الفهرس 
Introduction
Chapter 1: Epidemiology of pigmented malignant skin tumorsOnly 14 pages are availabe for public view
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Abstract
Pigmented skin cancers can be classified into two types mainly {melanocytic , nonmelanocytic skin tuomors (NMSCS)}.
In Egypt, according to cancer pathology report obtained from national cancer institute NCI , Cairo university , malignant skin tumors constituted 4.76% of total malignancy.
Melanocytic cancer (malignant melanoma) is less common than other skin cancers but it is much more dangerous, it causes the majority(75%) of deaths related to skin cancers.
Melanoma is a neoplastic disorder produced by malignant transformation of the normal melanocyte. Melanocytes are cells responsible for the production of the pigment melanin.
Melanoma usually arises from melanocytes at the dermal/epidermal junction .
Risk factors for melanoma include skin type, personal history of prior melanoma, atypical moles, positive family history of melanoma, and recently inherited genetic mutations.
As with nearly all malignancies , the outcomes of melanoma depends on the stage at presentation.
The classic appearance of primary cutaneous melanoma is summarized by ” ABCD” for asymmetry, border irregularity, color variation, and diameter greater than 6 mm
In general , the prognosis is excellent for patients who present with localized and primary tumors 1 mm or less in thickness , with 5-year survival achieved in more than 90% of patients. For patients with localized melanomas more than 1 mm in thickness , survival rates range from 50% to 90% depending on tumor thickness, ulceration and mitotic rate. With stage III , 5-year survival rates range from 20% to 70%. Historically , long term survival in patients with distant metastatic melanoma, taken as a whole, has been less than10%. However , some patients with stage IV , have a more indolent clinical course . further more the impact of emerging effective systemic therapies on survival of those patients , either at presentation or recurrence, has made long term remission possible for a larger proportion of patients.
Biopsy of a suspicious skin lesion is necessary for an accurate diagnosis and for optimal staging.
The primary treatment modality for cutaneous melanoma is wide surgical excision, lymph node dissection.
Non surgical modalities of treatment include immunotherapy (pembrolizumab, nivolumab ,ipilimumab) and interferon, targeted therapy (trametinib, cobimetinib, vemurafenib, dabrafenib) , chemotherapy and radiotherapy.
Pigmented NMSCS include pigmented variation of basal cell carcinoma, Squamous cell carcinoma, Kaposi sarcoma, angiosarcoma, dermatofibrosarcoma ,merkle skin carcinoma and mycosis fungoids ,sezary syndrome .
The management of NMSCS is guided by the histologic and biologic nature of the tumor, the anatomic site, the underlying medical status of the patient, and whether the tumor is primary or recurrent. Accurate interpretation of the diagnostic biopsy is essential for appropriate clinical management. Depending on the biologic aggressiveness of the tumor, cancers of the skin may be excised or, in some cases of superficial tumors or precancerous lesions, eliminated in a less invasive fashion . surgical options include conventional excision and Mohs micrographic surgery (MMS).