Skin Cancer: Melanoma

Melanoma is associated with the highest mortality rate among commonly diagnosed skin cancers. Intense intermittent exposure to UV radiation via sunlight is the most significant risk factor. A history of sunburns is another major factor. Patients with suspicious lesions or nevi typically ask about them during primary care visits, so it is imperative that primary care clinicians learn to recognize them. Clinicians and patients can apply the ABCDE (Asymmetry, irregular Borders, Color variation, Diameter greater than 6 mm, Evolution over time) criteria to monitor suspicious lesions. Dermatoscopy can aid clinicians in assessment. If melanoma is suspected, excisional biopsy is preferred over incisional biopsy. After a diagnosis of melanoma is confirmed, a multidisciplinary approach to management is needed, with involvement of a dermatology subspecialist and possibly an oncology subspecialist. Surgical excision is performed for early stage melanoma, and surgical excision with wide margins and possible sentinel lymph node biopsy for stages IB or II. For patients with metastatic disease, a combination of targeted therapy and immunotherapy is recommended. After initial treatment, patients should undergo follow-up examinations on a regular schedule. All patients diagnosed with stage IA to IV melanoma should undergo skin examinations at least annually for their lifetime.