Keywords

The International Agency for Research on Cancer (IARC), a component of the World Health Organization (WHO), estimated that there were 160,177 new cases of cutaneous melanoma worldwide in 2002 (1). The IARC also estimated that there were 40,781 deaths due to this cause in 2002 (1).

The American Cancer Society estimated that there were 59,940 new cases and 8,110 deaths due to this cause in the USA in 2007(2). The estimated 5-year survival rate (all races) in the USA in 2007 was 92% for this cancer (2). Survival rates were adjusted for normal life expectancies and were based on cases diagnosed from 1996 to 2002 and followed through 2003.

There is a marked effect of race. Whites, particularly fair-skinned individuals, are at much higher risk than darker-skinned people. There is a marked effect of age as well, although young people are affected. Exposure to ionizing radiation, particularly in the form of sunlight, is a major risk factor. Genetic factors have been known for decades and specific genes have been identified. Patients with xeroderma pigmentosum, a disorder of defective DNA repair, have a greatly increased risk (3, 4). Skin morphology, including the presence of many pigmented nevi and congenital nevi, appears to confer risk. Immunosuppression, such as in organ transplant patients, increases the risk of melanoma (3, 4).

Geographic Variation Worldwide

The people of mainly non-European origin have much lower rates of melanoma than do people of mainly European origin. The highest incidence is found in Australia, New Zealand, Scandinavia, Switzerland, and white populations of the USA, including Hawaii. The populations with the lowest rates are those of Southern and Eastern Europe and South America (3). Within the USA, the incidence of this cancer is lower in northern regions than in southeastern and south-central regions (5).

Surveillance Strategies Proposed By Professional Organizations or National Government Agencies and Available on the Internet

National Comprehensive Cancer Network (NCCN, www.nccn.org)

NCCN guidelines were accessed on January 28, 2012 (Tables 49.1–49.3). There were major quantitative and qualitative changes compared to the guidelines accessed on April 10, 2007.

Table 49.1 Melanoma: stage 0 in situ
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Table 49.2 Melanoma: stage IA–IIA (no evidence of disease after treatment)
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Table 49.3 Melanoma: stage IIB–IV (no evidence of disease after treatment)
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American Society of Clinical Oncology (ASCO, www.asco.org)

ASCO guidelines were accessed on January 28, 2012. No quantitative guidelines exist for melanoma surveillance, including when first accessed on October 31, 2007.

The Society of Surgical Oncology (SSO, www.surgonc.org)

SSO guidelines were accessed on January 28, 2012. No quantitative guidelines exist for melanoma surveillance, including when first accessed on October 31, 2007.

European Society for Medical Oncology (ESMO, www.esmo.org)

ESMO guidelines were accessed on January 28, 2012. No quantitative guidelines currently exist for melanoma surveillance, compared to the quantitative guidelines accessed on October 31, 2007.

European Society of Surgical Oncology (ESSO, www.esso-surgeonline.org)

ESSO guidelines were accessed on January 28, 2012. No quantitative guidelines exist for melanoma surveillance, including when first accessed on October 31, 2007.

Cancer Care Ontario (CCO, www.cancercare.on.ca)

CCO guidelines were accessed on January 28, 2012. No quantitative guidelines exist for melanoma surveillance, including when first accessed on October 31, 2007.

National Institute for Clinical Excellence (NICE, www.nice.org.uk)

NICE guidelines were accessed on January 28, 2012. No quantitative guidelines currently exist for melanoma surveillance, compared to the quantitative guidelines accessed on October 31, 2007.

The Cochrane Collaboration (CC, www.cochrane.org)

CC guidelines were accessed on January 28, 2012. No quantitative guidelines exist for melanoma surveillance, including when first accessed on November 24, 2007.

American Academy of Dermatology Association (AAD, www.aad.org)

AAD guidelines were accessed on January 28, 2012 (Table 49.4). There are new quantitative guidelines compared to the guidelines accessed on January 14, 2008.

Table 49.4 Primary cutaneous melanoma
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The M.D. Anderson Surgical Oncology Handbook also has follow-up guidelines, proposed by authors from a single National Cancer Institute-designated Comprehensive Cancer Center, for many types of cancer (6). Some are detailed and quantitative, others are qualitative.

Summary

This is a common cancer with significant variability in incidence worldwide. We found consensus-based guidelines but none based on high-quality evidence.