Melanoma for Primary Care
The incidence of newly diagnosed malignant melanoma is rapidly increasing. In 2016, it is estimated that there will be 76,380 new cases with 10,130 deaths in the United States. Incidence has increased from 1 in 1500 persons born in the early 1900s to 1 in 50 of Caucasian persons born in 2014, 1 in 200 Hispanics, and 1 in 1000 for African-Americans. Unlike basal and squamous cell carcinoma, malignant melanoma correlates more with intense intermittent UV radiation exposure. Malignant melanoma is the aggressive therapy-resistant skin cancer of melanocytes where thickness of the tumor is the most important prognostic factor. The ABCDs (Asymmetry, Border Irregularity, Color Variation, Diameter >6 mm) of melanoma serve as the foundation for patient education, but the use of EFGs (Evolving, Elevation, Firmness, Growth) provide a more comprehensive screening method for malignant melanomas. The authors recommend self-skin examinations and that family physicians maintain a high clinical suspicion in high risk patients since early diagnosis with appropriate treatment significantly impacts survival.