Malignant melanoma is predominantly a disease of the skin, but may in rare instances occur at other sites, including the mucous membranes (vulva, vagina, lip, throat, esophagus and perianal region), as well as in the eye (uvea and retina). Melanoma arises from melanocytes, which are cells located in the upper layer of the skin that are responsible for producing pigment (skin color). Most melanomas are dark in color (black/brown) because they contain pigment; however, some melanomas do not contain pigment. These are referred to as an amelanotic malignant melanoma and are very difficult to diagnose.
Since the majority of patients enrolled in clinical trials have skin melanoma, this treatment overview will focus on that type of melanoma. It is important to realize that the treatment principles derived from clinical trials involving patients with skin melanoma are applicable to melanomas of the vulva, vagina, male genitalia or anal-rectal areas but, in general, melanomas in these sites have a worse prognosis than skin melanomas.
Melanoma occurs predominantly in adults and 54,000 individuals are diagnosed each year in the United States. The incidence of melanoma of the skin appears to be on a steady rise throughout the world due to increased ultraviolet exposure from the sun and possibly tanning beds. In the United States, researchers have estimated that there is a 2-3% increase per year in the incidence of cutaneous melanoma.1
1 Cancer Facts & Figures 2017. American Cancer Society website. Available at: http://www.cancer.org/acs/groups/content/@epidemiologysurveilance/documents/document/acspc-036845.pdf.
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