- 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.
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%.
- 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