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Chapter 124. Cutaneous Melanoma

Evans C. Bailey; Arthur J. Sober; Hensin Tsao; Martin C. Mihm Jr.; Timothy M. Johnson Jr.

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Melanoma at a Glance
  • Rising incidence worldwide; United States estimated lifetime risk of developing invasive melanoma is 1:1,500 if born in 1935, 1:600 if born in 1960, 1:62 if born in 2006, and 1:50 if born in 2010 (1:30 with inclusion of in situ melanoma).
  • 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 52 years, 10–15 years younger than other more common cancers of the breast, lung, colon, and prostate.
  • 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 (irregular borders), C (color variegation), D (diameter >6 mm in most common use, but others have changed D to difference—“ugly duckling” sign or different with respect to change in size, shape, color, or persistent lesional pruritus), and E (evolving over time).
  • 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.

The incidence of melanoma has increased significantly worldwide over the last several decades. One in 50 born in the United States in 2010 is projected to develop invasive melanoma over their lifetime (1:39 men and 1:58 women), a 2,000% increase from 1930. With the inclusion of melanoma in situ, the lifetime risk increases to >1:30.1 It is estimated that 121,840 men and women were diagnosed with melanoma of the skin in 2009, of which 68,720 were invasive melanomas and 53,120 were melanoma in situ.2 Invasive melanoma of the skin is the fifth most frequent site for cancer to occur in men and the sixth most frequent site in women, representing approximately 5% of all newly diagnosed cancers.

Mortality rates for melanoma have recently stabilized for women, but continue to increase for men. The US surveillance, epidemiology, and end results (SEER) data estimates that in 2009, there were 8,650 deaths (5,550 men and 3,100 women) due to melanoma.2 Melanoma accounts for 75% of all skin cancer deaths. Melanoma is one of the leading cancers in terms of average years of life lost per death from disease.

The mean age of diagnosis is relatively young at 52 years, which is 10–15 years earlier than the mean age of diagnosis in the more common tumors of the breast, lung, colon, and prostate. More than 35% of melanomas occur in persons less than 45 years of age.1 Melanoma is the most common type of cancer in young adults in the US ages 25–29, second most common cancer in adolescents and young adults 15–29 years old. Incidence rises with age, especially in ...

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