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AT-A-GLANCE

AT-A-GLANCE

  • Rising incidence worldwide in countries with white inhabitants, with highest incidence rates in Australia (35 new cases per year per 100,000 population), followed by North America (21.8 new cases per 100,000 population) and Europe (13.5 new cases per 100,000 population).

  • Risk factors include history of sunburns and/or heavy sun exposure, blue or green eyes, blonde or red hair, fair complexion, >100 typical nevi, any atypical nevi, prior personal or family history of melanoma, or p16 mutation.

  • Mean age of diagnosis is 63 years, with 15% being younger than 45 years.

  • Most common location is the back for men, and lower extremities followed by trunk for women, but can occur anywhere on the skin surface.

  • Features used for melanoma recognition: A (asymmetry), B (border), C (color), D (diameter, >5 mm in most common use), and E (evolution).

  • Follows a highly variable course and represents a heterogeneous disorder; surgically curable if diagnosed and treated in early phase, but potentially lethal with increased risk when diagnosed and treated late.

  • In the last decades, completely new and effective treatment options for metastatic melanoma approved with immunotherapies such as the immune checkpoint blockade (anti-CTLA4, anti-PD-1 antibodies) and targeted therapies like BRAF/MEK inhibitors leading to a median overall survival of 2 years in stage IV melanoma and the chance for a long-term tumor control.

INTRODUCTION

DEFINITIONS

Melanoma (a word derived from the greek melas [dark] and oma [tumor]) is a malignant tumor arising from melanocytic cells and hence can occur anywhere where these cells are found. The most frequent type is cutaneous melanoma but melanomas develop also at the mucosal, the uveal, or even the meningeal membrane. Ten percent of melanomas are detected by lymph node metastases with so-called “unknown primary” and are likely to develop in the lymph node from preexisting nodal nevi.1

HISTORICAL PERSPECTIVE

Cancer is a disease that probably accompanied human life from the very beginning. The earliest physical evidence of melanoma comes from diffuse melanotic metastases found in skeletons of Pre-Colombian mummies from Chancay and Chingas in Peru, dated to be about 2400 years old (radiocarbon). However, the first descriptions of the disease can be found in the writings of Hippocrates of Cos in the 5th century BC.2

Until a few years ago, the only cure was by surgery in the early stages. The first documented operation of a melanoma was done by the Scottish surgeon John Hunter in 1787. The preserved tumor is still housed in the Hunterian Museum at Lincolns Inn Fields in London.2 Until recently, in the unresectable metastatic setting, no treatment was available that could prolong patients’ survival. This was revolutionized in the last decade by the approval of immunotherapies, the so-called immune checkpoint blockers, and targeted treatments to the frequently found BRAF mutations.

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