return to: Melanoma (Evaluation and Management) (8th Edition AJCC)
General Guidelines
5-year survival = 93% (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 |
Consider |
|
National Comprehensive Cancer Network (NCCN) (Swetter et al, 2021) (Vetto, 2024) |
Per tumor (T) classification |
No |
Yes |
Yes |
Yes |
Consider |
Yes |
Additional comments
ESMO: There may be some subsets of stage IIIA patients with higher risk of relapse (tumor burden with sentinel node >1 mm). In these patients, discussion of risk reduction and long-term side-effects of adjuvant therapy can be considered.
NCCN: If patient is sentinel node positive, consider imaging for baseline staging, nodal basin US surveillance (preferred) or completion lymph node dissection (CLND). Consider BRAF mutation testing. Adjuvant options include nivolumab, pembrolizumab, and dabrafebib/trametinib (BRAF-600 activating mutations)
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.