LAUSR

BACKGROUND Melanoma is a malignancy that originates from the skin’s pigment-producing cells, melanocytes. Although accounting for only about 1% of skin cancers, melanoma causes most skin cancer deaths (American Cancer Society, 2016). The average age of diagnosis is 63 years; however, it is not uncommon to diagnose a person younger than 30 years (American Cancer Society, 2016). The American Cancer Society reports rising rates of melanoma and estimates 76,380 new melanoma cases and 10,130 melanoma deaths in the United States for 2016 (American Cancer Society, 2016). Cutaneous melanoma is the most common type of melanoma in comparison with noncutaneous types such as ocular andmucosalmelanomas. Cutaneousmelanoma is categorized as Stages 0YIV by the American Joint Committee on Cancer TNM (primary tumor [T], regional lymph nodes [N], distant metastases [M]) system (Balch et al., 2009). On the basis of the staging, the National Comprehensive Cancer Network (NCCN) provides recommendations regarding initial workup, management, and metastatic surveillance (Coit et al., 2016). For example, Stage 0 and 1a tumor workup may consist solely of wide surgical excision, whereas Stage 4metastatic tumorworkup would consist of biopsy or fine needle aspiration, lactate dehydrogenase levels, and imaging of the chest, abdomen, and brain (Coit et al., 2016). Follow-up may vary from having an annual skin examination by a dermatology provider to additional close surveillance with routine imaging and laboratory monitoring for several years (Coit et al., 2016). Although the latest NCCN guidelines include important prognostic information such as tumor ulceration, mitotic figures, and sentinel lymph node biopsy (SLNB) status (NCCN, 2017), there is high prognostic variability within a stage classification. Although Stage I or II patients are considered to be at a low risk of recurrent metastasis, the 10-year survival rate ranges from 95% to 40% for Stages IA to IIC (American Cancer Society, 2016), and 20% of these patients die from the disease within 4 years of initial diagnosis (Gerami, Cook, Wilkinson, et al., 2015). Another impacting factor on patient care is that the recommendations are nonspecific, allowing for wide ranges of follow-up with similar management for the various stages (Coit et al., 2016). This results in overmanagement of less biologically aggressive tumors and insufficient evaluation of more aggressive lesions (Berger et al., 2016).