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

*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

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.

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