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Epidemiology

Definition

Malignant tumor arising from melanocytes most commonly of cutaneous origin, but can be of mucosal (oral, conjunctival, vaginal), uveal or leptomeningeal origin

  • Most rapidly expanding cancer in white population
  • Lifetime melanoma risk in white population 1:40
  • Male > Female
  • Worldwide greater incidence: Australia and New Zealand (39 female: 60 male cases per 100 000)
  • Mortality stable since the 90’s

Genetic
  • Family history of melanoma
  • Familial or genetic melanoma ~10% of cases
    • CDKN2A mutation in 20% of familial cases associated with risk of pancreatic cancer. Suspect if ≥ 3 primary CDKN2A-dependent cancers in patient and/or first-degree relatives.
    • BAP1 mutation
    • MITF (renal cancer risk)
    • Shelterin complex
    • Tert
    • CDK4
    • Other mutations include: MC1R (red hair phenotype), PTEN , BRCA1/2, p53, XP genes
  • Lightly pigmented skin
  • Tendency to burn, inability to tan
  • Red hair
Environmental
  • Excessive intermittent sun exposure, UVB>UVA, PUVA, tanning bed
  • Sunburn history
  • Chronic sun exposure
  • Residence in equatorial latitudes
  • Iatrogenic or acquired immuno-suppression
Phenotypic expression
  • >100 melanocytic nevi (10-fold increased risk); >5 atypical nevi (5-fold risk)
  • Multiple solar lentigines (3-4-fold risk)
  • Previous skin cancer

  • Physical sun blocking (clothing, hats, glasses)
  • Limiting UV exposure
  • Sunscreen
  • Screening for high risk groups only
Malignant tumor