Skin patients with stage I have a greater

            Skin cancer can be divided into melanoma and non-melanoma skin cancer. Altogether, skin cancer is segmented into basal and squamous cell carcinoma – the most common form of skin cancer -, Merkle cell, lymphoma of the skin, Kaposi’s sarcoma, and melanoma (118). Thought the true number is difficult to estimate, skin cancer is one of the most diagnosed cancers in the United States. It was estimated in 2012 that the number of newly diagnosed cases of basal and squamous cancers alone was 5.4 million among 3.3 million people, which was a difficult estimation to make considering that reporting of this statistic is not required (117). Comparatively, melanoma is certainly not one of the more common forms of skin cancer – accounting for an estimation of 87,110 newly diagnosed melanomas in the United States in 2017 (119). The problem lies in its mortality rate, where it is responsible for the most skin cancer related deaths at an estimation of 9,730 for 2017 compared to basal and squamous carcinoma which is estimated to account for 2,000 (119, 120). Unlike basal and squamous carcinoma, melanoma has also risen over the past 30 years (119, 120).

Early
detection of melanoma has significantly improved the 5-year survival rate where
patients with stage I have a greater than 90% survival compared to patients
with metastatic disease who have less than 20% (122, 124, 128). Screening will
typically evaluate factors that relate to the Asymmetry, Border, Color,
Diameter, and Evolution of atypical moles. Screening will also look for an
increase in the number of new moles or the total number of moles (>100) a
patient has at the time of referral, as these patients are typically more at
risk than others (122, 124, 125). If a mole has multiple colors – or simply odd
colors such as blue or white -, has asymmetrical borders, is larger than 6
millimeters, or is changing overtime it is flagged for closer inspection. This
ABCDE rule has become a common and easy way to remember these diagnostic
criteria, allowing for patients with a family history of melanoma to monitor
themselves at home (122).

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Melanoma
– sometimes referred to as malignant melanoma or cutaneous melanoma when cancer
arises from the epidermis – arises from melanocytes, which we often think of as
residing in the epidermal layer of skin (121). Melanocytes are derived from
neural crest cells which migrate throughout the body to take residence in the
epidermis and to a lesser extent eyes, hair, mouth, gastrointestinal tract, and
genital mucosa (122, 123). Once there, they produce melanin to protect deeper
layers of tissue from UV damage, producing more as an individual is
increasingly exposed. Melanomas can continue to produce melanin – taking on a
dark brown or black appearance – , but there are some instances where they do
not and display a white, blue, or pink color as is the case with nodular
melanoma  (121, 122).

            A typical way that melanoma can
develop is through repeat exposure to UV radiation from either the sun or
tanning beds (123). Melanomas that arise from chronic sun damage (CSD) are
often found on the face, arms, and legs. Meanwhile, melanoma can also develop
on areas that are routinely covered by the sun in individuals with a family
history or predisposition (ex. red hair, blue eyes, fair skin, or more than 100
moles) (123). As a result, differences between CSD and non-CSD melanomas can be
divided into placement on the body, accumulated DNA damage, host age, exposure
to UV radiation, and types of mutations (123). CSD melanomas appear in older
populations (> 55 years) where tumors contain a high mutation burden in key
signaling pathways such as in the proliferation and growth members NF1, NRAS, BRAF, or KIT (123). Meanwhile, non-CSD melanomas can arise in younger
individuals (