Guidelines of care for the management of primary cutaneous melanoma.

Swetter SM1, Tsao H2, Bichakjian CK3, Curiel-Lewandrowski C4, Elder DE5, Gershenwald JE6, Guild V7, Grant-Kels JM8, Halpern AC9, Johnson TM3, Sober AJ10, Thompson JA11, Wisco OJ12, Wyatt S13, Hu S14, Lamina T15.

Author information

1: Department of Dermatology, Stanford University Medical Center and Cancer Institute, Stanford, California; Veterans Affairs Palo Alto Health Care System, Palo Alto, California. Electronic address: sswetter@stanford.edu.
2: Department of Dermatology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts; Wellman Center for Photomedicine, Boston, Massachusetts.
3: Department of Dermatology, University of Michigan Health System, Ann Arbor, Michigan; Comprehensive Cancer Center, Ann Arbor, Michigan.
4: Division of Dermatology, University of Arizona, Tucson, Arizona; University of Arizona Cancer Center, Tucson, Arizona.
5: Department of Dermatology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania; Department of Pathology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.
6: Department of Surgical Oncology, The University of Texas M.D. Anderson Cancer Center, Houston, Texas; Department of Cancer Biology, The University of Texas M.D. Anderson Cancer Center, Houston, Texas.
7: AIM at Melanoma Foundation, Plano, Texas.
8: Department of Dermatology, University of Connecticut Health Center, Farmington, Connecticut; Department of Pathology, University of Connecticut Health Center, Farmington, Connecticut; Department of Pediatrics, University of Connecticut Health Center, Farmington, Connecticut.
9: Department of Dermatology, Memorial Sloan-Kettering Cancer Center, New York, New York.
10: Department of Dermatology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts.
11: Division of Oncology, University of Washington, Seattle, Washington; Seattle Cancer Care Alliance, Seattle, Washington.
12: Department of Dermatology, Oregon Health and Science University, Portland, Oregon.
13: Decatur Dermatology, Decatur, Alabama.
14: Department of Dermatology, University of Miami Health System, Miami, Florida.
15: American Academy of Dermatology, Rosemont, Illinois.

Abstract

The incidence of primary cutaneous melanoma continues to increase each year. Melanoma accounts for the majority of skin cancer-related deaths, but treatment is usually curative following early detection of disease. In this American Academy of Dermatology clinical practice guideline, updated treatment recommendations are provided for patients with primary cutaneous melanoma (American Joint Committee on Cancer stages 0-IIC and pathologic stage III by virtue of a positive sentinel lymph node biopsy). Biopsy techniques for a lesion that is clinically suggestive of melanoma are reviewed, as are recommendations for the histopathologic interpretation of cutaneous melanoma. The use of laboratory, molecular, and imaging tests is examined in the initial work-up of patients with newly diagnosed melanoma and for follow-up of asymptomatic patients. With regard to treatment of primary cutaneous melanoma, recommendations for surgical margins and the concepts of staged excision (including Mohs micrographic surgery) and nonsurgical treatments for melanoma in situ, lentigo maligna type (including topical imiquimod and radiation therapy), are updated. The role of sentinel lymph node biopsy as a staging technique for cutaneous melanoma is described, with recommendations for its use in clinical practice. Finally, current data regarding pregnancy and melanoma, genetic testing for familial melanoma, and management of dermatologic toxicities related to novel targeted agents and immunotherapies for patients with advanced disease are summarized.

Published by Elsevier Inc.

KEYWORDS:

Mohs micrographic surgery; biopsy; follow-up; genetic counseling; imiquimod; melanoma; molecular techniques; nonsurgical techniques; pathology report; pregnancy; radiation therapy; sentinel lymph node biopsy; skin toxicities; staged excision; surgical margins; treatment