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  • image Cutaneous melanoma is an increasingly common malignancy, but it is a cancer that can be cured if detected early. Public education about screening and early detection is one strategy for controlling the increase in incidence and the mortality associated with cutaneous melanoma.
  • image Surgical resection can cure patients with early-stage melanoma.
  • image The toxicities associated with interferon-α2b (IFN-α2b) therapy are significant and require patient education, close patient monitoring, and appropriate dose modification based on toxicity.
  • image Patients with locally advanced disease should be evaluated for adjuvant therapy; recommended options include IFN-α2b or participation in a clinical trial.
  • image Metastatic melanoma remains a clinical challenge. At this time, there is not a single standard treatment approach for individuals with metastatic disease. Dacarbazine and temozolomide are considered the most active chemotherapies and can be used as single agents. Combination chemotherapy has not been shown to be superior to single-agent therapy with dacarbazine.
  • image As the biology of melanoma has been further delineated, a growing number of potential targets for drug therapy have been identified. BRAF mutations appear in up to 70% of melanoma patients. Vemurafenib is a BRAF inhibitor that has been shown to improve overall survival in patients with this mutation.
  • image Ipilimumab is an option for some individuals with metastatic melanoma. The immune-related toxicities associated with the use of this drug are significant and warrant close patient selection. Individuals require close monitoring and management by an experienced healthcare team. Clinical trials using this drug showed a significant improvement in overall survival.
  • image Treatment of melanoma is determined by many factors. As the number of treatment options for patients with metastatic melanoma grows, it will be important to consider disease- and patient-related aspects when determining appropriate therapy.

On completion of the chapter, the reader will be able to:

  1. Identify known environmental risk and genetic factors associated with melanoma.

  2. Outline the pathogenesis of melanoma.

  3. Describe the common clinical features of melanoma using the mnemonic ABCD.

  4. Discuss strategies for early detection and prevention of melanoma.

  5. Summarize current staging criteria for melanoma and how they correlate with prognosis.

  6. Discuss the role of interferon alfa in the treatment of patients with metastatic melanoma including appropriate adverse effect management strategies for its use.

  7. Discuss the role of aldesleukin therapy in the treatment of patients with metastatic melanoma including appropriate adverse effect management strategies for its use.

  8. Discuss the current role of chemotherapy, biochemotherapy, and vaccines in the treatment of a patient with melanoma.

  9. Describe the advantages and disadvantages of ipilimumab for the treatment of metastatic melanoma including appropriate monitoring and adverse effect management strategies for its use.

  10. Discuss the rationale for the use of BRAF inhibitors in the treatment of patients with metastatic melanoma.

  11. Formulate an appropriate treatment plan for a patient with metastatic melanoma based on genetic- and disease-related factors.

Melanoma is the seventh most common cancer in the United States. The incidence of melanoma has steadily increased from the 1970s, and today ...

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