Melanoma remains one of the most vexing problems
faced by dermatologists. The incidence of melanoma is
increasing faster than any other cancer in the United States,1,2
with the lifetime risk now estimated to be 1 in 59 (1 in 39 for
white men).3 It is not simply a matter of earlier, more aggressive
diagnosis because tumors of all thickness have shown
increases in incidence. More than 68,130 new cases of invasive
melanoma are expected to be diagnosed this year.4 It is
now the sixth most common cancer in the United States and
is presently the leading cause of cancer deaths in women
between the ages of 20 and 35.5
Fortunately there is also some good news about melanoma.
There have been significant advances recently in our ability to
identify patients at high risk, to diagnose melanoma at an earlier
and more curable point in the disease process, and to treat melanoma
of all stages. Now more than 85% of newly diagnosed
melanoma patients have the disease limited to the primary cutaneous
site (American Joint Committee on Cancer stage I and
II) and have an excellent prognosis. The ability to sequence and
analyze the human genome has altered our traditional dysplastic
nevus to melanoma model and identified multiple divergent
oncogenic pathways leading to melanoma. This new information
is having a significant impact on both bench research and
clinical trials and, as medicine becomes more personalized, will
likely help create more customized and targeted therapy. In
addition, there are new noninvasive technologies developed
each year that help clinicians evaluate suspicious lesions.
As experience with dermoscopy increases, so too does the
ability to recognize patterns more clearly and an associated increase
in the sensitivity and specificity of diagnosing pigmented
lesions. This helps reduce the number of unnecessary biopsies
as well as minimize the risk of missing potentially serious lesions.
In addition, bedside confocal microscopy, optical coherence
tomography, reflex transmission imaging, and other imaging
systems, such as SIAscopy and MelaFind, have shown real
potential to improve our ability to quickly and accurately
determine a pigmented lesion’s malignant potential. Sentinel
lymph node biopsies have been shown to accurately stage
regional lymph node basins in stage I and II melanoma patients,
and as histologic examination of the biopsied nodes
become more sensitive and more thorough, our ability to
define true positive and negative subsets will be even further
enhanced.
In this issue of the journal we will examine many of the
aspects of melanoma and discuss where the experts in our field
believe we stand in 2011 and where we may be headed in the
future. We begin with an in-depth look at the epidemiology of
melanoma. Dr Darrel Rigel discusses the alarming increase in
both the incidence and mortality of melanoma and evaluates the
exogenous and endogenous risk factors that may help us identify
those at higher risk for the disease and potential avenues to
reduce their risk. This article is followed by a review of the latest
discoveries on the divergent pathways of melanoma development
from Drs Velez, Ko, and Tsao. New mutations have been
identified that may have significant practical implications in patient
care. Drs Wasserman and Monheit present an update on
the most recent bedside technology available to help clinicians
diagnose melanoma. Dr Marghoob and colleagues continue in
the next article with an in-depth discussion on dermoscopy of
pigmented lesions and other tumors with particular attention to
the pediatric population. Dr Merrik Ross, a surgical oncologist
from the M D Anderson Cancer Center, presents an update on
sentinel node biopsies and its implications in clinical practice
after 20 years of experience. Dr Jose Lutzky, a medical oncologist
from Mount Sinai, addresses new therapeutic options in the
medical management of advanced melanoma. Dr Marc Brown
sums up the material and details a practical clinical approach to
the melanoma patient. Likewise, Dr Eric Parlette discusses melanoma
in situ and a practical approach to treatment. We are
indebted to these thought leaders in our field for sharing their
experience with us.