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Melanoma

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Dermatology in Public Health Environments

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Abstract

Melanoma incidence has rapidly been increasing and mortality rates have remained relatively stable, which reflects an improved survival attributable to earlier detection of thin melanomas at a curable stage. When invasive, melanoma is the cutaneous tumor with the highest metastatic capacity and is responsible for 75% of deaths from skin cancer. Melanoma etiology is complex and involves environmental, phenotypic, and genetic risk factors. Noninvasive techniques such as dermoscopy and reflectance confocal microscopy increase accuracy in melanoma diagnosis while minimizing unnecessary excisions. Excisional biopsy and histopathologic evaluation remain the gold standard for melanoma diagnosis. Surgery in two stages is a key concept in the treatment of cutaneous melanoma. After initial biopsy, the definitive treatment of primary melanoma is wide local excision associated with sentinel lymph node biopsy when indicated. In selected patients with locoregional advanced or metastatic disease when lesions are completely resectable, surgery may be indicated. For many years, cytotoxic chemotherapy had been widely used as the main therapeutic strategy in patients with advanced melanoma, although no schedule has demonstrated an increased overall survival. Advances in immunotherapy and molecularly targeted therapy have led to better therapy guidance and interventions with impact on clinical endpoints in patients with advanced melanoma.

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  1. Av. Ipiranga, 7464/430, 91530-000, Porto Alegre, RS, Brazil

    Thais Corsetti Grazziotin & Louise Lovatto

  2. R. Professor Annes Dias, 295, 90020-090,, Porto Alegre, RS, Brazil

    Felice Riccardi, Antônio Dal Pizzol & Alexei Peter dos Santos

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  1. Thais Corsetti Grazziotin
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    Renan Rangel Bonamigo

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Glossary

Confocal microscopy

Noninvasive technique using a confocal laser microscope that allows in vivo evaluation at cellular level and quasi-histologic resolution, improving diagnostic accuracy of melanocytic and nonmelanocytic skin lesions and reducing unnecessary excisions.

Dermoscopy

Noninvasive technique that increases diagnostic accuracy of melanocytic and nonmelanocytic skin lesions using a magnifier polarized or nonpolarized light source.

Dysplastic nevus

Atypical nevus or Clark’s nevus. Melanocytic lesions that are larger than 5 mm, have irregular shape, indistinct borders, and variable pigmentation. Histologic features include disordered growth pattern, random cytologic atypia of melanocytes, and lymphocytic host response.

Sentinel lymph node

The first lymph node or group of nodes draining the tumor site.

Target molecular therapy

Drugs that block the growth and spread of cancer by interfering with specific molecules (“molecular targets”) that are involved in the growth and spread of cancer.

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Grazziotin, T.C., Lovatto, L., Riccardi, F., Pizzol, A.D., dos Santos, A.P. (2018). Melanoma. In: Bonamigo, R., Dornelles, S. (eds) Dermatology in Public Health Environments. Springer, Cham. https://doi.org/10.1007/978-3-319-33919-1_16

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