Thissiteisintendedforhealthcareprofessionals

MalignantMelanoma
Updated:Nov09,2016
Author:WinstonWTan,MD,FACPChiefEditor:DirkMElston,MDmore...

OVERVIEW

PracticeEssentials
Malignantmelanoma(seetheimagebelow)isaneoplasmofmelanocytesoraneoplasmofthecells
thatdevelopfrommelanocytes.Althoughitwasonceconsidereduncommon,theannualincidence
hasincreaseddramaticallyoverthepastfewdecades.Surgeryisthedefinitivetreatmentforearly
stagemelanoma,withmedicalmanagementgenerallyreservedforadjuvanttreatmentofadvanced
melanoma.

Malignantmelanoma.ImagecourtesyofHonPak,MD.

ViewMediaGallery
SeeMoleorMelanoma?TestYourselfWithTheseSuspiciousLesions,aCriticalImagesslideshow,to
helpidentifyvariousskinlesions.
Also,seeTheCaseoftheMiddleAgedWomanwithSuddenUnilateralVisionLossslideshowtohelp
identifyandtreatmalignantintraocularmelanomas.

Signsandsymptoms

Thehistoryshouldaddressthefollowing:
Familyhistoryofmelanomaorskincancer
Familyhistoryofirregular,prominentmoles
Familyhistoryofpancreaticcancerorastrocytoma
Previousmelanoma(sometimesmultiplepatientshavereportedasmanyas8ormoreprimary
melanomas)
Previoussunexposure
Changesnotedinmoles(eg,size,color,symmetry,bleeding,orulceration)
Historyorfamilyhistoryofmultiplenevussyndrome
Physicalexaminationincludesthefollowing:
Totalbodyskinexamination,tobeperformedoninitialevaluationandduringallsubsequent
visits
Serialphotography,epiluminescencemicroscopy,andcomputerizedimageanalysis,tobe
consideredasadjuncts
Skinexaminationinvolvesassessingthenumberofnevipresentanddistinguishingbetweentypical
andatypicallesions.(Theimagesbelowdepictexamplesofmelanomas.)Earlymelanomasmaybe
differentiatedfrombenignnevibytheABCDs,asfollows:
AAsymmetry
BBorderirregularity
CColorthattendstobeverydarkblackorblueandvariable
DDiameter6mm
Ifapatientisdiagnosedwithamelanoma,examinealllymphnodegroups.
SeeClinicalPresentationformoredetail.

Diagnosis
Thefollowinglaboratorystudiesareindicated:
Completebloodcount
Completechemistrypanel(includingalkalinephosphatase,hepatictransaminases,totalprotein,
andalbumin)
Lactatedehydrogenase
Thefollowingimagingmodalitiesmaybeconsidered:
Chestradiography
Magneticresonanceimagingofthebrain
Ultrasonography(possiblythebestimagingstudyfordiagnosinglymphnodeinvolvement)
Computedtomographyofthechest,abdomen,orpelvis
Positronemissiontomography(PETPETCTmaybethebestimagingstudyforidentifyingother
sitesofmetastasis)
Procedurestobeconsideredintheworkupincludethefollowing:
Completeexcisionalbiopsyofasuggestivelesion
Surgicalexcisionorreexcisionafterbiopsy
Electivelymphnodedissection(ELND)forpatientswithclinicallyenlargednodesandno
evidenceofdistantdisease

Sentinellymphnodebiopsy(SLNBseeSentinelLymphNodeBiopsyinPatientsWith
Melanoma)
Characteristichistologicfindingsincludethefollowing:
Cytologicatypia,withenlargedcellscontaininglarge,pleomorphic,hyperchromicnucleiwith
prominentnucleoli
Numerousmitoticfigures
Pagetoidgrowthpatternwithupwardgrowthofthemelanocytes
SeeWorkupformoredetail.

Management
Surgery(eg,widelocalexcisionwithSLNB,ELND,orboth)isthedefinitivetreatmentforearlystage
melanoma.Medicalmanagementisreservedforadjuvanttherapyofpatientswithadvanced
melanoma.
Agentsusedinadjuvanttherapyincludethefollowing:
Interferonalfa
Pegylatedinterferon
Granulocytemacrophagecolonystimulatingfactor(GMCSF)
Agentsthatmaybeconsideredfortreatmentofadvancedstage(stageIV)melanomaincludethe
following:
Dacarbazine
Temozolomide(currentlyusedasthefirstlinedrugformelanomabymostoncologists)
Interleukin2
Cisplatin,vinblastine,anddacarbazine(CVD)
Cisplatin,dacarbazine,carmustine,andtamoxifen(Dartmouthregimen)
Imatinibmesylate[1]
Carboplatinandpaclitaxel(sometimescombinedwithsorafenib)
Ipilimumab
Pembrolizumab[2]
Trametinib
Vemurafenib
Dabrafenib
Peginterferonalfa2b[3]
Nivolumab[4]
Thefollowingproceduresmaybeusedtotreatbrainmetastases:
Stereotacticradiosurgery(forpatientswithalimitednumberofmetastases)
Externalbeamradiation
SeeTreatmentandMedicationformoredetail.

Background
Malignantmelanomaisaneoplasmofmelanocytesorofthecellsthatdevelopfrommelanocytes.
(Seetheimagesbelow.)Althoughmelanomawasonceconsideredanuncommondisease,theannual

incidencehasincreaseddramaticallyoverthepastfewdecades,ashavedeathsfrommelanoma.
(SeeEtiologyandEpidemiology.)

A1.5cmmelanomawithcharacteristicasymmetry,irregularborders,andcolorvariation.

ViewMediaGallery

Malignantmelanoma.ImagecourtesyofHonPak,MD.

ViewMediaGallery
AlsoseeLentigoMalignaMelanoma,OralMalignantMelanoma,andHeadandNeckMucosal
Melanomas.

Growth
Melanomashavetwogrowthphases,radialandvertical.Duringtheradialgrowthphase,malignant
cellsgrowinaradialfashionintheepidermis.Withtime,mostmelanomasprogresstothevertical
growthphase,inwhichthemalignantcellsinvadethedermisanddeveloptheabilitytometastasize.
(SeeEtiologyandWorkup.)
Clinically,lesionsareclassifiedaccordingtotheirdepth,asfollows:
Thin:1mmorless
Moderate:14mm
Thick:>4mm

Histologictypesofmelanoma
Therearefivedifferentforms,orhistologictypes,ofmelanoma:
Superficialspreadingmelanomas
Nodularmelanomas
Lentigomalignamelanomas
Acrallentiginousmelanomas
Mucosallentiginousmelanomas

Superficialspreadingmelanomas
Approximately70%ofcutaneousmalignantmelanomasarethesuperficialspreadingmelanoma
(SSM)type.ManySSMsarisefromapigmenteddysplasticnevus,oftenonethathaslongbeen
stable.Typicalchangesincludeulceration,enlargement,orcolorchanges.AnSSMmaybefoundon
anybodysurface,especiallythehead,neck,andtrunkofmalesandthelowerextremitiesoffemales.

Nodularmelanomas
Nodularmelanomas(NMs)representapproximately1015%ofmelanomasandalsoarefound
commonlyonallbodysurfaces,especiallythetrunkofmales.Theselesionsarethemostsymmetrical
anduniformofthemelanomasandaredarkbrownorblack.Theradialgrowthphasemaynotbe
evidentinNMshowever,ifthisphaseisevident,itisshortlived,becausethetumoradvancesrapidly
totheverticalgrowthphase,thusmakingtheNMahighrisklesion.Approximately5%ofallNMsare
amelanoticmelanomas.

Lentigomalignamelanomas
Lentigomalignamelanomas(LMMs)alsoaccountfor1015%ofmelanomas.Theytypicallyarefound
onsunexposedareas(eg,hand,neck).LMMsmayhaveareasofhypopigmentationandoftenare
quitelarge.LMMsarisefromalentigomalignaprecursorlesion.(Seetheimageoflentigomaligna
melanomabelow.)

Lentigomalignamelanoma,rightlowercheek.Thecentrallylocatederythematouspapulerepresentsinvasive
melanomawithsurroundingmacularlentigomaligna(melanomainsitu).ImagecourtesyofSusanM.Swetter,
MD.

ViewMediaGallery

Acrallentiginousmelanomas
Acrallentiginousmelanomas(ALMs)aretheonlymelanomasthathaveanequalfrequencyinblacks
andwhites.Theyoccuronthepalms,soles,andsubungualareas.Subungualmelanomasoftenare
mistakenforsubungualhematomas(splinterhemorrhages).LikeNM,ALMisextremelyaggressive,
withrapidprogressionfromtheradialtoverticalgrowthphase.

Mucosallentiginousmelanomas
Mucosallentiginousmelanomas(MLMs)developfromthemucosalepitheliumthatlinesthe
respiratory,gastrointestinal,andgenitourinarytracts.Theselesionsaccountforapproximately3%of
themelanomasdiagnosedannuallyandmayoccuronanymucosalsurface,includingtheconjunctiva,
oralcavity,esophagus,vagina,femaleurethra,penis,andanus.
Noncutaneousmelanomascommonlyarediagnosedinpatientsofadvancedage.MLMsappearto
haveamoreaggressivecoursethancutaneousmelanomas,althoughthismaybebecausethey
commonlyarediagnosedatalaterstageofdiseasethanthemorereadilyapparentcutaneous
melanomas.

Sitesotherthantheskin
Themajorityofmelanomasareintheskin,butothersitesincludetheeyes,mucosa,gastrointestinal
tract,genitourinarytract,andleptomeninges.Metastaticmelanomawithanunknownprimarysitemay
befoundinlymphnodesonly.

Staging
Clarkstagingisasfollows:
LevelIAlltumorcellsabovebasementmembrane(insitu)
LevelIITumorextendsintopapillarydermis
LevelIIITumorextendstointerfacebetweenpapillaryandreticulardermis
LevelIVTumorextendsbetweenbundlesofcollagenofreticulardermis(extendsintoreticular
dermis)

LevelVTumorinvasionofsubcutaneoustissue
Breslowclassification(thickness)isasfollows:
0.75mmorless
0.761.5mm
1.514mm
4mmormore
ThestagingsystemforcutaneousmelanomawasrevisedbytheAmericanJointCommitteeon
Cancer(AJCC)inearly2002.[5,6]AJCCgroupingsbasedonTNMclassificationareasfollows:
Stage0Tis,N0,M0
StageIAT1a,N0,M0
StageIBT1b,N0,M0T2b,N0,M0
StageIIAT2b,N0,M0T3a,N0,M0
StageIIBT3b,N0,M0T4a,N0,M0
StageIICT4b,N0,M0
StageIIIAnyT,N13,M0
StageIIIApT14a,N1a,M0pT14a,N2a,M0
StageIIIBpT14b,N1a,M0pT14b,N2a,M0pT14a,N1b,M0pT14a,N2b,M0pT14a/b,
N2c,M0
StageIIICpT14b,N1b,M0pT14b,N2b,M0anyT,N3,M0
StageIVAnyT,AnyN,AnyM
Tclassification(thickness)isasfollows:
TXPrimarytumorcannotbeassessed(shavebiopsy,regressedprimary)
TisMelanomainsitu
T11.0mm(a:withoutulceration,b:withulceration)
T21.012.0mm(a:withoutulceration,b:withulceration)
T32.014.0mm(a:withoutulceration,b:withulceration)
T4<4.0mm(a:withoutulceration,b:withulceration)
Nclassificationisasfollows:
N11lymphnodea:micrometastasis(clinicallyoccult),b:macrometastasis(clinically
apparent)
N223lymphnodesa:micrometastasis,b:macrometastasis,c:intransitmet(s),satellite(s),
withoutmetastaticlymphnodes(N2a:23nodespositiveformicrometastasisN2b:23nodes
positiveformacrometastasisN2c:Intransitmet(s)orsatellite(s)withoutmetastaticnodes)
N34ormoremetastaticnodesormattednodesorintransitmetastasesorsatellite(s)with
metastaticnode(s)
Notethatmicrometastasesarediagnosedafterelectiveorsentinellymphadenectomy.
Macrometastasesaredefinedasclinicallydetectablenodalmetastasesconfirmedbytherapeutic
lymphadenectomyorwhennodalmetastasisexhibitsgrossextracapsularextension.
Mclassificationisasfollows:
M1aDistantskin,subcutaneous,ornodalmetastases,normallactatedehydrogenase(LDH)
level
M1bLungmetastases,normalLDHlevel
M1cAllothervisceralmetastasesoranydistantmetastaseswithanelevatedLDHlevel

AlsoseeMalignantMelanomaStaging.

Etiology
Melanomasoriginatefrommelanocytes,whicharisefromtheneuralcrestandmigratetothe
epidermis,uvea,meninges,andectodermalmucosa.Themelanocytes,whichresideintheskinand
produceaprotectivemelanin,arecontainedwithinthebasallayeroftheepidermis,atthejunctionof
thedermisandepidermis.
Melanomasmaydevelopinornearapreviouslyexistingprecursorlesionorinhealthyappearingskin.
Amalignantmelanomadevelopinginhealthyskinissaidtoarisedenovo,withoutevidenceofa
precursorlesion.Manyofthesemelanomasareinducedbysolarirradiation.Melanomaalsomay
occurinunexposedareasoftheskin,includingthepalms,soles,andperineum.
Certainlesionsareconsideredtobeprecursorlesionsofmelanoma.Theseincludethefollowingnevi:
Commonacquirednevus
Dysplasticnevus
Dongenitalnevus
Cellularbluenevus

Genetics
Manygenesareimplicatedinthedevelopmentofmelanoma,includingCDKN2A(p16),CDK4,RB1,
CDKN2A(p19),PTEN/MMAC1,andras.CDKN2A(p16)appearstobeespeciallyimportantinboth
sporadicandhereditarymelanomas.Thistumorsuppressorgeneislocatedonband9p21,andits
mutationplaysaroleinvariouscancers.

Ultravioletradiation
Exposuretoultravioletradiation(UVR)isacriticalfactorinthedevelopmentofmostmelanomas.
UltravioletA(UVA),wavelength320400nm,andultravioletB(UVB),290320nm,potentiallyare
carcinogenicandactuallymayworkinconcerttoinduceamelanoma.
UVRappearstobeaneffectiveinducerofmelanomathroughmanymechanisms,including
suppressionoftheimmunesystemoftheskin,inductionofmelanocytecelldivision,freeradical
production,anddamageofmelanocyteDNA.
Interestingly,melanomadoesnothaveadirectrelationshipwiththeamountofsunexposurebecause
itismorecommoninwhitecollarworkersthaninthosewhoworkoutdoors.

Sunburn
Acute,intense,andintermittentblisteringsunburns,especiallyonareasofthebodythatonly
occasionallyreceivesunexposure,arethegreatestriskfactorforthedevelopmentofsunexposure
inducedmelanoma.Thissunassociatedriskfactorisdifferentthanthatforsquamousandbasalcell
skincancers,whichareassociatedwithprolonged,longtermsunexposure.
LMMisanexceptiontothisrule,becauseitfrequentlyappearsontheheadandneckofolder
individualswhohaveahistoryoflongtermsunexposure.

Additionalriskfactors

Importantly,otherfactorsexistthatmaypredisposeanindividualtomelanomachemicalsandviruses
are2etiologicagentsthatalsohavebeenimplicatedinthedevelopmentofmelanoma.
Greatlyelevatedriskfactorsforcutaneousmelanomaincludethefollowing:
Changingmole
Dysplasticneviinfamilialmelanoma
Morethan50nevi,2mmorgreaterindiameter
Moderatelyelevatedriskfactorsforcutaneousmelanomaincludethefollowing:
Onefamilymemberwithmelanoma
Previoushistoryofmelanoma
Sporadicdysplasticnevi
Congenitalnevus
Slightlyelevatedriskfactorsforcutaneousmelanomaincludethefollowing:
Immunosuppression
Sunsensitivity
Historyofacute,severe,blisteringsunburns
Freckling

Epidemiology
OccurrenceintheUnitedStates
TheAmericanCancerSocietyestimatesthat73,870casesofcutaneousmelanomawillbediagnosed
intheUnitedStatesin2015(42,670inmenand31,200inwomen).Overallratesofmelanomarose
rapidlyoverthepast3decades.From2007to2011,however,incidenceratesremainedstableinmen
andwomenyoungerthanage50,whileincreasing2.6%peryearinthose50orolder.[7]
Althoughmelanomaaccountsforlessthan2%ofskincancers,itisresponsibleforthevastmajorityof
deathsfromskincancers.TheAmericanCancerSocietyestimatesthat9,940peopleintheUS(6,640
menand3,300women)willdieofmelanomain2015.[7]

Internationalstatistics
Theincidenceofmalignantmelanomahasbeenincreasingrapidlyworldwide,andthisincreaseis
occurringatafasterratethanthatofanyothercancerexceptlungcancerinwomen.Queensland,
Australia,hasthehighestincidenceofmelanomaintheworld,approximately57casesper100,000
peopleperyear.Israelalsohasoneofthehighestincidences,approximately40casesper100,000
peopleannually.

Racialdemographics
MelanomaismorecommoninwhitesthaninblacksandAsians.Therateofmelanomainblacksis
estimatedtobeonetwentieththatofwhites.Whitepeoplewithdarkskinalsohaveamuchlowerrisk
ofdevelopingmelanomathandothosewithlightskin.Thetypicalpatientwithmelanomahasfairskin
andatendencytosunburnratherthantan.Whitepeoplewithblondorredhairandprofusefreckling
appeartobemostpronetomelanomas.InHawaiiandthesouthwesternUnitedStates,whiteshave
thehighestincidence,approximately2030casesper100,000peopleperyear.

Sexdemographics
Overall,melanomaisthefifthmostcommonmalignancyinmenandtheseventhmostcommon
malignancyinwomen,accountingfor5%and4%ofallnewcancercases,respectively.However,the
relativeincidenceofmelanomainmenandwomenvariesmarkedlybyage:inpeopleyoungerthan
50yearsofage,incidenceratesarehigherinwomenthaninmen,butbyage65,theyaretwiceas
highinmenasinwomen,andbyage80theyarethreetimesashighinmen.Thosedifferences
primarilyreflectdifferencesinoccupationalandrecreationalsunexposure,whichhavechangedover
time.[7]Womentendtohavelesionsthatarenonulceratedandthinnerthanthoseinmen.

Agedemographics
Melanomamayoccuratanyage,althoughchildrenyoungerthanage10yearsrarelydevelopade
novomelanoma.
Theaverageageatdiagnosisis57years,andupto75%ofpatientsareyoungerthan70years.
Melanomaisthemostcommonmalignancyinwomenaged2529yearsandaccountsformorethan
7000deathsannually.
Melanomaisnotoriousforaffectingyoungandmiddleagedpeople,unlikeothersolidtumors,which
mainlyaffectolderadults.Itiscommonlyfoundinpatientsyoungerthan55years,anditaccountsfor
thethirdhighestnumberofliveslostacrossallcancers.

Prognosis
Ifdetectedearly,melanomacanbecuredwithsurgicalexcision.
Superficialspreadingandnodulartypesofmelanomaarethe2mostcommonfatalmelanomas,
basedonareviewofdatafromtheoriginal9registriesoftheSurveillance,Epidemiology,andEnd
ResultsProgramfrom19782007.[8]Thisconfirmspriorstudies.
Factorspredictingthelikelihoodofresponsetotreatmentincludethefollowing:
Goodperformancestatus
Softtissuediseaseoronlyafewvisceralmetastases
Ageyoungerthan65years
Nopriorchemotherapy
Normalhepaticandrenalfunction
Normalcompletebloodcount(CBC)
Absenceofcentralnervoussystem(CNS)metastases
Theprognosisofamelanomalesioncanbepredictedbasedonthefollowing:thedepthofinvasion,
thepresenceorabsenceofulceration,andthenodalstatusatdiagnosis.Importantfactorsthatalso
affectmelanomaspecificsurvivalincludeage,lymphnodeinvolvement,andextranodalextension.[9]
Malignantmelanomasusuallypresentat2extremes:atoneendofthespectrumarepatientswith
smallskinlesionsthatareeasilycurablebysurgicalresection,andattheotherarepatientswith
widelymetastaticdisease,inwhomthetherapeuticoptionsarelimitedandtheprognosisisnil,witha
mediansurvivalofonly69months.Forthisreason,physiciansmustbeawareoftheclinical
characteristicsofmelanomatomakeanearlydiagnosis.Prognosisalsoisrelatedtothetypeof
melanoma.

Inareviewof3,872casesoflymphnodepositivemelanoma,theproportionofexaminedlymph
nodesfoundtobepositive(thelymphnoderatio)independentlypredicteddiseasespecificsurvival.
Theseresearchersconcludedthatthelymphnoderatioconsistentlyimprovedtheprognostic
accuracyoftheTNMsystem.[10]
Astudyofpatientswhodevelopedmelanomaaftersolidorgantransplantationfoundthattheiroverall
survivalwasworsethantheratereportedinanationalsampleofpatientswithmelanoma.Among
transplantrecipientswiththickermelanomas,diseasespecificsurvivalwassignificantlypoorerthanin
patientswithoutapriorhistoryoftransplantation.[11]
Inpatientswithmucosalmelanoma,amultivariableanalysisdeterminedthatanatomicprimarysite
wasanindependentpredictorofoverallsurvivalanddiseasespecificsurvival.Tumorsinthenasal
cavityandoralcavitywereassociatedwithsurvivalsuperiorcomparedwithtumorsinthe
nasopharynxandparanasalsinuses.Ageolderthan70years,tumorsize,nodalstatus,anddistant
metastasisstatuswerealsopredictiveofoutcome.[12]

Stageandprognosis
Prognosisdependsonthediseasestageatdiagnosis,asfollows:
PatentswithstageIdisease5yearsurvivalrateofgreaterthan90%
PatientswithstageIIdisease5yearsurvivalraterangingfrom4577%
PatientswithstageIIIdisease5yearsurvivalraterangingfrom2770%
Patientswithmetastaticdiseasehaveagrimprognosis,witha5yearsurvivalrateoflessthan20%.

StageIA
Lesionslessthanorequalto1mmthickwithnoevidenceofulcerationormetastases(T1aN0M0)are
associatedwitha5yearsurvivalrateof95%.

StageIB
Lesionslessthanorequalto1mmthickwithulcerationnotedbutwithoutlymphnodeinvolvement
(T1bN0M0)orlesions1.012mmthickwithoutulcerationorlymphnodeinvolvement(T2aN0M0)are
associatedwitha5yearsurvivalrateofapproximately91%.

StageIIA
Melanomasgreaterthan1mmbutlessthan2.01mminthicknesswithnoevidenceofmetastasesbut
withevidenceofulceration(T2bN0M0)orlesions2.014.0mmwithoutulcerationorlymphnode
involvement(T3aN0M0)areassociatedwithanoverall5yearsurvivalrateof7779%.

StageIIB
Melanomas2.014mmthickwithulcerationbutnolymphnodeinvolvement(T3bN0M0)orlesions
greaterthan4mmwithoutulcerationorlymphnodeinvolvement(T4aN0M0)areassociatedwitha5
yearsurvivalrateof6367%.

StageIIC

Lesionsgreaterthan4mmwithulcerationbutnolymphnodeinvolvement(T4bN0M0)areassociated
witha5yearsurvivalrateof45%.

StageIIIA
Patientswithanydepthlesion,noulcerationand1positive(micrometastatic)lymphnode(T1
4a,N1a,M0)havea5yearsurvivalrateof70%.T14a,N2a,M0lesions(anydepthlesion,no
ulcerationbut23nodespositiveformicrometastasis)areassociatedwitha5yearsurvivalrateof
63%.

StageIIIB
Patientswithanydepthlesion,positiveulceration,and1lymphnodepositiveformicrometastasis(T1
4b,N1a,M0)or23nodespositiveformicrometastasis(T14b,N2a,M0)havea5yearsurvivalrateof
5053%.Patientswithanydepthlesion,noulceration,and1lymphnodepositiveformacrometastasis
(T14a,N1b,M0)or23nodespositiveformacrometastasis(T14a,N2b,M0)havea5yearsurvival
rateof4659%.

StageIIIC
Patientswithanydepthlesion,positiveulceration,and1lymphnodepositiveformacrometastasis
(T14b,N1b,M0)or23nodespositiveformacrometastasis(T14b,N2b,M0)or4ormoremetastatic
lymphnodes,mattedlymphnodes,orintransitmet(s)/satellite(s)havea5yearsurvivalrateof24
29%.

StageIV
Melanomametastatictoskin,subcutaneoustissue,orlymphnodeswithnormalLDH(M1a)is
associatedwitha5yearsurvivalrateof19%.M1bdisease(metastaticdiseasetolungswithnormal
LDH)hasa5yearsurvivalrateof7%.M1cdisease(metastaticdiseasetoallothervisceralorgans
andnormalLDHoranydistantdiseasewithelevatedLDH)isassociatedwitha5yearsurvivalrateof
10%.
AlsoseeMalignantMelanomaStaging.

PatientEducation
Thefocusofmelanomapreventionandpatienteducationisavoidanceofsunexposure.
Forpatienteducationinformation,seetheCancerCenter,aswellasSkinCancer,SkinBiopsy,and
MoleRemoval.
ClinicalPresentation
WhattoReadNextonMedscape
RelatedConditionsandDiseases

MalignantMelanomaStaging
MalignantMelanomaGuidelines
OralMalignantMelanoma
MalignantMelanomaTreatmentProtocols

Melanoma
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NivolumabResponseHigherinMelanomaPatientsWithImmuneRelatedAEs

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Formulary
Slideshow

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