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  • Melanoma accounts for over 80% of skin cancer–related deaths.

  • The incidence of melanoma has continued to increase over the last 30 years, with the highest incidence observed among fair-skinned populations.

  • A new or changing lesion on the skin should raise suspicion for melanoma.

  • An excisional skin biopsy, when feasible, is recommended for histopathologic evaluation and definitive diagnosis of melanoma.

  • The staging of melanoma is determined by tumor, node, and metastatic status.

  • Treatment of melanoma localized to the skin is by surgical excision, while metastatic disease may be treated with surgery, molecular target therapy, immunotherapy, and/or radiation therapy.


  • Both environmental (exogenous) and genetic (endogenous) risk factors contribute to the development of melanoma.

  • Tumor thickness and ulceration are the most important prognostic markers for cutaneous melanoma in the absence of regional and systemic disease.


  • Clinical diagnosis of melanoma is enhanced by the use of dermoscopy and other imaging techniques, such as total body photography and reflectance confocal microscopy.

  • Self-skin examination and full-body skin examinations by health care providers are key components in the surveillance of patients with melanoma.


  • Exposure to ultraviolet radiation is the major preventable environmental risk factor for melanoma.

  • Early detection and treatment of melanoma are fundamental, as this cancer is often curative at early stages. Late diagnoses are associated with poorer outcomes.

  • During and after treatment of melanoma, patients should continue to follow up with their health care providers, including the dermatology team.


Melanoma of the skin accounts for over 80% of skin cancer–related deaths.1 It arises from melanocytes in preexisting nevi, or more frequently de novo without a preexisting skin lesion. Although the vast majority of primary melanomas occur in the skin, they may also rarely develop in other areas of the body where melanocytes are found, including the eye or on mucosal surfaces of the head and neck, vulvovaginal, and anorectal regions.

Detection and treatment of melanoma in its early stages is essential for prognosis, as tumors are often curative with surgical removal. The 5-year melanoma-specific survival (MSS) rate for patients with melanoma is inversely related to the thickness and stage at diagnosis.2

According to the eighth edition of the American Joint Committee on Cancer (AJCC), for patients presenting with melanomas localized to the skin (stages I and II), the 5-year MSS ranges from 82% to 99%. The 5-year MSS varies widely for patients with regional metastatic melanoma (stage III), ranging from 93% (stage IIIA) to 32% (stage IIID).

Although the 5-year MSS for melanomas with distant metastases (stage IV) has historically been reported between 10% and 25%, the advances in treatment for patients with stage IV melanoma have dramatically improved the 5-year MSS (not included in the eighth edition of the AJCC).2 Therefore, with the advent of novel targeted ...

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