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INTRODUCTION

Epidemiology

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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

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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 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:

  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

Survival

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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

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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

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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

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