The incidence of malignant melanoma has increased in recent years more than
that of any other cancer in the United States. About one in 70 people will
develop melanoma during their lifetime. Family physicians should be aware
that a patient with a changing mole, an atypical mole or multiple nevi is a
t considerable risk for developing melanoma. Any mole that is suggestive of
melanoma requires an excisional biopsy, primarily because prognosis and tr
eatment are based on tumor thickness. Staging is based on tumor thickness (
Breslow's measurement) and histologic level of invasion (Clark level). The
current recommendations for excisional removal of confirmed melanomas inclu
de 1-cm margins for lesions measuring 1.0 mm or less in thickness and 2-cm
margins for lesions from 1.0 mm to 4.0 mm in thickness or Clark's level IV
of any thickness. No evidence currently shows that wider margins improve su
rvival in patients with lesions more than 4.0 mm thick. Clinically positive
nodes are typically managed by completely removing lymph nodes in the area
. Elective lymph node dissection is recommended only for patients who are y
ounger than 60 years with lesions between 1.5 mm and 4.0 mm in thickness. I
n the Eastern Cooperative Oncology Group Trial, interferon alfa-ab was show
n to improve disease-free and overall survival, but in many other trials it
has not been shown to be effective at prolonging overall survival. Vaccine
therapy is currently being used to stimulate the immune system of melanoma
patients with metastatic disease.