Preface

The American Cancer Society report states that skin cancer is the most common cancer of all cancer types with numbers exceeding all of the other cancers altogether. In spite of melanoma representing only about 1% of all skin cancers, this tumour is still responsible for most skin cancer deaths. The incidence of melanoma is steadily on the rise in respect to all thicknesses and stages. The peak incidence of the tumour is noted in late adulthood, yet according to US Surgeon General's 2018 report it is reported to be the third most common cancer in adolescents and young adults and the reason for this situation is multifactorial. A worrying trend is both outdoor and indoor tanning especially among young people and this is a main factor, even though the awareness of the need for sun protection is slightly on the rise due to social media campaigns. Recent reports indicate that the lifetime risk of developing a secondary melanoma has been underestimated for many years. This is a large-scale medical problem for the patients and a financial burden for the healthcare systems as many of these people will see the practitioners too late to avoid metastatic disease. Therefore, melanoma should be a matter of concern worldwide.

The book is divided into 3 sections. The first section focuses on the genetics and epigenetics of melanoma. Understanding the underlying mechanisms in tumour development and progression is pivotal for the development of new therapies. There has been massive progress in drug development for advanced stage disease in recent years. Presurgical biological treatment of a melanoma with dabrafenib/ trametinib (BRAF/MEK inhibitors), nivolumab/ipilimumab and tissue agnostic anti-PD1 drug, pembrolizumab, showed promising outcomes in clinical trials regarding the recurrence rate in comparison to post-surgery treatment. Although IDO inhibitors are a disappointment, a whole new range of anti-cancer agents (eg. tavokinogene telsaplasmid, PKC inhibitors, and novel TLR9 agonists and anti-PD-1 drugs) give new hope to patients in with the advanced stage disease.

The second section of the book focuses on special melanoma scenarios. This section deals with the problem of melanoma in pregnancy. Many myths still surround this topic including the incidence, prognosis, available therapeutic options, possible complications, and prognosis. This sections also covers the subungual melanoma, as this clinical subtype tends to be a diagnostic challenge.

The third section follows the emerging trend of implementing mathematic models in skin cancer diagnosis. These models are being implemented nowadays in artificial intelligence deep-learning systems opening a new era of AI-assisted diagnostics. Although radiology was the first area affected by this process, I believe that the forthcoming years will bring it further to areas where visual imaging is crucial to establish the precise diagnosis - dermatology, ophthalmology, and pathology.

I hope that this book written by international experts will be a useful resource for both clinicians and researchers.
