return to: Melanoma (Evaluation and Management) (8th Edition AJCC)
|
Stage IA T1aN0M0 |
Breslow ≤ 1mm |
T1a: no ulceration (U-), mitosis <1mm2 |
|
|
|
5 yr survival = 97% |
|
|
no adverse features (AJCC 7th edition, 2010) |
Margins |
Mohs? |
SLN bx |
PET |
CT |
Radiation |
Adjuvant |
|
ESMO |
1 cm |
no |
no |
no |
no |
no |
no |
|
NCCN (ref Coit et al 2010) |
1 cm |
no |
no |
no |
no |
no |
no |
|
U of Iowa |
1 cm* |
no** |
no *** |
no |
no |
consider: PNI, desmoplastic |
no |
*comment: margins are not inviolate and may be modified by proximity to critical structures with attention to lymphatic drainage patterns
**comment: Mohs surgery may be considered for melanoma with lentigo maligna extending beyond the 1 margin encompassing melanoma
***comment: may consider SLN bx: >0.75 mm invasion; SLN not generally considered useful for desmoplastic melanoma
Follow-up
- Modify significantly according to prognosis
- Avoidance of sun exposure
- Surveillance as per NCCN Guidelines (ref Coit et al 2010)
- All melanoma patients: Skin examination and surveillance at least once a year for life is recommended
- Stage IA to IIA: Comprehensive H&P with specific emphasis on the regional nodes and skin every 3-12 months for five years and annually thereafter. Routine lab or imaging not useful in this group.
- Stage IIB-IV melanoma, NED: Comprehensive H&P every 3-6 months for two years; then every 3-12 months for three years and annually thereafter. CXR, CT, MRI and/or PET/CT can be considered to screen for recurrent or metastatic disease at the discretion of the physician. Because most recurrences manifest within the first 5 years, routine lab tests and imaging are not recommended beyond this period.
- All patients with melanoma treated for cure should have at least yearly follow-up with dermatology to permit total-body surveillance.
References
Edge S et al (editors) AJCC Cancer Staging Manual Seventh Edition: "Melanoma of Skin" pp325 to 344 in Springer New York 2010
Coit DG et al NCCN Clincal Practice Guidelines in Oncology: "Melanoma" v.2.2010 accessed 4-14-10 www.nccn.org