Skin cancer: melanoma

The development of cutaneous melanoma is attributed mainly to UV-induced DNA damage producing genetic mutations that make melanocytes capable of invasion and metastasis. Early diagnosis and surgical excision are the key to successful treatment. Breslow thickness, ulceration and mitotic rate are the most important prognostic factors. Histological examination of the ‘sentinel’ lymph node indicates prognosis with even greater accuracy, and is now routinely recommended for patients with melanomas ≥1.0 mm in Breslow thickness. Early complete regional node clearance in sentinel node-positive patients may improve melanoma-specific survival. Clinically involved nodes are best treated by surgery, as are isolated systemic metastases. However, new systemic therapies are achieving good short- to-medium term systemic disease control; these include BRAF and MEK inhibitors and immune check-point regulators (e.g. CTLA-4 inhibitors and agents targeting PD-1 and PDL-1). Radiotherapy, regional chemotherapy, topical therapies and intralesional therapies may also be effective in patients with metastatic melanoma.