return to: Melanoma (Evaluation and Management) (8th Edition AJCC)

§comment: SLNB can be discussed in pT1a for special cases [e.g. ≥3 mitoses/mm², a positive deep margin or when Breslow thickness cannot be reliably determined (pTx)]

♦comment: if patient's risk of positive SLN is <5% (T1a melanoma), NCCN does NOT recommend SLNB. If there is clinical uncertainty about the microstaging or, in the rare event that a conventional high-risk feature is present (e.g., ulceration, high mitotic rate, lymphovascular invasion), SLNB can be discussed.

*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 cm margin encompassing melanoma

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Follow-up

1. Modify significantly according to prognosis
2. Avoidance of sun exposure
3. Stage IA-IIA Surveillance as per NCCN Guidelines (ref Swetter et al 2021)

   1. All melanoma patients: Skin examination and surveillance at least once a year for life is recommended

   2. Comprehensive H&P with emphasis on regional nodes and skin every 6-12 months x 5 years, then annually as clinically indicated

   3. Routine surveillance imaging without symptoms/signs NOT recommended

   4. Routine blood testing NOT recommended

4. All patients with melanoma treated for cure should have at least yearly follow-up with dermatology to permit total-body surveillance

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References

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

Keung, Emily Z, and Jeffrey E Gershenwald. “The eighth edition American Joint Committee on Cancer (AJCC) melanoma staging system: implications for melanoma treatment and care.” Expert review of anticancer therapy vol. 18,8 (2018): 775-784. doi:10.1080/14737140.2018.1489246

Keilholz U, Ascierto PA, Dummer R, Robert C, Lorigan P, van Akkooi A, Arance A, Blank CU, Chiarion Sileni V, Donia M, Faries MB, Gaudy-Marqueste C, Gogas H, Grob JJ, Guckenberger M, Haanen J, Hayes AJ, Hoeller C, Lebbé C, Lugowska I, Mandalà M, Márquez-Rodas I, Nathan P, Neyns B, Olofsson Bagge R, Puig S, Rutkowski P, Schilling B, Sondak VK, Tawbi H, Testori A, Michielin O. ESMO consensus conference recommendations on the management of metastatic melanoma: under the auspices of the ESMO Guidelines Committee. Ann Oncol. 2020 Nov;31(11):1435-1448. doi: 10.1016/j.annonc.2020.07.004. Epub 2020 Aug 4. PMID: 32763453.