Pigmented lesions and melanoma including premalignant conditions

Throughout the world, each year, approximately 250,000 people develop melanoma and 40,000 die from the disease. Melanoma is characteristically a disease of fair-skinned persons exposed to high ambient levels of ultraviolet (UV) radiation. The incidence has doubled over the last 20 years although unlike other countries the rate of increase in Australia has slowed in recent years, possibly due to public education campaigns targeting excessive UV exposure. Globally the incidence in patients over the age of 65 continues to increase and accounts for disproportionately more melanoma-related deaths. Nevertheless, melanoma in younger persons (<35 years) is among the leading causes of cancer-related mortality in fair-skinned populations. Until the last decade, the outlook for patients with advanced melanoma was uniformly poor but the development of specific therapies targeting the mitogen-activated protein kinase pathway (mutated BRAF melanoma) and immune checkpoint therapy has delivered enormous improvements in outcome.