macroscopic changes. The diagnosis method should be used in conjunction with (and not as a replacement for) dermoscopic imaging, with a combination of both methods appearing to give extremely high rates of detection. Histopathologic types
Melanoma is a type of neuroectodermal neoplasm. There are four main types of melanoma:
Other histopathologic types are:

Mucosal melanoma; When melanoma occurs on mucous membranes.
As pulmonary heart disease progresses, most individuals will develop symptoms like:
Shortness of breath
Wheezing
Cyanosis
Ascites
Jaundice
Enlargement of the liver
Raised jugular venous pressure (JVP)
Third heart sound
Intercostal recession
Presence of abnormal heart sounds

Causes
The causes of pulmonary heart disease (cor pulmonale) are the following:

Acute respiratory distress syndrome (ARDS)
COPD
Primary pulmonary hypertension
Blood clots in lungs
Kyphoscoliosis
Interstitial lung disease
Cystic fibrosis
Sarcoidosis
Obstructive sleep apnea (untreated)
Sickle cell anemia
Bronchopulmonary dysplasia (in infants)

Pathophysiology
The pathophysiology of pulmonary heart disease (cor pulmonale) has always indicated that an increase in right ventricular afterload causes RV failure (pulmonary vasoconstriction, anatomic disruption/pulmonary vascular bed and increased blood viscosity are usually involved), however most of the time, the right ventricle adjusts to an overload in chronic pressure. According to Voelkel, et al., pressure overload is the initial step for changes in RV, other factors include:
Ischemia
Inflammation
Oxidative damage
Epigenetics
Abnormal cardiac energetics

Diagnosis
Investigations available to determine the cause of cor pulmonale include the following:
Chest x-ray – right ventricular hypertrophy, right atrial dilatation, prominent pulmonary artery
ECG – right ventricular hypertrophy, dysrhythmia, P pulmonale (characteristic peaked P wave)
Thrombophilia screen- to detect chronic venous thromboembolism (proteins C and S, antithrombin III, homocysteine levels)

Differential diagnosis
The diagnosis of pulmonary heart disease is not easy as both lung and heart disease can produce similar symptoms. Therefore, the differential diagnosis (DDx) should assess:
Atrial myxoma
Congestive heart failure
Constrictive pericarditis
Infiltrative cardiomyopathies
Right heart failure (right ventricular infarction)
Ventricular septal defect

Treatment
The treatment for cor pulmonale can include the following: antibiotics, expectorants, oxygen therapy, diuretics, digitalis, vasodilators, and anticoagulants. Some studies have indicated that Shenmai injection with conventional treatment is safe and effective for cor pulmonale (chronic).Treatment requires diuretics (to decrease strain on the heart).