einstein (São Paulo). 21/Dec/2021;19:eED6680.
Melanoma: implications of diagnostic failure and perspectives
DOI: 10.31744/einstein_journal/2021ED6680
Melanoma accounts for only approximately 5% of all skin cancer diagnoses worldwide, but it is very important due to its metastatic potential and the fact that it can lead to death.() In Brazil, in 2019, there were 1,978 deaths from the disease, and the estimate was 8,450 new cases for 2020.() A recently published study with Brazilian data showed that the mean incidence in men increased from 2.52 to 4.84, and in women, from 1.33 to 3.22 cases/100,000 inhabitants in the period from 2000 to 2013.()The best management for melanoma remains its early diagnosis and treatment, which is curative in 95% of cases, when located only in skin.()Failure to early diagnose a case of localized melanoma can bring many dire consequences to the patient. The longer the time lost to diagnosis, the worse the situation becomes. The impact on health care costs by the Brazilian Public Health System (SUS – Sistema Único de Saúde) increases exponentially in more advanced cases.
There is not much data on the cost of melanoma in Brazil. A study conducted in 2009 showed 95.8% of all spending in São Paulo state on melanoma was for treatment of stage III and IV patients.() This study was carried out when treatment of advanced cases involved only interferon-alpha and dacarbazine. When target therapy and immunotherapy are used, the cost certainly increases, as has been shown in recent studies in Australia and France.(,) However, this investment is reflected in the survival of individuals. Ten years ago, the 5-year survival rate of patients with metastatic melanoma was only 10% with chemotherapeutical agents, such as dacarbazine, paclitaxel, and carboplatin. With the new medications, this 5-year survival rate went to 52% for the combination of ipilimumab+ nivolumab (two immunotherapies).()
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