Sections View Full Chapter Figures Tables Videos Annotate Full Chapter Figures Tables Videos Supplementary Content +++ INTRODUCTION ++ Epidemiology Table Graphic Jump Location | Download (.pdf) | Print 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) ++ Work-up Table Graphic Jump Location | Download (.pdf) | Print 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 ++ Five-Year Relative Survival Table Graphic Jump Location | Download (.pdf) | Print 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 ++ Pathology Table Graphic Jump Location | Download (.pdf) | Print 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 ++ Staging Table Graphic Jump Location | Download (.pdf) | Print Staging 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 a. Without ulceration b. With ulceration T4 >4.00... Your MyAccess profile is currently affiliated with '[InstitutionA]' and is in the process of switching affiliations to '[InstitutionB]'. Please click ‘Continue’ to continue the affiliation switch, otherwise click ‘Cancel’ to cancel signing in. Get Free Access Through Your Institution Learn how to see if your library subscribes to McGraw Hill Medical products. Subscribe: Institutional or Individual Sign In Username Error: Please enter User Name Password Error: Please enter Password Forgot Username? Forgot Password? Sign in via OpenAthens Sign in via Shibboleth