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LEARNING OBJECTIVES

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LEARNING OBJECTIVES

Upon completion of this chapter, the reader will be able to:

  1. Identify the risk factors associated with skin cancer.

  2. Devise a plan of lifestyle modifications for the prevention of skin cancer.

  3. Explain the goals of therapy for the treatment of the different stages of nonmelanoma and melanoma skin cancer.

  4. Discuss the role of mutation testing in patients with newly diagnosed metastatic melanoma and the impact of the test on choosing drug therapy.

  5. Compare and contrast the pharmacologic treatment options that are available for patients diagnosed with nonmelanoma and melanoma skin cancer.

  6. Suggest management options for patients experiencing adverse effects of pharmacologic therapy.

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KEY CONCEPTS

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  • Image not available. Exposure to ultraviolet radiation from the sun is recognized as one of the primary triggers for skin cancer development.

  • Image not available. Staging of malignant melanoma is important to deter-mine prognosis, categorize patients with regard to meta-static potential and survival probability, and aid in clinical decision making.

  • Image not available. Determination of lymph node status is important in melanoma staging because it is an independent prognostic factor, and it provides the oncologist with guidance for therapy decisions.

  • Image not available. Stages IIB, IIC, and III melanoma are considered to be high risk because of their potential for recurrence and distant metastasis. The primary treatment modality is surgical excision of the tumor and a lymphadenectomy for patients with positive lymph nodes.

  • Image not available. Stage IV melanoma is not curable, and the primary goal of therapy is local control of the disease and relief of identifiable symptoms.

  • Image not available. Melanoma is an immunogenic tumor and strategies to enhance the patient's immune response to treat the cancer are an area of active research. Ipilimumab is an immunotherapy agent that has a major role in the treatment of unresectable or metastatic melanoma.

  • Image not available. Interferon alfa 2b is indicated as adjuvant therapy for patients with bulky stages IIB, IIC, and stage III melanoma because they are at high risk for recurrence after curative surgical resection of the cancer.

  • Image not available. Advances in molecular profiling and genome seq-uencing have lead to the identification of the BRAF V600E gene mutation in patients with melanoma. Genetic testing for this mutation should be performed in patients with unresectable or metastatic melanoma to determine the patient's eligibility to start targeted therapy with vemurafenib.

  • Image not available. In patients diagnosed with basal cell carcinoma and squamous cell carcinoma, the primary goal of therapy is to cure the patient and to prevent recurrence.

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Skin cancer is the most prevalent of all malignancies occurring in humans, and in the United States, it accounts for more than 50% of all cancers.1 The most common cutaneous malignancies are basal cell carcinoma (BCC), squamous cell carcinoma (SCC), and malignant melanoma (MM). BCC and SCC are categorized as nonmelanoma skin cancer (NMSC). It is estimated that more than 3.5 million cases (in more than 2 million people) of BCC and SCC and more than 100,000 cases of melanomas are diagnosed in the United States each year.1 Ultraviolet radiation ...

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