Melanoma Review: Background and Treatment

Eva Berrios-Colon, PharmD, MPH, BCPS; Shalonda Williams, PharmD


US Pharmacist 

In This Article

Classification and Staging

Melanoma is classified into four major types: superficial spreading melanoma, lentigo maligna melanoma, acral lentiginous melanoma, and nodular melanoma. The types differ in appearance, site, and population affected. Superficial spreading, lentigo maligna, and acral lentiginous melanomas have a period of superficial growth and, if identified early, may be cured by surgical excision. However, nodular melanoma usually presents as a deeply invasive lesion that is highly capable of early metastasis and is difficult to cure.[3]

Melanoma staging is important to help determine prognosis and treatment options. The American Joint Committee on Cancer TNM staging system for melanoma contains three major components that define the extent of disease: Tumor size, lymph Node involvement, and Metastasis. A stage 0 melanoma is defined as a melanoma in situ that has not yet spread from the epidermis to the dermis. Stages I and II are localized to a specific area. Stage III encompasses lymph nodes, but there is no distant spread. Stage IV indicates metastasis to distant sites. Tumor thickness, level of tumor invasion, and ulceration are powerful predictors of survival, and TNM status and stage are used to determine prognosis and survival. Other predictors include serum lactate dehydrogenase, presence and site of distant metastases, evidence of nodular involvement, and regression of primary melanoma.[1–4]


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