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Stage IA T1aN0M0 no adverse features Breslow ≤ 1mm T1a no ulceration (U-) mitotic rate less than 1 mm2

last modified on: Wed, 06/21/2017 - 14:46

Stage IA   T1aN0M0

Breslow     ≤ 1mm

T1a: no ulceration (U-), mitosis <1mm2

 

 

 

5 yr survival = 97%
(ref Edge 2010)

 

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

 


Followup

  1. Modify significantly according to prognosis
  2. Avoidance of sun exposure
  3. Surveillance as per NCCN Guidelines (ref Coit et al 2010)
    1. All melanoma patients: Skin examination and surveillance at least once a year for life is recommended
    2. 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.
    3. 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.
  4. All patients with melanoma treated for cure should have at least yearly follow-up with dermatology to permit total-body surveillance.
  5. SUGGESTED READING
    1. Edge S et al (editors)  AJCC Cancer Staging Manual Seventh Edition: "Melanoma of Skin" pp325 to 344 in Springer New York  2010
    2. Coit DG et al  NCCN Clincal Practice Guidelines in Oncology: "Melanoma" v.2.2010 accessed 4-14-10 www.nccn.org
  6. return to Melanoma (Evaluation and Management)