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MALIGNANT MELANOMA
  • There has been a dramatic increase in the incidence of melanoma.
  • The incidence is rising faster than any other cancer in men and second only to lung cancer in women.
  • Melanoma and non-melanoma have common causative factors: exposure to ultraviolet rays in sunlight. Most dangerous is UV-B (wavelength 290 - 320nm).
  • Exposure to intermittent solar radiation appears more important versus chronic exposure to exposed areas of skin for basal and squamous carcinoma.
  • About 10% of melanomas occur in patients with positive family history, where melanoma is diagnosed at a younger age.
  • The most common presentation is increase in size or color of a pigmented lesion.
  • Biopsy is required for diagnosis.
  • Tumor thickness is measured in millimeters is the strongest predictor and single most important factor.
  • Prognosis in extremity is better than trunk or head and neck.
  • They have high metastatic potential.
  • However, sometimes they can be slow growing.

TREATMENT

Surgical excision is the treatment of choice.

  • For advanced lesions, regional lymph node dissection is done.
  • Recently, interferon was shown to improve survival when used after surgery in advanced lesions.
  • For metastatic disease, treatment options include chemotherapy, interleukin-2, interferon, lymphokine activated killer cells.
  • The response rates, however, are less than 40%.
  • Some novel treatment options with combination of the above agents are being tried.
  • Long term survival is possible for less than 1.5mm deep melanoma in 85% of cases.
  • For lesions deeper than this, less than half can have long term survival.
  • For those with lymph node involvement, the chances drop further to 20% to 30%.


PREVENTION

  • Since majority of skin cancers are related to chronic UV-B exposure, they can be prevented by reducing exposure to UV-B rays beginning early in life.
  • Sunscreen should be used regularly and sun exposure avoided from 10:00 a.m. to 2:00 p.m. Tanning salons should be avoided