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The most recent analysis of global cancer statistics for melanoma, from 2012, demonstrated an age-standardized incidence of 34.9 cases per 100,000 men and women in Australia and 35.84 cases per 100,000 men and women in New Zealand, compared with 14.3 cases per 100,000 men and women in the United States.
However, mortality rates are higher in African Americans and Hispanics, who are more likely to have acral melanoma and advanced disease at presentation.
In the United States, invasive melanoma has a higher female predilection from birth to age 49 years (1 in 155 women compared with 1 in 220 men in 2017).
Regional lymph node metastasis is associated with a 5-year survival rate of 38-78%, depending on the number of nodes involved, microscopic or macroscopic (matted nodes/gross extracapsular extension) disease, and ulceration of the primary melanoma.
In-transit metastasis/satellite lesions are associated with a 69% 5-year survival rate, with a significantly worse prognosis in the setting of concomitant regional nodal metastasis (40%).
Most data support the hypothesis that melanoma development is related to intermittent, intense sun exposure, particularly in childhood or adolescence.
In contrast, chronic sun exposure does not appear to confer increased risk, except for the more UV-related melanoma subtypes (lentigo maligna and lentigo maligna melanoma).In addition, a study assessing melanoma incidence among young white girls and women (15-39 y) in California showed significantly higher incidence in those living in higher socioeconomic areas, with the highest UV radiation exposure compared with those from lower socioeconomic neighborhoods, suggesting that affluence (and associated lifestyle behaviors) may have a bigger impact on melanoma risk than UV exposure alone.Melanoma incidence has continued to increase worldwide, with the highest incidence in Australia and New Zealand.The sequence of events in which normal melanocytes transform into melanoma cells, referred to as melanomagenesis, is poorly understood.It likely involves a multistep process of progressive genetic mutations that (1) alter cell proliferation, differentiation, and death and (2) impact susceptibility to the carcinogenic effects of ultraviolet radiation.Recent data suggest multiple pathways of melanoma pathogenesis, with melanomas in sun-protected skin (trunk) developing in association with a high nevus count and intermittent ultraviolet radiation as opposed to those developing on sun-exposed skin in patients with low nevus counts and chronic sun exposure.