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 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