Advances in melanoma: epidemiology, diagnosis, and prognosis

Abstract

Unraveling the multidimensional complexities of melanoma has required concerted efforts by dedicated community of researchers and clinicians battling against this deadly form of skin cancer. Remarkable advances have been made in the realm of epidemiology, classification, diagnosis, and therapy of melanoma. The treatment of advanced melanomas has entered the golden era as targeted personalized therapies have emerged that have significantly altered the mortality rate. A paradigm shift in the approach to melanoma classification, diagnosis, prognosis, and staging is underway, fueled by discoveries of genetic alterations in melanocytic neoplasms. A morphologic clinicopathologic classification of melanoma is expected to be replaced by a more precise molecular based one. As validated, convenient, and cost-effective molecular-based tests emerge, molecular diagnostics will play a greater role in the clinical and histologic diagnosis of melanoma. Artificial intelligence augmented clinical and histologic diagnosis of melanoma is expected to make the process more streamlined and efficient. A more accurate model of prognosis and staging of melanoma is emerging based on molecular understanding melanoma. This contribution summarizes the recent advances in melanoma epidemiology, classification, diagnosis, and prognosis.

Keywords: melanoma; melanoma classification; melanoma diagnosis; melanoma epidemiology; melanoma genomics.

Figure 1

United States melanoma incidence and mortality.

Figure 2

A patient multiple nevi presents with a changing mole. Dermatoscopic image shows an asymmetric melanocytic lesion with regular network and black blotch.

Figure 3

The biopsy of the Figure 2 lesion showing a thin (Stage 1A) superficial spreading melanoma arising in a dysplastic nevus. (A) A shave biopsy showing a melanocytic lesion with an asymmetric architecture (20× magnification). (B) The left side of the lesion shows the melanoma in situ component: large atypical pagetoid melanocytes in pagetoid spread within the epidermis (200× magnification). (C) The right side of the lesion shows the nevus component: nested monomorphous melanocytes at the dermoepidermal junction (200× magnification).

Figure 4

Unsuspected nodular melanoma (Stage 2B) clinically diagnosed as an inflamed skin tag. (A) Polypoid asymmetrical melanocytic lesion with irregular distribution of melanocytes (40× magnification). (B) Melanocytes arranged in sheets in the superficial dermis (100× magnification). (C) Large atypical melanocytes that vary in size and shape with occasional mitotic figures (400× magnification).