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Cutaneous Malignant Melanoma: Screening and Diagnosis

Members of the College of Family Physicians of Canada may claim one non-certified credit per hour for this non-certified educational program.

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Fatemeh Akbarian, MD,1 Mehdi Aarabi, MD,2 Ali Vahidirad, MD,3 Mehrdad Ghobadi, MD,4 Mohaddeseh Ghelichli MD,5
Mohammad A. Shafiee, MD, MSc, FRCPC,6

1Dermatologist, Research Fellow, Department of Medicine, University of Toronto, Toronto, ON. 2Research Fellow, Department of Medicine, University of Toronto, Toronto, ON. 3,4,5Joint, Bone, Connective Tissue Research Center, Golestan University of Medical Sciences, Iran. 6Division of General Internal Medicine, Assistant Professor, Department of Medicine, University of Toronto, Toronto, ON.

Abstract
Cutaneous Malignant Melanoma has the highest morbidity and mortality among different types of skin cancers; as one of the most common malignancies in the world. Early detection and diagnosis of Cutaneous Malignant Melanoma followed by adequate surgical excision are the most important tasks in management of this potentially curable skin cancer. Screening methods and diagnostic criteria including clinical and dermoscopic findings will be discussed in this article.
Key Words: Melanoma, Dermoscopy, UV Exposure, Epiluminescence Microscopy (ELM).

Introduction
Melanoma is a tumor arising from melanocytes. The incidence of melanoma and patient mortality rates has been rising in recent decades. It affects the younger population more than most cancers. Therefore it represents a substantial public health problem. Among skin cancers, malignant melanoma is the least common but the most serious one. Up to 20% of patients develop metastatic disease, which usually is associated with death. However, early detection and appropriate excision of the tumor leads to a cure rate of over 90% in low risk melanoma patients. Surgery including removal of the primary tumor and involved lymph nodes along with chemotherapy is still the most important part of treatment of melanoma. Thus, melanoma screening and diagnosis is very important topic for general practitioners.

Epidemiology

Melanoma incidence is variable based on geographic location. In United States Skin cancer is the most common neoplasm.1 Three percent of skin cancers are cutaneous malignant melanoma; however it accounts for the most numbers of deaths in skin cancers.2 In Australia melanoma is the third most common cancer in men and women. It is responsible for the 75% of skin cancer death in this country. The highest incidence of melanoma is reported in Auckland, New Zeland with a rate 40.2/100,000 both in men and women.3 In Asia the incidence is as low as approximately 1/100,000.4 In Europe the highest incidence has been recorded in Switzerland and Scandinavian countries. In Australia and North America incidence of melanoma is higher in Males than females. However in all European countries females suffer more than males from melanoma.5 Based on the information driven from national cancer registries and also the international agency for research on cancer, in Europe the incidence of melanoma has raised within the past two decades.6 In Unites States, the lifetime risk of developing invasive melanoma was 1 in 1500 for persons born in 1935, 1 in 600 persons for those born in 1960, 1 in 150 persons for those born in 1980 and is estimated to be 1 in 62 persons for individuals born in 2006.7,8 Based on the national cancer institute publication in United States of America the diagnosis of melanoma is made averagely at 57 years of age and the median age at death is 67 years.9 Cancer Research UK has demonstrated the world age-standardized incidence of Malignant Melanoma in different parts of the world (Figure 1).9