Malignant melanoma is the most aggressive skin cancer, with 48,600 new cases last year. Its incidence is rapidly increasing throughout the world at a faster rate than any other tumor type. This is due to an increase in exposure to the sun. Approximately 38,000 new cases of invasive melanoma and 30,000 to 50,000 new in situ cases are seen each year in the United States. The lifetime risk for Americans developing melanoma is 1 in 87. Early diagnosis is the most important survival factor. Usually, it depends on visual surveillance. Once identified, a suspected lesion is biopsied and, if found to be melanoma, surgically removed--often with surrounding lymph nodes. The high mortality of melanoma is because it spreads quickly through the lymphatic and blood systems. This method of metastasizing also makes it very difficult to monitor recurrence.
Diagnostic tests for staging include chest x-ray and liver function tests. Other tests are used only when signs or symptoms warrant. Sentinel node biopsy is becoming an increasingly common procedure since melanoma usually metastasizes to regional lymph nodes before dissemination.
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