MELANOMA clinical guideline
More than 1 million people are living with melanoma, and one person dies of the disease every hour. These new evidence-based guidelines of the American Academy of Dermatology address the most commonly considered and utilized approaches for the surgical and medical treatment of primary cutaneous melanoma:
- The guideline recommends the types of biopsies that obtain the histopathologic information necessary to optimize the diagnosis of cutaneous melanoma and guide further management.
- Surgery remains the cornerstone of cutaneous melanoma treatment. Mohs micrographic surgery and other staged excision techniques can provide exhaustive peripheral margin histologic assessment for melanoma in situ, lentigo maligna type, as well as tissue sparing in anatomically constrained sites.
- Nonsurgical approaches (imiquimod and traditional forms of radiation therapy) should only be considered if surgery is impractical or contraindicated, and only for melanoma in situ, lentigo maligna type, as the cure rates associated with these treatments are lower.
- As options to treat metastatic disease have greatly improved, including in the adjuvant setting, accurate staging is critical and may incorporate sentinel lymph node biopsy for pathological staging of the regional lymph nodes in appropriate patients.
- The frequency and intensity of cutaneous melanoma follow-up, including surveillance imaging, depends on the stage of disease, risk for recurrence, and risk of new primary melanoma.
- The guideline also addresses melanoma in pregnancy, genetic testing for hereditary risk, and the management of dermatologic toxicities related to novel therapies for advanced disease.