return to: Melanoma (Evaluation and Management) (8th Edition AJCC)
General Guidelines
5-year survival = 82% (Gershenwald et al, 2017)
|
Guidelines |
Margins |
Mohs |
SLN Biopsy |
PET |
CT |
Radiation |
Adjuvant |
|---|---|---|---|---|---|---|---|
|
European Society of Medical Oncology (ESMO) (Michielin et al, 2019) |
2 cm |
No |
Yes |
Yes |
Yes |
No |
No |
|
National Comprehensive Cancer Network (NCCN) (Swetter et al, 2021) (Vetto, 2024) |
2 cm |
No |
Yes |
No |
No |
No |
No |
Additional comments
NCCN: Consider nodal basin ultrasound prior to sentinel lymph node biopsy for melanoma patients with an equivocal regional lymph node physical exam. Nodal basin US is NOT a substitute for SLNB. BRIM8 trail showed that in select patients with resected AJCC 7th Edition stage IIC-III disease and BRAF V600 mutation, adjuvant treatment with the BRAF inhibitor, vemurafenib monotherapy improved disease-free survival (DFS) and possibly DMFS compared to placebo. The impact on overall survival (OS) was not statistically significant. Vermuranfenib monotherapy was associated with higher rates of toxicity compared to placebo and is NOT FDA approved for adjuvant treatment of melanoma (Maio et. al., 2018)
References
Gershenwald JE, Scolyer RA, Hess KR, Sondak VK, Long GV, Ross MI, Lazar AJ, Faries MB, Kirkwood JM, McArthur GA, Haydu LE, Eggermont AMM, Flaherty KT, Balch CM, Thompson JF; for members of the American Joint Committee on Cancer Melanoma Expert Panel and the International Melanoma Database and Discovery Platform. Melanoma staging: Evidence-based changes in the American Joint Committee on Cancer eighth edition cancer staging manual. CA Cancer J Clin. 2017 Nov;67(6):472-492. doi: 10.3322/caac.21409. Epub 2017 Oct 13. PMID: 29028110; PMCID: PMC5978683.
Michielin, O., et al. “Cutaneous melanoma: ESMO clinical practice guidelines for diagnosis, treatment and follow-up.” Annals of Oncology, vol. 30, no. 12, Dec. 2019, pp. 1884–1901, https://doi.org/10.1093/annonc/mdz411.
Swetter, S. M., Thompson, J. A., Albertini, M. R., Barker, C. A., Baumgartner, J., Boland, G., Chmielowski, B., DiMaio, D., Durham, A., Fields, R. C., Fleming, M. D., Galan, A., Gastman, B., Grossmann, K., Guild, S., Holder, A., Johnson, D., Joseph, R. W., Karakousis, G., Kendra, K., Lange, J. R., Lanning, R., Margolin, K., Olszanski, A. J., Ott, P. A., Ross, M. I., Salama, A. K., Sharma, R., Skitzki, J., Sosman, J., Wuthrick, E., McMillian, N. R., & Engh, A. M. (2021). NCCN Guidelines® Insights: Melanoma: Cutaneous, Version 2.2021, Journal of the National Comprehensive Cancer Network J Natl Compr Canc Netw, 19(4), 364-376. Retrieved Jun 14, 2021, from https://jnccn.org/view/journals/jnccn/19/4/article-p364.xml
Vetto, John T. “Clinical and imaging follow-up for high-risk cutaneous melanoma: Current evidence and guidelines.” Cancers, vol. 16, no. 14, 18 July 2024, p. 2572, https://doi.org/10.3390/cancers16142572.
Maio M, Lewis K, Demidov L, et al. Adjuvant vemurafenib in resected BRAF(V600) mutation-positive melanoma (BRIM8): a randomized, double-blind, placebo-controlled, multicentere, phase 3 trial. Lancet Oncol 2018; 19:510-520.