Since summer is approaching I would like to talk a little about malignant melanoma, a potentially devastating disease if not caught in the early stages.
The incidence of melanoma in the U.S. is rising faster than any other cancer. One in 74 Americans will develop malignant melanoma in their lifetime.
A small percentage of patients have a genetic predisposition harboring the pig mutation. Individuals with a personal history of multiple melanomas or individuals with personal and family history of malignant melanoma and pancreatic cancer should have the genetic screening.
The biggest risk factor for melanoma is UV radiation exposure from the sun or tanning salons. The World Health Organization recommends that individuals under the age of 18 avoid tanning salons. An Australian study including 1,600 patients who used sunscreen regularly versus controls who did not, showed an 80% reduction in development of invasive melanoma over a 10 year follow up period. Sunscreen with SPF > 30 is recommended.
A key point to remember is that melanoma can develop in areas where the sun does not shine. Complete physical exam to screen for melanoma should include a thorough examination of the skull through the hair, the perianal area and the soles of the feet. There is also the misconception that African Americans cannot develop melanoma. The incidence in African Americans is much lower but this population can develop subungueal lesions.
The treatment for early stage is surgical excision with a wide clean margin. For intermediate stage, thick lesions or with nodal involvement in addition to surgery adjuvant biologics (interferon) constitute the therapeutic option. The advanced stage (with distant metastasis) is no longer curable. Chemotherapy and biologic agents have response rates ranging from 10 to 30% at best. New therapeutic targets are emerging. For example, 50% of melanomas have the BRAF mutation and currently new therapeutic agents that target the BRAF protein are being tested and appear to be promising but lots of work still needs to be done.