return to: Melanoma (Evaluation and Management) (8th Edition AJCC)
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Margins |
Mohs? |
SLN bx |
PET |
CT |
Radiation |
Adjuvant |
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ESMO |
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NCCN |
per T |
no |
no |
yes |
yes |
yes |
yes |
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U of Iowa |
per T* |
no** |
no |
yes |
yes |
yes |
yes |
*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
NCCN: Treatment for stage IV metastatic melanoma depends on whether the disease is limited (resectable) or disseminate (unresectable). Clinical trial is the preferred treatment option for patients with distant metastatic disease.
U of Iowa: See open protocols at the bottom of Melanoma (Evaluation and Management)
The median survival time following diagnosis of disseminated disease has been reported between 6 to 8 months with a five-year survival rate of 6%. M1a has better prognosis than M1b which has a better prognosis than M1c. (ref: Schmalbach 2006).
Note M1 (presence of distant metastases) sub-classification
M1a - Metastasis to distant skin (not just satelite or in-transet), distant subcutaneous tissues or distant lymph nodes
M1b - Metastasis to lung
M1c - Metastasis to all other visceral sites or distant metastasis at any site associated with an elevated serum lactic dehydrogenase
References
AJCC Cancer Staging Manual 6th edition 2002 Springer-Verlag New York Eds Green FL et al
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
Schmalbach, C: The Management of Head and Neck melanoma in Curr Proble Surg 2006;43:781-835