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Simplified Evolution Model Of The Genetic Landscape

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Figure 10: Simplified evolution model of the genetic landscape in melanoma development and progression30. In sequence, melanoma formation is initiated by activating mutation in BRAF from the ERK MAPK pathway, which induces senescence forming a nevus. Mutation of TERT promoter, which increases transcriptional activity, as well as disruption of cell cycle control that abrogates cell cycle arrest (elevated levels observed in melanoma in situ) are events that allows the bypass of OIS mechanism proceeding towards melanoma transformation. Copy number alteration (CNA) is observed exclusively in invasive malignant melanoma alongside mutations in p53 and PTEN tumor suppressors suggesting that these alterations are important in the event of cancer cell invasion and dissemination. Mutation burden, specifically point mutations (indicative of UVR damage) increases throughout progression. Frequency of the driver oncogenes remains constant throughout tumor progression.

9. Management and therapeutic approach of disease
Surgical removal is the standard treatment for localized primary melanomas. Localized melanomas are exceedingly curable when removed properly within the recommended excision margins (maximum 2cm according to the National Comprehensive Cancer Network (NCCN) guidelines for melanoma). However, as melanoma progresses, it becomes increasingly difficult to treat as the disease is likely to recur and become more resilient to the immune system as well as treatment.
The average

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