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Preface Julie E. Russak Darrell S. Rigel xi
Update on the Current State of Melanoma Incidence Emily G. Little MelodyJ. Eide 355
The incidence of melanoma is rising worldwide, and in the United States has increased by approximately 2.8% annually since 1981. Melanoma is more common in whites, and is generally more prevalent in men. However, there is a 6.1 % annual increase in US incidence of melanomas in white women younger than age 44, with growing concern that increases in skin cancer in younger women may reflect recent trends in indoor tanning. Melanoma incidence is also greater in higher economic groups. Globally, melanoma incidence is highest in Australia, followed by the United States and parts of Europe.
Risk Factors for the Development of Primary Cutaneous Melanoma Julie E. Russak Darrell S. Rigel 363
Melanoma is an important public health problem in the United States and worldwide. The incidence of melanoma continues to increase at a high rate and deaths from melanoma are also increasing. The endogenous risk factors that are currently recognized are in many cases surrogates for genetic markers yet to be determined. Exogenous risk factors need to be better defined and understood to help develop better public education programs that can change risk behaviors and subsequently lower future incidence and mortality from melanoma.
The Effect of Sunscreen on Melanoma Risk Jennifer S. Mulliken Julie E. Russak Darrell S. Rigel 369
Total cumulative sun exposure is associated with the development of squamous cell and basal cell cancers, whereas intense intermittent sun exposure is associated with the development of melanoma. Exposure to UV radiation is the only known modifiable cause of melanoma, but the role of sunscreen in melanoma prevention remains somewhat controversial. This article discusses how UV radiation contributes to the pathogenesis of melanoma, how sunscreen modulates the action of UV radiation on the skin, and the effect of sunscreen on the risk of developing melanoma. A review of available sunscreen agents and their sun-protective properties is also included.
Current Management Approaches for Congenital Melanocyte Nevi Sven Krengel Ashfaq A. Marghoob 377
Lack of information and misinformation abounds regarding the potential risks of malignancy, management approaches, benefits of surgical intervention, follow-up strategies, and overall prognosis for individuals with congenital melanocyte nevi (CMN). This review is intended to provide answers to questions that frequently arise shortly after the birth of individuals with CMN, especially of larger types.
Dysplastic Nevi MicheleJ. Farber Edward R. Heilman Robert J. Friedman 389
Dysplastic nevi have been a subject of much debate since their original description in 1978. Although some question the biological potential of dysplastic nevi themselves, several studies have shown that their presence confers substantial risk for melanoma. In addition to predisposing patients to melanoma, dysplastic nevi have been shown to harbor genetic mutations, indicating their position on a continuum between banal nevi and melanomas. Dysplastic nevi are also clinically relevant as mimickers of melanoma, and can be challenging diagnostically. This article reviews the history, epidemiology, biology and genetics, clinical features, histopathologic features, and management guidelines for patients with these lesions.
New Approaches to Melanoma Prevention June K. Robinson Mary Kate Baker Joel J. Hillhouse 405
Skin cancer is a major public health concern, and tanning remains a modifiable risk factor. Multidimensional influences, including psychosocial, individual, environmental, and policy-related factors, create the milieu for individuals to engage in tanning. Parents and physicians can modify the behavior of teens and young adults using strategies based on harm reduction. Environmental and policy-related factors similar to those used to limit smoking by restricting access of minors to cigarettes in the United States in the 20th century need to be created. Federal regulations can restrict direct advertising and the excise tax can be increased to a prohibitive amount. Social networking may assist with affect regulation.
Dermatoscopy for Melanoma and Pigmented Lesions Babar K. Rao Christine S. Ahn 413
This article presents an overview of the history and development of dermatoscopy over the last 2 decades. The common dermatoscopic diagnostic algorithms are discussed, including classic pattern analysis, the ABCD rule (asymmetry, border, color, and dermatoscopic structures), 7-point checklist, and Menzies method, as well as a new method by the authors (ASAP: a simple and practical approach). In addition, evidence on the clinical impact and challenges of dermatoscopy for the diagnosis and management of pigmented lesions and the importance of training are reviewed.
Biopsy of the Pigmented Lesions David Silverstein Kavita Mariwalla 435
Although new technologies are becoming available to aid in diagnosis, the skin biopsy continues to be the fundamental tool of the dermatologist to evaluate the nature of a pigmented lesion. There are 3 major techniques for the biopsy of a pigmented lesion: shave biopsy, punch/incisional biopsy, and excisional biopsy. This article discusses when to biopsy a pigmented lesion and reviews the different biopsy techniques, with reference to specific clinical scenarios.
The Pathology of Melanoma Clay J. Cockerell 445
Although melanoma represents only 10% of all skin cancer diagnoses, it accounts for at least 65% of all skin cancer-related deaths. The number of new cutaneous melanoma cases projected during 2010 was 68,000-a 23% increase from the 2004 prediction of 55,100 cases. In 2015, the lifetime risk of developing melanoma is estimated to increase to 1 in 50. As the incidence of melanoma continues to rise, now more than ever, clinicians and histopathologists must have familiarity with the various clinical and pathologic features of cutaneous melanoma.
Prognostic Factors for Melanoma Oliver J. Wisco Arthur J. Sober 469
The current melanoma staging system, as defined by the American Joint Committee on Cancer (AJCC), is the standard by which melanoma prognosis is determined. This article focuses on the components of the AJCC melanoma staging system regarding patient prognosis. In addition, this article summarizes the other commonly researched clinical and histologic melanoma prognostic factors and reviews the recent advancements in genetic biomarkers associated with prognosis.
Surgical Treatment of Malignant Melanoma: Practical Guidelines Steven M. Levine Richard L. Shapiro 487
Melanoma is currently the fifth and sixth most common solid malignancy diagnosed in men and women, respectively. Although accounting for only 4% of cases of all cutaneous malignancies, melanoma accounts for more than 75% of all deaths from skin cancer. This article discusses epidemiology and risk factors, proper biopsy technique, advanced histologic evaluation of biopsy material, assessment of tumor thickness and staging, preoperative metastatic evaluation, excision margin, treatment of regional lymph nodes, treatment of recurrence, and some special clinical situations.
Mohs Micrographic Surgery for the Treatment of Melanoma Andrea M. Hui Michael Jacobson Orit Markowitz Norman A. Brooks Daniel M. Siegel 503
For melanoma treatment, the primary goal is complete removal with histologically negative margins. Mohs micrographic surgery (MMS) has been extensively used and studied for the treatment of nonmelanoma skin cancer, particularly at sites where tissue conservation is vital. The use of MMS for melanoma treatment has yet to become widely accepted owing to difficulties in histologic interpretation, among other factors. MMS may offer lower recurrence rates and improved survival when compared with historical controls for standard excision. Continued advances in M MS technique and immunohistochemical staining have allowed the technique to gain further support.
Targeted Therapies for Metastatic Melanoma Sunandana Chandra Anna C. Pavlick 517
The next few years may show that when the novel therapeutics reviewed in this article are used in thoughtful combinations, a new standard of care for the treatment of advanced melanoma will emerge. As more understanding is gained on the different signaling pathways for tumor cell growth and mechanisms of action of the different classes of drugs, the ability to identify different subsets of patients with differentially dysregulated oncogenic signaling pathways may allow for more individualized treatments of advanced melanoma in the near future, which will ultimately translate into improved survival.
Radiation Therapy for Cutaneous Melanoma Christopher A. Barker Nancy Y. Lee 525
Radiation therapy is used infrequently for cutaneous melanoma, despite research suggesting benefit in certain clinical scenarios. This review presents data forming the highest level of evidence supporting the use of radiation therapy. Retrospective and prospective studies demonstrate radiation therapy for primary tumors is associated with high control rates. Two randomized trials have found improvements in regional control with adjuvant radiotherapy to regional lymphatics. Retrospective and prospective studies demonstrate radiation therapy is associated with palliative response and metastatic tumor control. Optimal care of melanoma patients involves radiation therapy; awareness of this is incumbent of clinicians caring for patients with this disease.
New Diagnostic Aids for Melanoma Laura Korb Ferris Ryan J. Harris 535
Detection of melanoma at an early stage is crucial to improving survival rates in melanoma. Accurate diagnosis by current techniques including dermatoscopy remains difficult, and new tools are needed to improve our diagnostic abilities. This article discusses recent advances in diagnostic techniques including confocal scanning laser microscopy, MelaFind, SIAscopy, and noninvasive genomic detection, as well as other future possibilities to aid in diagnosing melanoma. Advantages and barriers to implementation of the various technologies are also discussed.