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: 100,350 (male: 60,190; female: 40,160. Estimated new cases for 2020 in the United States) Stage at Presentation 22.2 per 100,000 male and female per year (28.8 per 100,000 male 17.5 per 100,000 female) Localized 81.0% Deaths: Estimated 6850 in 2020 (male: 4610; female: 2240) Regional 8.6% Median age: 65 years Distant 4.2% Male to female ratio: 1.6:1 Unstaged 6.1% Koh HK. N Engl J Med 1991;325:171–182 Siegel R et al. CA Cancer J Clin 2020;70:7–30 Surveillance, Epidemiology and End Results (SEER) Program, available from http://seer.cancer.gov [accessed in 2020] ++ 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 brain) Stage IIIA Chest x-ray, LDH. Further imaging as clinically indicated (CT scan ± PET, and/or MRI brain) BRAF mutation testing Stage IIIB Stage IIIC Stage IIID FNA of clinically palpable lymph node preferred, if feasible, otherwise lymph node or other accessible metastatic disease biopsy Chest x-ray, LDH. Further imaging as clinically indicated (CT scan ± PET, and/or MRI brain) BRAF mutation testing Stage IV FNA preferred, if feasible, otherwise lymph node or other accessible metastatic disease biopsy LDH; CT scan ± PET, and/or MRI brain Further imaging as clinically indicated BRAF mutation testing Note: Consider sentinel lymph node biopsy (SLNB) for Stage IA with adverse features (positive deep margins, lymphovascular invasion, mitotic rate ≥1 mm2) Encourage SLNB for Stage IB and II Discuss the impact of SLNB as an important staging tool and that the impact on survival is still unclear ++ Survival Table Graphic Jump Location|Download (.pdf)|Print Survival 5-Year Melanoma-specific Survival 10-Year Melanoma-specific Survival Stage IA 99% 98% Stage IB 97% 94% Stage IIA 94% 88% Stage IIB 87% 82% Stage IIC 82% 75% Stage IIIA 93% 88% Stage IIIB 83% 77% Stage IIIC 69% 60% Stage IIID 32% 24% Gershenwald JE et al. CA Cancer J Clin 2017;67:472–492 ++ Pathology Table Graphic Jump Location|Download (.pdf)|Print Pathology Melanoma Types 1. Superficial spreading melanoma 60–70% 2. Nodular melanoma 15–30% 3. Lentigo malignant melanoma 5% 4. Acral lentiginous melanoma 2–8% Lotze MT et al. Cutaneous melanoma. In: DeVita VT et al (editors). Cancer: Principles & Practice of Oncology, 6th ed. Philadelphia: Lippincott Williams & Wilkins; 2001 ++ Staging Table Graphic Jump Location|Download (.pdf)|Print Staging Primary Tumor (T) Classification Thickness (mm) Ulceration Status/Mitoses TX: primary tumor thickness cannot be assessed (eg, diagnosis by curettage) NA NA T0: no evidence of primary tumor (eg, unknown primary or completely regressed melanoma) NA NA Tis (melanoma in situ) NA NA T1 ≤1.0 Unknown or unspecified T1a <0.8 mm Without ulceration T1b <0.8 mm With ulceration 0.8–1.0 mm With or without ulceration T2 >1.0–2.0 mm Unknown or unspecified... Your Access profile is currently affiliated with [InstitutionA] and is in the process of switching affiliations to [InstitutionB]. Please select how you would like to proceed. Keep the current affiliation with [InstitutionA] and continue with the Access profile sign in process Switch affiliation to [InstitutionB] and continue with the Access profile sign in process 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 Error: Incorrect UserName or Password Username Error: Please enter User Name Password Error: Please enter Password Sign in Forgot Password? Forgot Username? Sign in via OpenAthens Sign in via Shibboleth You already have access! Please proceed to your institution's subscription. Create a free profile for additional features.