Malignant Melanoma Questions & Answers

Updated: Jan 31, 2020
  • Author: Winston W Tan, MD, FACP; Chief Editor: Dirk M Elston, MD  more...
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Questions & Answers

Overview

What is malignant melanoma?

What should be the focus of history for suspected malignant melanoma?

What should be included in the physical exam for malignant melanoma?

How is a malignant melanoma differentiated from a benign nevi?

Which lab studies are performed in the evaluation of malignant melanoma?

Which imaging modalities are performed in the evaluation of malignant melanoma?

Which procedures performed in the workup of malignant melanoma?

What are the characteristic histologic findings of a malignant melanoma?

What is included in the treatment of early-stage malignant melanoma?

Which agents are used in adjuvant therapy for resectable stage III malignant melanoma?

Which agents are used in adjuvant therapy for unresectable stage III, stage IV, and recurrent malignant melanoma?

What agents are used in immunotherapy for malignant melanoma?

Which signal-transduction inhibitors are used to treat malignant melanoma?

Which chemotherapy agents are used for the treatment of malignant melanoma?

How are brain metastases treated in malignant melanoma?

What are lentigo maligna melanomas (LMMs)?

What is the disease progression of malignant melanoma?

How are malignant melanoma lesions classified?

What are the forms of malignant melanoma?

What is a superficial spreading melanoma (SSM)?

What are nodular melanomas (NMs)?

What are acral lentiginous melanomas (ALMs)?

What are mucosal lentiginous melanomas (MLMs)?

Where other than the skin are malignant melanomas found?

What is the role of melanocytes in the pathogenesis of malignant melanoma?

How does a malignant melanoma develop?

What are precursor lesions of malignant melanoma?

What is the role of genetics in the etiology of malignant melanoma?

What is the role of ultraviolet radiation (UVR) in the etiology of malignant melanoma?

How does ultraviolet radiation (UVR) cause malignant melanoma?

What is the role of sun exposure in the etiology of malignant melanoma?

What is the greatest risk factor for the development of sun exposure–induced malignant melanoma?

What is the relationship between malignant melanoma and Parkinson disease (PD)?

Other than ultraviolet radiation (UVR), what are etiologic factors in malignant melanoma?

Which factors greatly increase the risk for cutaneous malignant melanoma?

What factors moderately increase the risk for cutaneous malignant melanoma?

Which factors slightly increase the risk for cutaneous malignant melanoma?

What is the incidence of malignant melanoma in the US?

What is the annual mortality rate of malignant melanoma in the US?

What is the global incidence of malignant melanoma?

What are the racial predilections of malignant melanoma?

How does the incidence of malignant melanoma vary between men and women?

Which age groups are at highest risk for malignant melanoma?

Which patient groups are at highest risk for malignant melanoma?

What is the prognosis of malignant melanoma?

Which types of malignant melanoma are most fatal?

What are the most important prognostic factors in malignant melanoma?

What are the positive prognostic factors of malignant melanoma?

What can improve prognostic accuracy for malignant melanoma?

How does organ transplantation affect the prognosis of malignant melanoma?

What are the prognostic indications of mucosal melanoma?

What are the 5-year relative survival rates of malignant melanoma?

What is the focus of malignant melanoma prevention and patient education?

Presentation

What should be the focus of family history in the evaluation of malignant melanoma?

What should be the focus of patient history in the evaluation of malignant melanoma?

How is a total body exam performed in the evaluation of malignant melanoma?

What are useful adjuncts to total body exam for evaluation of malignant melanoma?

How are early melanomas differentiated in the skin exam of malignant melanoma?

Why is the lymph node examined in the evaluation of malignant melanoma?

DDX

Which conditions should be included in the differential diagnoses of malignant melanoma?

What are the differential diagnoses for Malignant Melanoma?

Workup

How is the diagnosis of malignant melanoma confirmed?

Which lab studies are performed in the workup of malignant melanoma?

What is the role of imaging studies in the workup of malignant melanoma?

Which histologic findings are characteristic of malignant melanoma?

What is the role of immunohistochemical stains in the diagnosis of malignant melanoma?

What is the role of chemistry panels in the workup of malignant melanoma?

What is the role of total protein and albumin measurement in the workup of malignant melanoma?

What test is required prior to initiation of chemotherapy for malignant melanoma?

What is the role of high lactate dehydrogenase (LDH) measurement in the diagnosis of malignant melanoma?

What is the role of chest radiography in the evaluation of malignant melanoma?

What is the role of imaging studies in stage III malignant melanoma?

What is the role of MRI in the evaluation of malignant melanoma?

When is MRI of the brain indicated in the evaluation of malignant melanoma?

What is the role of chest CT scan in stage IV malignant melanoma management?

What is the role of chest CT scan in the management of stage I, II, or III malignant melanoma?

When is a CT scan of the abdomen indicated in the workup of malignant melanoma?

When is a CT scan of the pelvis indicated in the workup of malignant melanoma?

What is the role of positron emission tomography (PET) scans in the workup of malignant melanoma?

What is the role of biopsy in the workup of malignant melanoma?

When is an incisional or punch biopsy indicated in the workup of malignant melanoma?

What is the role of a shave biopsy in the workup of malignant melanoma?

What is the role of reexcision in the workup of malignant melanoma?

What are the recommendations for surgical margins of excision in malignant melanoma?

When is a complete regional lymph node dissection (LND) indicated in the management of malignant melanoma?

What is the significance of the sentinel lymph node in the workup of malignant melanoma?

How is the sentinel node identified in the workup of malignant melanoma?

What are the benefits of a sentinel lymph node biopsy (SLNB) in the workup of malignant melanoma?

What are the recommendations by the National Comprehensive Cancer Network (NCCN) for sentinel lymph node biopsy (SLNB) in the workup of malignant melanoma?

What are the recommendations by the American Society of Clinical Oncology (ASCO) and Society of Surgical Oncology (SSO) for sentinel lymph node biopsy (SLNB) in the workup of malignant melanoma?

What is the role of a sentinel lymph node biopsy (SLNB) in determining metastasis in malignant melanoma?

What is the Clark staging for malignant melanoma?

What is the Breslow classification for malignant melanoma?

What is the T classification (thickness) for malignant melanoma?

What is the N classification for malignant melanoma?

What is the M classification for malignant melanoma?

What is the AJCC prognostic staging system for malignant melanoma?

Treatment

What is the role of surgery in the treatment of early-stage malignant melanoma?

What is the role of medical therapy in the treatment of malignant melanoma?

What are the standard treatment options for malignant melanoma by stage?

How does the BRAF mutation affect the treatment options for malignant melanoma?

What is the role of interferon alfa-2b in the treatment of malignant melanoma?

What are the American Society of Clinical Oncology and the Society of Surgical Oncology recommendations for treatment of malignant melanoma following a positive sentinel lymph node biopsy (SLNB)?

What is the role of completion lymph node dissection (CLND) in the treatment of malignant melanoma?

What is the efficacy of completion lymph node dissection (CLND) in the treatment of malignant melanoma?

What are the benefits of completion lymph node dissection (CLND) in patients with micrometastases on SLNB in malignant melanoma?

What is the role of adjuvant therapy in the treatment of malignant melanoma?

What is the efficacy of combination dabrafenib and trametinib for the treatment of malignant melanoma?

What is the role of pembrolizumab in the treatment of malignant melanoma?

What is the role of nivolumab in the treatment of malignant melanoma?

What is the role of ipilimumab in the treatment of malignant melanoma?

When is talimogene laherparepvec (Imlygic) indicated in the treatment of malignant melanoma?

What is the mechanism of action for talimogene laherparepvec (Imlygic) in the treatment of malignant melanoma?

What is the efficacy of talimogene laherparepvec (Imlygic) against malignant melanoma?

What is the durable response rate (DRR) for talimogene laherparepvec (Imlygic) in the treatment of malignant melanoma?

What is the overall response rate (ORR) for talimogene laherparepvec (Imlygic) in the treatment of malignant melanoma?

What is the efficacy of combination therapy for malignant melanoma with talimogene laherparepvec (Imlygic) and immune checkpoint inhibitors?

What is the efficacy of interferon (IFN) alfa-2b in the treatment of malignant melanoma?

Which factors are predictors of response to interferon alfa/pegylated-interferon in the treatment of malignant melanoma?

What is the role of peginterferon alfa-2b in the treatment of malignant melanoma?

What is the efficacy of granulocyte-macrophage colony-stimulating factor (GM-CSF) for the treatment of malignant melanoma?

What are the treatment options for advanced-stage malignant melanoma?

What is the efficacy of dacarbazine in the treatment of advanced-stage malignant melanoma?

What is the efficacy of interleukin-2 (IL-2) in the treatment of advanced-stage malignant melanoma?

What are the adverse effects of interleukin-2 (IL-2) in the treatment of malignant melanoma?

What is the role of combination carboplatin and paclitaxel in the treatment of malignant melanoma?

What is the prevalence of BRAF mutations in patients with malignant melanoma and how does it affect treatment selection?

What is the first-line treatment for malignant melanoma in patients with BRAF mutations?

What is the role of vemurafenib (Zelboraf) in the treatment of malignant melanoma?

What is the role of dabrafenib (Taflinar) in the treatment of malignant melanoma?

What is the role of vemurafenib (Zelboraf) in the treatment of malignant melanoma?

What are possible adverse events from vemurafenib for the treatment of malignant melanoma?

What is the efficacy of dabrafenib in the treatment of malignant melanoma?

What is the role of trametinib (Mekinist) in the treatment of malignant melanoma?

What is the role of trametinib in the treatment of malignant melanoma?

What is the role of cobimetinib in the treatment of malignant melanoma?

What is the role of binimetinib plus encorafenib in the treatment of malignant melanoma?

What is the first-line treatment for BRAF V600 wild-type, unresectable, or metastatic malignant melanoma?

How is nivolumab (Opdivo) used in the treatment of malignant melanoma?

What was the efficacy of nivolumab in the treatment of malignant melanoma?

What is the benefit of nivolumab to treat unresectable or metastatic malignant melanoma?

When is nivolumab indicated for the treatment of malignant melanoma?

What is the role of pembrolizumab (Keytruda) in the treatment of malignant melanoma?

What is the mechanism of action of ipilimumab in the treatment of malignant melanoma?

What is the efficacy of ipilimumab in the treatment of malignant melanoma?

What are the immune-related adverse events (AEs) of ipilimumab in the treatment of malignant melanoma?

What are the indications for the treatment of malignant melanoma with the combination regimen of nivolumab plus ipilimumab?

What is the efficacy of ipilimumab combination regimens in the treatment of melanoma?

Which drug is approved for adjuvant therapy and for treatment of advanced stage malignant melanoma?

What is the efficacy of combination nivolumab and ipilimumab in the treatment of malignant melanoma?

What are the treatment options for brain metastases in malignant melanoma?

How is malignant melanoma treated in patients with KIT mutations?

What is the role of vaccines in the treatment of malignant melanoma?

What is the focus of malignant melanoma prevention?

What is the role of sunscreen in the prevention of malignant melanoma?

Which patients should have annual skin exams for malignant melanoma prevention?

When is consultation with a dermatologist or surgical oncologist warranted in the evaluation of malignant melanoma?

When is an oncology consultation needed for the treatment of malignant melanoma?

Which factors determine the follow-up care for a patient with malignant melanoma?

What is the NCCN recommended follow-up care for stage 0 in situ malignant melanoma?

What is the follow-up care for stage IA malignant melanoma?

What is the NCCN recommended follow-up care for stage IB-IV (patients with no evidence of disease) malignant melanoma?

Guidelines

What are the USPSTF guidelines for routine screening for malignant melanoma?

What are the recommendations of the National Comprehensive Cancer Network (NCCN) for the workup of malignant melanoma?

What are the European Society of Medical Oncology (ESMO) diagnostic guidelines for malignant melanoma?

What are the American Academy of Dermatology (AAD) diagnostic guidelines for malignant melanoma?

What are the NCCN guidelines for surveillance of asymptomatic patients with stage IA, IB, and IIA malignant melanoma?

What are the NCCN guidelines for use of imaging studies in malignant melanoma?

What is the American Joint Committee on Cancer (AJCC) recommendation for use of serum lactate dehydrogenase (LDH) levels for staging malignant melanoma?

What are the AAD guidelines for the surgical management of malignant melanoma?

What are the NCCN guidelines for sentinel lymph node biopsy in patients with malignant melanoma?

What are the American Academy of Dermatology (AAD) guidelines for sentinel lymph node biopsy in patients with malignant melanoma?

What are the American Society of Clinical Oncology (ASCO) and Society of Surgical Oncology (SSO) guidelines for sentinel lymph node biopsy in patients with malignant melanoma?

What are the NCCN guidelines for use of Mohs surgery in the treatment of malignant melanoma?

What are the AAD, American College of Mohs Surgery (ACMS), American Society for Dermatologic Surgery Association (ASDSA), and the American Society for Mohs Surgery (ASMS) appropriate-use criteria for Mohs surgery for malignant melanoma?

What are the surgical margin recommendations for primary malignant melanoma?

What are the NCCN recommendations for radiation therapy in the treatment of malignant melanoma?

What are the NCCN recommendations for treatment of melanoma stage IV disease with distant metastasis?

What are the NCCN recommended first-line immunotherapy regimens for systemic therapy of malignant melanoma?

What are the NCCN category 1 recommendations for first-line therapy of malignant melanoma in patients with a BRAF V600 activating mutation?

What is the NCCN second-line therapy for the treatment of malignant melanoma?

What is the NCCN recommendations for follow-up of stage 0 in situ malignant melanoma cancer survivors?

What is the NCCN recommendations for follow-up of stage IA malignant melanoma cancer survivors?

What are the NCCN recommendations for follow-up of stage IB-IV (patients with no evidence of disease) malignant melanoma cancer survivors?

Medications

Which medications are used in the treatment of malignant melanoma?

Which medications in the drug class Oncolytic Immunotherapy are used in the treatment of Malignant Melanoma?

Which medications in the drug class Biological Response Modulators are used in the treatment of Malignant Melanoma?

Which medications in the drug class Antineoplastic Agents are used in the treatment of Malignant Melanoma?