Upon completion of this chapter, the reader will be able to:
Identify the risk factors associated with skin cancer.
Devise a plan of lifestyle modifications for the prevention of skin cancer.
Discuss the role of mutation testing in patients with newly diagnosed metastatic melanoma and the impact of the test on choosing drug therapy.
Explain the goals of therapy for the treatment of the different stages of nonmelanoma and melanoma skin cancer.
Compare and contrast the pharmacologic treatment options that are available for patients diagnosed with nonmelanoma and melanoma skin cancer.
Suggest management options for patients experiencing adverse effects of pharmacologic therapy.
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 NMSC and MM differ with regard to prognosis, metastatic potential, mortality, curability, and treatment options.2
EPIDEMIOLOGY AND ETIOLOGY
MM is the most common serious form of skin cancer, and the lifetime risk of developing it is 1 in 37 for men and 1 in 56 for women.1 Approximately 73,870 new cases of melanoma are predicted to occur in 2015.3 Melanoma represents about 2% of all skin cancers in the United States, but it accounts for 75% of all skin cancer deaths.1 The incidence of melanoma is not evenly distributed among all populations; race, gender, and age confer different rates. The annual incidence rate per 100,000 is 1 for blacks, 4 for Hispanics, and 25 for non-Hispanic whites.3 While women are more likely to develop melanoma than men before the age of 50, the converse occurs after the age of 50, with men having double the incident rate at age 65 and triple the rate at age 80 compared to women.4 The change in risk may be due to the different level of sun exposure, be it occupational or recreational, through the lifetime of a particular sex. Even though incidence rates have significantly increased in the last 30 years, the rate among young age groups has leveled off; the incidence rate for men and women 50 years of age or older increased 2.6% per year from 2007 to 2011 but was relatively stable for those below age 50.
The risk factors for developing MM can be categorized as environmental factors and host factors. KEY CONCEPT Exposure to ultraviolet ...