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INTRODUCTION

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Epidemiology

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Epidemiology
Incidence: 76,100 (male: 43,890; female: 32,210. Estimated new cases for 2014 in the United States) Stage at Presentation
Stage 0: 49.3%
21.1 per 100,000 male and female per year (27.4 per 100,000 male 16.7 per 100,000 female) Stage I: 36.3%
Stage II: 7.3%
  Deaths: Estimated 9,710 in 2014 (male: 6,470; female: 3,240) Stage III: 3.7%
Median age: 61 years Stage IV: 3.4%
Male to female ratio: 1.5:1

Koh HK. N Engl J Med 1991;325:171–182

National Cancer Institute, Surveillance, Epidemiology and End Results (SEER) Program

Siegel R et al. CA Cancer J Clin 2014;64:9–29

Surveillance, Epidemiology and End Results (SEER) Program, available from http://seer.cancer.gov (accessed in 2013)

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Work-up

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Work-up

Stage IB

Stage II

Chest x-ray (optional), LDH

Further imaging as clinically indicated for stage IIB, IIC patients (CT scan ± PET/MRI)

Stage IIIA Chest x-ray, LDH. Further imaging if clinically indicated (CT scan ± PET, and/or MRI)

Stage IIIB

Stage IIIC

FNA preferred, if feasible, otherwise lymph node biopsy

Chest x-ray, LDH, pelvic CT and if inguinofemoral nodes positive Further imaging if clinically indicated (CT scan ± PET, or MRI)

Stage IV

FNA preferred, if feasible, otherwise lymph node biopsy

Chest x-ray and/or chest CT, LDH; consider abdomen/pelvic CT, head MRI and/or PET

Further imaging if clinically indicated

Notes:

1. Consider sentinel lymph node biopsy (SLNB) for stage IA with adverse features (positive deep margins, lymphovascular invasion, mitotic rate ≥1 mm2)

2. Encourage SLNB for stage IB and II

3. Discuss the impact of SLNB as an important staging tool and that the impact on survival is still unclear

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Five-Year Relative Survival

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Five-Year Relative Survival
Stage I: 91–99%
Stage II: 56–77%
Stage III: 27–59%
Stage IV: 18%

Rates are not available for stage IIIA patients (with microscopic lymph node involvement) because patients have at most 4 years of follow-up

 

Gimotty PA et al. A population-based validation of the American Joint Committee on Cancer melanoma staging system. J Clin Oncol 2005;23:8065–8075

NCI, Surveillance, Epidemiology and End Results (SEER) Program

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Pathology

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Pathology
Melanoma types
1. Superficial spreading melanoma 60–70%
2. Nodular melanoma 15–30%
3. Lentigo maligna melanoma 5%
4. Acral lentiginous melanoma 2–8%

Lotze MT, Dollard RM, Kirkwood JM, Flickinger JC. Cutaneous melanoma. In: DeVita VT et al.: Cancer: Principles & Practice of Oncology, 6th ed. Lippincott Williams & Wilkins, 2001

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Staging

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Staging
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Primary Tumor (T)
Classification Thickness (mm) Ulceration Status/Mitoses
Tis NA NA
T1 ≤1.00

a. Without ulceration and mitosis <1/mm2

b. With ulceration or mitoses ≥1/mm2

T2 1.01–2.00

a. Without ulceration

b. With ulceration

T3 2.01–4.00

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