LWBK1006-27 LWW-Govindan-Review December 12, 2011 19:32
Chapter 27•Cancer of the Skin and Melanoma 379ANSWERS
Answer 27.1. The answer is A.
The most common sites for melanoma in men are trunk and head and
neck.Answer 27.2. The answer is D.
SEER statistics continue to show increasing rates for older men. The
median age at diagnosis is 59 years. The age-adjusted incidence is 19.4
per 100,000 men and women per year. The most recent age-adjusted inci-
dence rate for men (aged 65 to 74 years) is 91 (per 100,000) and has
increased steadily since 1975. In comparison, the rate for women (aged
65 to 74 years) is 37 (per 100,000).Answer 27.3. The answer is D.
The most common site of primary cutaneous melanoma in women is the
lower extremities. In men, the most common sites are the head and neck
area and the back.Answer 27.4. The answer is D.
Prior scalp radiation (during childhood), familial p16 mutation, and
higher socioeconomic status have all been shown to be risk factors for
cutaneous melanoma. In contrast, pregnancy is not considered to be a
risk factor for the development of primary or recurrent melanoma.Answer 27.5. The answer is C.
The management of primary cutaneous melanoma is straightforward.
It is essential that primary care providers have a firm understanding of
the guidelines to expedite referral to the appropriate surgical specialist.
Excisional biopsy is the preferred method for diagnosis of most pigmented
lesions and permits the accurate assessment of primary depth (Breslow
thickness). Intraoperative lymphatic mapping with sentinel node biopsy
remains the standard approach at major centers. Sentinel node mapping
is performed for primary lesions 1 mm or more in depth and selected thin
(<1 mm) lesions with features of regression or ulceration, high mitotic
rate, and positive deep margin.
Body fluorodeoxyglucose (FDG) PET-CT imaging as an initial staging
procedure is not recommended unless clinically indicated on the basis
of history and physical examination. Clinical research provides strong
evidence that the sensitivity of standard FDG-PET imaging is inadequate
to detect micrometastasis in draining nodal basins. Finally, there is no
standard adjuvant therapy currently recommended for patients with stage
IIA (T3a N0 Mx) cutaneous melanoma. Oncology referral should be made
after the pathologic staging is completed.