Physical Address

304 North Cardinal St.
Dorchester Center, MA 02124

Management of the Patient with Melanoma


Key Points

  • Melanoma management should be tailored to the needs of each individual patient.

  • Surgical excision is the cornerstone of melanoma management.

  • Sentinel lymph node biopsy is currently a staging and prognostic tool in the management of melanoma.

  • Adjuvant therapy should be considered in patients at high risk of recurrence.

  • Single drug chemotherapy remains the standard treatment for advanced metastatic disease. Clinical trials should be strongly considered for patients with metastatic melanoma.

  • Regular follow-up, skin self-examinations, and sun protection are important for patients with a history of melanoma and their family members.

Introduction

Existing guidelines

Melanoma is increasingly recognized as a major public health concern due to a continued rise in incidence and mortality over the past few decades. Optimal management of a patient diagnosed with melanoma remains challenging, and the most effective strategies for reducing morbidity and mortality rely on prevention and early detection. A multifaceted approach is employed when deciding management of the primary site, staging procedures, adjuvant therapy, and follow-up.

Several guidelines for melanoma management have been set forth by different organizations, including the National Comprehensive Cancer Network (NCCN), American Academy of Dermatology, Society of Surgical Oncology, and the British Association of Dermatologists. The NCCN guidelines have been most recently updated and a practical representation of their recommendations on staging and initial management for common scenarios is provided in Figure 28.1 . The significant variations among these different published guidelines highlight the absence of a single ‘evidence-based’ approach for managing melanoma patients. Therefore, treatment should be tailored to the needs of each individual patient. This chapter presents a generalized approach to the diagnostic and staging work-up for melanoma, surgical management, adjuvant treatment, and post-treatment surveillance, and more detailed descriptions of each of these components.

Figure 28.1, Schema for staging and initial management of melanoma based on NCCN guidelines. 2a Footnotes reproduced with permission from the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines™) for Melanoma V.1.2011 . © 2010 National Comprehensive Cancer Network, Inc. All rights reserved. The NCCN Guidelines™ and illustrations herein may not be reproduced in any form for any purpose without the express written permission of the NCCN. To view the most recent and complete version of the NCCN Guidelines, go online to HYPERLINK http://www.nccn.org/NCCN.org . NATIONAL COMPREHENSIVE CANCER NETWORK®, NCCN®, NCCN GUIDELINES™, and all other NCCN Content are trademarks owned by the National Comprehensive Cancer Network, Inc.

Detailed discussions concerning the various stage-specific treatment modalities, including current practice, recent advances, and controversies, may be found in subsequent chapters.

Management

You're Reading a Preview

Become a Clinical Tree membership for Full access and enjoy Unlimited articles

Become membership

If you are a member. Log in here