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.
Keywords: Melanoma, Dermoscopy, UV Exposure, Epiluminescence Microscopy (ELM).

Wey Leong, MSc, MD, Department of Surgical Oncology, Princess Margaret Hospital, University Health Network, University of Toronto, ON.
Alexandra M. Easson, MSc, MD, Department of Surgical Oncology, Princess Margaret Hospital and Mount Sinai Hospital, University of Toronto, ON.
Michael Reedijk, PhD, MD, Department of Surgical Oncology, Princess Margaret Hospital, University Health Network, University of Toronto, ON.

Melanoma must be considered in the differential diagnosis of any skin lesion in older adults. With the incidence of melanoma increasing in general and even more so among older people, more older adults are being diagnosed with melanoma than in the past. Among older adults, melanomas display more aggressive histological features with worse prognosis and treatment outcomes than among younger individuals. Furthermore, older individuals have fewer surgical and medical treatment options because of age-associated comorbidities. This article reviews the epidemiology and management of melanoma with emphasis on the older adult population.
Key words: older adults, melanoma, aged, cancer, skin neoplasm.

Patricia K. Long, FNP-C, Division of Surgical Oncology and Endocrine Surgery, Department of Surgery, University of North Carolina, Chapel Hill, NC.
David W. Ollila, MD, Division of Surgical Oncology and Endocrine Surgery, Department of Surgery, University of North Carolina, Chapel Hill, NC.

Proper management of patients with biopsy-proven melanoma is vitally important. Patients with melanoma in situ, invasive melanoma <1 mm thick, and invasive melanoma >1 mm thick should have surgical resection margins of 5 mm, 1 cm, and 2 cm, respectively. All patients with melanomas >1 mm should be offered a sentinel node procedure, the most important prognostic variable in this group of patients. All patients with metastatic melanoma in the sentinel node should undergo a complete therapeutic lymphadenectomy.
Key words: melanoma, margin of resection, sentinel node biopsy.

Patricia K. Long, FNP-C, Division of Surgical Oncology and Endocrine Surgery, Department of Surgery, University of North Carolina, Chapel Hill, NC.
David W. Ollila, MD, Division of Surgical Oncology and Endocrine Surgery, Department of Surgery, University of North Carolina, Chapel Hill, NC.

The incidence of melanoma continues to rise. The clinician needs to be familiar with characteristics of lesions more likely to be melanoma and be able to apply the “ABCDE” criteria. Additional imaging techniques such as digital photography and dermoscopy aid the clinician in deciding which nevi require biopsy. The techniques for biopsying cutaneous lesions vary, and clinicians need to be familiar with the various techniques. Once a cutaneous melanoma is diagnosed, the most important histologic feature of the primary is Breslow thickness.
Key words: melanoma, pigmented nevi, digital imaging, dermoscopy.

Joseph F. Coffey, BSc, MD, Currently PGY4 Dermatology, University of Alberta, Edmonton, AB.
Gordon E. Searles, OD, MD, MSc, FRCPC, Assistant Clinical Professor; Program Director, University of Alberta, Edmonton, AB.

Accumulation of sun exposure is an important factor resulting in aging of the skin and development of cutaneous malignancy. Unfortunately, most people think of suntanning as a healthy, natural process, and damaging effects of the sun are not experienced until 15-20 years after the initial damage has been done. By the time we see patients in our clinic, the majority of our older clientele has extensive, irreversible photo damage and precursors of skin cancer. It is difficult to treat many of these patients as multiple lesions are frequently present, and patients are sometimes unwilling to initiate sun-protective measures, are not ideal surgical candidates, and may not comply with treatments suggested by the dermatologist due to financial burden. We emphasize the critical role of sun exposure as a cause of skin aging, benign stigmata of aging, and development of skin cancers. Treatment options including topical therapies, oral medications, surgery, and new-age technologies are discussed.
Key words: photo-aging, therapy, skin cancer, dermatoheliosis, melanoma.

Gordon E. Searles, OD, MD, MSc, FRCPC, FACP, Internal Medicine and Dermatology, Western Canada Dermatology Institute, Edmonton, AB.

Practitioners are commonly asked about issues of skin and skin disorders. While many skin lesions are benign, it is becoming increasingly important for clinicians to be able to distinguish benign lesions from premalignant or malignant lesions. The goal of this article is to describe the most common forms of benign lesions in older patients and suggest various treatment strategies.

Key words: melanoma, pigmentary, macules, keratosis, ephelides.