Role of Dermatologists in Treating Melanoma

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Melanoma is a major focus of dermatology training and practice, with dermatologists playing a central role in managing melanoma through primary prevention, secondary prevention, diagnosis, and treatment of thinner tumors. Dermatologists have led public health efforts to raise melanoma awareness, promulgate the early warning signs of melanoma, and promote melanoma prevention through sun protection. Dermatologists have unique expertise in melanoma risk assessment and the clinical diagnosis of melanoma through visual inspection and the use of diagnostic aids, including dermoscopy and photographically assisted follow-up. Increasing incidence of melanoma, earlier melanoma detection, narrower excision margins, and improved surgical training in dermatology have recently combined to enhance the role of dermatologists in melanoma care. For patients with thin primary melanomas, dermatologists are increasingly assuming complete care, including wide local excision and long-term surveillance for both disease recurrence and detection of new primary melanoma. Conversely, the advent of sentinel lymph node biopsy and adjuvant therapy has made melanoma management more complex and has intensified the need for a multidisciplinary approach to the disease. In this context, dermatologists contribute significantly to the formation, administration, and implementation of multidisciplinary melanoma programs.

Correspondence: Allan C. Halpern, MD, Chief, Dermatology Service, Memorial Sloan-Kettering Cancer Center, 160 East 53rd Street, New York, NY 10022. E-mail: halperna@mskcc.org
  • 1.

    JemalAMurrayTWardE. Cancer statistics, 2005. CA Cancer J Clin2005;55:1030.

  • 2.

    de VriesECoeberghJW. Melanoma incidence has risen in Europe. BMJ2005;331:698.

  • 3.

    WelchHGWoloshinSSchwartzLM. Skin biopsy rates and incidence of melanoma: population based ecological study. BMJ2005;331:481.

  • 4.

    de VriesESchoutenLJVisserO. Rising trends in the incidence of and mortality from cutaneous melanoma in the Netherlands: a Northwest to Southeast gradient?Eur J Cancer2003;39:14391446.

    • Search Google Scholar
    • Export Citation
  • 5.

    ThompsonJFScolyerRAKeffordRF. Cutaneous melanoma. Lancet2005;365:687701.

  • 6.

    RobertsDLAnsteyAVBarlowRJ. UK guidelines for the management of cutaneous melanoma. Br J Dermatol2002;146:717.

  • 7.

    CarliPDe GiorgiVNardiniP. Melanoma detection rate and concordance between self-skin examination and clinical evaluation in patients attending a pigmented lesion clinic in Italy. Br J Dermatol2002;146:261266.

    • Search Google Scholar
    • Export Citation
  • 8.

    GutzmerRAl GhazalMGeerlingsHKappA. Sentinel node biopsy in melanoma delays recurrence but does not change melanoma-related survival: a retrospective analysis of 673 patients. Br J Dermatol2005;153:11371141.

    • Search Google Scholar
    • Export Citation
  • 9.

    MorettiSCarliPBiggeriA. Cohort study of metastatic melanoma patients in the Dermatology Institute of Florence 1990/1997. J Eur Acad Dermatol Venereol2001;15:3033.

    • Search Google Scholar
    • Export Citation
  • 10.

    SalopekTGSladeJMMarghoobAA. Management of cutaneous malignant melanoma by dermatologists of the American Academy of Dermatology. II. Definitive surgery for malignant melanoma. J Am Acad Dermatol1995;33:451461.

    • Search Google Scholar
    • Export Citation
  • 11.

    ArmstrongBKKrickerA. The epidemiology of UV induced skin cancer. J Photochem Photobiol B2001;63:818.

  • 12.

    TuckerMAGoldsteinAM. Melanoma etiology: where are we?Oncogene2003;22:30423052.

  • 13.

    WhitemanDCWattPPurdieDM. Melanocytic nevi, solar keratoses, and divergent pathways to cutaneous melanoma. J Natl Cancer Inst2003;95:806812.

    • Search Google Scholar
    • Export Citation
  • 14.

    RiversJK. Is there more than one road to melanoma?Lancet2004;363:728.

  • 15.

    BerkingC. The role of ultraviolet irradiation in malignant melanoma [in German]. Hautarzt2005;56:687696.

  • 16.

    PhoLGrossmanDLeachmanSA. Melanoma genetics: a review of genetic factors and clinical phenotypes in familial melanoma. Curr Opin Oncol2006;18:173179.

    • Search Google Scholar
    • Export Citation
  • 17.

    KeffordRFMannGJ. Is there a role for genetic testing in patients with melanoma?Curr Opin Oncol2003;15:157161.

  • 18.

    UribePAndradeLGonzalezS. Lack of association between BRAF mutation and MAPK ERK activation in melanocytic nevi. J Invest Dermatol2006;126:161166.

    • Search Google Scholar
    • Export Citation
  • 19.

    YangGRajaduraiATsaoH. Recurrent patterns of dual RB and p53 pathway inactivation in melanoma. J Invest Dermatol2005;125:12421251.

  • 20.

    SmalleyKSHerlynM. Targeting intracellular signaling pathways as a novel strategy in melanoma therapeutics. Ann N Y Acad Sci2005;1059:1625.

    • Search Google Scholar
    • Export Citation
  • 21.

    BlissJMFordDSwerdlowAJ. Risk of cutaneous melanoma associated with pigmentation characteristics and freckling: systematic overview of 10 case-control studies. The International Melanoma Analysis Group (IMAGE). Int J Cancer1995;62:367376.

    • Search Google Scholar
    • Export Citation
  • 22.

    MarrettLDKingWDWalterSDFromL. Use of host factors to identify people at high risk for cutaneous malignant melanoma. CMAJ1992;147:445453.

    • Search Google Scholar
    • Export Citation
  • 23.

    TuckerMAHalpernAHollyEA. Clinically recognized dysplastic nevi. A central risk factor for cutaneous melanoma. JAMA1997;277:14391444.

    • Search Google Scholar
    • Export Citation
  • 24.

    GellerACZhangZSoberAJ. The first 15 years of the American Academy of Dermatology skin cancer screening programs: 1985-1999. J Am Acad Dermatol2003;48:3441.

    • Search Google Scholar
    • Export Citation
  • 25.

    KohHKNortonLAGellerAC. Evaluation of the American Academy of Dermatology's National Skin Cancer Early Detection and Screening Program. J Am Acad Dermatol1996;34:971978.

    • Search Google Scholar
    • Export Citation
  • 26.

    AitkenJFJandaMElwoodM. Clinical outcomes from skin screening clinics within a community-based melanoma screening program. J Am Acad Dermatol2006;54:105114.

    • Search Google Scholar
    • Export Citation
  • 27.

    GellerACMillerDRAnnasGD. Melanoma incidence and mortality among US whites, 1969–1999. JAMA2002;288:17191720.

  • 28.

    GellerACSoberAJZhangZ. Strategies for improving melanoma education and screening for men age > or = 50 years: findings from the American Academy of Dermatological National Skin Cancer Sreening Program. Cancer2002;95:15541561.

    • Search Google Scholar
    • Export Citation
  • 29.

    CarliPDe GiorgiVPalliD. Dermatologist detection and skin self-examination are associated with thinner melanomas: results from a survey of the Italian Multidisciplinary Group on Melanoma. Arch Dermatol2003;139:607612.

    • Search Google Scholar
    • Export Citation
  • 30.

    BradyMSOliveriaSAChristosPJ. Patterns of detection in patients with cutaneous melanoma. Cancer2000;89:342347.

  • 31.

    OliveriaSADuszaSWPhelanDL. Patient adherence to skin self-examination. Effect of nurse intervention with photographs. Am J Prev Med2004;26:152155.

    • Search Google Scholar
    • Export Citation
  • 32.

    EpsteinDSLangeJRGruberSB. Is physician detection associated with thinner melanomas?JAMA1999;281:640643.

  • 33.

    MarghoobAASladeJKopfAW. Risk of developing multiple primary cutaneous melanomas in patients with the classic atypical-mole syndrome: a case-control study. Br J Dermatol1996;135:704711.

    • Search Google Scholar
    • Export Citation
  • 34.

    CurleyRKCookMGFallowfieldMEMarsdenRA. Accuracy in clinically evaluating pigmented lesions. BMJ1989;299:1618.

  • 35.

    WolfIHSmolleJSoyerHPKerlH. Sensitivity in the clinical diagnosis of malignant melanoma. Melanoma Res1998;8:425429.

  • 36.

    KittlerHPehambergerHWolffKBinderM. Diagnostic accuracy of dermoscopy. Lancet Oncol2002;3:159165.

  • 37.

    ArgenyiZB. Dermoscopy (epiluminescence microscopy) of pigmented skin lesions. Current status and evolving trends. Dermatol Clin1997;15:7995.

    • Search Google Scholar
    • Export Citation
  • 38.

    NehalKSOliveriaSAMarghoobAA. Use of and beliefs about dermoscopy in the management of patients with pigmented lesions: a survey of dermatology residency programmes in the United States. Melanoma Res2002;12:601605.

    • Search Google Scholar
    • Export Citation
  • 39.

    BraunRPMeierMPelloniF. Teledermatoscopy in Switzerland: a preliminary evaluation. J Am Acad Dermatol2000;42:770775.

  • 40.

    PiccoloDSmolleJWolfIH. Face-to-face diagnosis vs tele-diagnosis of pigmented skin tumors: a teledermoscopic study. Arch Dermatol1999;135:14671471.

    • Search Google Scholar
    • Export Citation
  • 41.

    NehalKSOliveriaSAMarghoobAA. Use of and beliefs about baseline photography in the management of patients with pigmented lesions: a survey of dermatology residency programmes in the United States. Melanoma Res2002;12:161167.

    • Search Google Scholar
    • Export Citation
  • 42.

    MortonDLCochranAJThompsonJF. Sentinel node biopsy for early-stage melanoma: accuracy and morbidity in MSLT-I, an international multicenter trial. Ann Surg2005;242:302311.

    • Search Google Scholar
    • Export Citation
  • 43.

    American Society for Dermatologic Surgery. 2005 Procedure Survey: dermasurgery trends and statistics. Available at: http://www.asds-net.org/Media/Articles/ASDS2005StatsReport.pdf. Accessed May 20 2006.

    • Search Google Scholar
    • Export Citation
  • 44.

    MacKieRMBrayCAHoleDJ. Observational study of type of surgical training and outcome of definitive surgery for primary malignant melanoma. BMJ2002;325:12761277.

    • Search Google Scholar
    • Export Citation
  • 45.

    DummerRPanizzonRBlochPHBurgG. Updated Swiss guidelines for the treatment and follow-up of cutaneous melanoma. Dermatology2005;210:3944.

    • Search Google Scholar
    • Export Citation
  • 46.

    SoberAJChuangTYDuvicM. Guidelines of care for primary cutaneous melanoma. J Am Acad Dermatol2001;45:579586.

  • 47.

    StanteMDe GiorgiVCarliP. Can dermopscopy improve the poor reliability of clinical approach in the diagnosis of lentigo maligna of the face?Br J Dermatol2005;153:1084.

    • Search Google Scholar
    • Export Citation
  • 48.

    KelleyLCStarkusL. Immunohistochemical staining of lentigo maligna during Mohs micrographic surgery using MART-1. J Am Acad Dermatol2002;46:7884.

    • Search Google Scholar
    • Export Citation
  • 49.

    BriccaGMBrodlandDGRenDZitelliJA. Cutaneous head and neck melanoma treated with Mohs micrographic surgery. J Am Acad Dermatol2005;52:92100.

    • Search Google Scholar
    • Export Citation
  • 50.

    SauderDN. Imiquimod: modes of action. Br J Dermatol2003;149(suppl 66):58.

  • 51.

    UrosevicMMaierTBenninghoffB. Mechanisms underlying imiquimod-induced regression of basal cell carcinoma in vivo. Arch Dermatol2003;139:13251332.

    • Search Google Scholar
    • Export Citation
  • 52.

    SuzukiHWangBShivjiGM. Imiquimod, a topical immune response modifier, induces migration of Langerhans cells. J Invest Dermatol2000;114:135141.

    • Search Google Scholar
    • Export Citation
  • 53.

    WolfIHCerroniLKodamaKKerlH. Treatment of lentigo maligna (melanoma in situ) with the immune response modifier imiquimod. Arch Dermatol2005;141:510514.

    • Search Google Scholar
    • Export Citation
  • 54.

    RayCMKlukMGrinCMGrant-KelsJM. Successful treatment of malignant melanoma in situ with topical 5% imiquimod cream. Int J Dermatol2005;44:428434.

    • Search Google Scholar
    • Export Citation
  • 55.

    GogginsWBTsaoH. A population-based analysis of risk factors for a second primary cutaneous melanoma among melanoma survivors. Cancer2003;97:639643.

    • Search Google Scholar
    • Export Citation
  • 56.

    FerroneCRBen PoratLPanageasKS. Clinicopathological features of and risk factors for multiple primary melanomas. JAMA2005;294:16471654.

    • Search Google Scholar
    • Export Citation
  • 57.

    FarshadABurgGPanizzonRDummerR. A retrospective study of 150 patients with lentigo maligna and lentigo maligna melanoma and the efficacy of radiotherapy using Grenz or soft X-rays. Br J Dermatol2002;146:10421046.

    • Search Google Scholar
    • Export Citation
  • 58.

    FaderDJWiseCGNormolleDPJohnsonTM. The multidisciplinary melanoma clinic: a cost outcomes analysis of specialty care. J Am Acad Dermat1998;38:742751.

    • Search Google Scholar
    • Export Citation
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