Sections

Workup

Approach Considerations

The diagnosis of melanoma is confirmed by excisional biopsy. Sentinel lymph node biopsy or gene profile assay may be appropriate as prognostic studies in selected patients, but there is little evidence that they affect longevity.

In early-stage disease, laboratory and imaging studies are rarely indicated. In all stages, they are generally appropriate when prompted by signs or symptoms. Routine testing can lead to frequent false-positive results and a cascade of unnecessary tests.

Preoperative imaging studies have significant costs and offer minimal benefit in most patients with melanoma.^[19]One meta-analysis of diagnostic tests used in staging melanoma has shown that ultrasonography is the best imaging study to diagnose lymph node involvement and that positron emission tomography computed tomography scanning (PET/CT) is the best imaging study to look for other sites of metastasis.^[20] In general, these studies are appropriate in high-risk patients or when localizing signs or symptoms are present.

Biopsy of a Suggestive Lesion

A complete excisional biopsy is preferred. The sample should have a 1-3 mm margin of healthy skin and should include all layers of skin and some subcutaneous fat. Inclusion of fascia is no longer standard.

If the suggestive lesion is large or situated in a cosmetically sensitive area, an incisional or punch biopsy may be appropriate. The incisional biopsy specimen should be taken from the most abnormal area of the lesion.

Shave biopsy should generally not be done, as it can lead to inadequate staging and diagnosis. The National Comprehensive Cancer Network acknowledges that superficial shave biopsy may compromise pathologic diagnosis and complete assessment of Breslow thickness, but considers shave biopsy acceptable when the index of suspicion is low, and advises that a broad shave biopsy may be optimal for histologic assessment of melanoma in situ, lentigo maligna (LM) type (ie, melanoma on skin with high cumulative sun damage).^[21]In cases where a shave biopsy was done inappropriately, a complete excisional biopsy of the lesion should be performed, if possible, to determine the depth and extent of the lesion.

Surgical Excision or Reexcision After Biopsy

Because failure to perform a reexcision after biopsy of a melanoma is associated with a local recurrence rate of as high as 40%, a reexcision must be performed. Recommendations are evolving.

Current recommendations for surgical margins of excision are as follows^[21]:

In situ lesions - 0.5-1 cm margin
Lesions ≤ 1 mm in thickness - 1 cm margin
Lesions 1.01 - 2 mm in thickness - 1-2 cm margin
Lesions 2.01-4 mm in thickness - 2 cm margin
Lesions greater than 4 mm in thickness - At least 2 cm margin

A study by Gillgren et al determined that a 2-cm excision provided a safe and reliable resection margin to treat lesions thicker than 2 mm.^[22]

Histologic Findings

Although no single histologic feature is pathognomonic for melanoma, many characteristic features exist. Cytologic atypia virtually always is noted, with enlarged cells containing large, pleomorphic, hyperchromic nuclei with prominent nucleoli. Numerous mitotic figures often are noted.

Immunohistochemical stains usually are not necessary for diagnosis; they may be necessary in cases with indeterminate findings on routine histology. Both S-100 and homatropine methylbromide (HMB45) stains are positive in melanocytes and the latter shows a gradient in most benign nevi other than blue nevi. S-100 and SOX-10 are highly sensitive, although not specific, for melanocytes. They are particularly helpful in poorly differentiated or spindled tumors.

PRAME (preferentially expressed antigen in melanoma) can stain the junctional component of benign nevi but dermal staining is suggestive of melanoma. It is not completely specific and stains other tumors, including testicular tumors and cellular neurothekeoma. It is particularly helpful in distinguishing preexisting nevus remnants from melanoma.^{[23, 24, 25, 26]}

Mart-1/MelanA as well as MITF are sometimes used to establish the pattern of melanocytes, but all 3 may stain pseudonests in lichenoid tissue reactions. S100 is often poorly expressed in the nail matrix; HMB-45 and Mart-1 may be superior in that location. Next-generation gene sequencing and microarray genomic hybridization are becoming commonplace for the diagnosis of unique types of nevi and difficult melanocytic lesions. Fluorescent in situ hybridization (FISH) assays also have evolving applications and molecular predictors of biologic response to targeted immunotherapy are in common use, with BRAF testing being the most frequent.^{[27, 28, 29, 30]}

Elective Lymph Node Dissection

Patients with clinically enlarged lymph nodes and no evidence of distant disease should undergo a lymph node biopsy. For years, patients without clinically enlarged nodes underwent lymph node dissection (LND). However, studies show that in patients with melanomas that are 1-4 mm thick, LND may not yield a significant survival advantage.

The only patients who seem to benefit from LND are those with lesions 1.1–2 mm thick and who are younger than 60 years. Patients with lesions greater than 4 mm in thickness are widely considered not to benefit from removal of clinically negative nodes.

Sentinel Lymph Node Biopsy

Lymphatics from any given region on the skin drain to a single lymph node. This node is called the sentinel lymph node and almost always is the first site of nodal involvement when melanoma spreads to regional nodes.

To determine which node is the sentinel node, the following two techniques, often in combination, are used. The combination of the two techniques allows detection of the sentinel node in as many as 98% of cases.

The first technique involves injecting a blue dye at the site of the primary melanoma and, through a small incision over the nodal basin, determining the location of the sentinel node. The second technique involves a radiolabeled solution injected into the site of the primary and the use of a hand-held gamma detector to determine the location of the sentinel node. The node is then removed for pathologic evaluation. Removal of the node should precede wide excision of the primary.^[1]

Sentinel lymph node biopsy (SLNB) is now known to offer important prognostic, diagnostic, and therapeutic information.^[31]

Guidelines from the National Comprehensive Cancer Network (NCCN) recommend discussing and offering SLNB to patients with stage IB or stage II melanoma that is 0.76-1 mm thick with ulceration or with a mitotic rate ≥1/mm², or > 1 mm thick with any characteristic adverse features. The NCCN recommends discussing and considering SLNB in patients with stage IA melanoma that is 0.76-1 mm thick, with no ulceration and a mitotic rate of 0/mm³.^[21]SLNB may be offered either as standard care or in the context of a clinical trial.

The NCCN does not recommend SLNB for patients whose melanoma is 0.75 mm or less in thickness. The NCCN advises that SLNB may be considered if conventional risk factors such as ulceration, high mitotic rate, or lymphovascular invasion are present, but notes that those are very uncommonly found with melanomas that thin.^[21]

Joint guidelines from the American Society of Clinical Oncology (ASCO) and Society of Surgical Oncology (SSO) recommend SLNB for patients with intermediate-thickness melanomas (Breslow thickness 1–4 mm) of any anatomic site. There is less evidence for patients with thick melanomas (T4; Breslow thickness >4 mm), but sentinel lymph node biopsy is recommended for staging and facilitating regional disease control. Evidence supporting routine sentinel lymph node biopsy for patients with thin melanomas (T1; Breslow thickness < 1 mm) is lacking, but it may be an option in selected patients with high-risk features in whom the benefits of staging outweigh the risks of the procedure.

Cadili et al reported that the likelihood of non–sentinel lymph node metastasis can be predicted on the basis of total metastasis within the sentinel lymph node. Their data showed that patients with ≥5 mm of metastasis have a 30% risk of metastasis. In contrast, those with less than 2 mm of total sentinel lymph node metastasis are unlikely (< 3.67% likelihood) to harbor metastasis in non-sentinel nodes, and those patients may not benefit from additional nodal dissection.^[32]

Go to Sentinel Lymph Node Biopsy in Patients With Melanoma for complete information on this topic.

Complete Chemistry Panel

The chemistry panel may give a clue to possible metastatic disease. For example, an elevated alkaline phosphatase level may signal metastasis to the bone or liver, while elevated levels on liver function tests (aspartate aminotransferase [AST], alanine aminotransferase [ALT]) may represent metastasis to the liver.

Total protein and albumin provide information concerning the overall health and nutritional status of the patient and may afford prognostic information.

Many chemotherapy regimens may be toxic to the kidneys; therefore, a creatinine level is necessary prior to initiation of any treatment.

Lactate Dehydrogenase Assay

The lactate dehydrogenase (LDH) level is elevated in many conditions, including many malignancies. Although LDH elevation is not specific for melanoma, it may be useful in the follow-up care of some patients with melanoma. A markedly elevated LDH at diagnosis or at a follow-up visit may indicate distant metastases, especially in the lung and liver.

Although the specificity and sensitivity of this test are low, multiple studies show an elevated LDH level to be an independent predictive factor for poor prognosis. LDH level now is considered part of the staging system for melanoma.

Chest Radiography

To date, no studies support obtaining a routine radiograph in patients with melanoma. However, a normal chest radiograph finding at diagnosis provides a baseline for future comparison.

Patients with stage III disease, in-transit disease, or local recurrence should have a chest radiograph or computed tomography (CT) scan of the chest, because the lungs often are the first site of metastatic disease.

Magnetic Resonance Imaging

Magnetic resonance imaging (MRI) of the brain should be obtained during the workup of a patient with known distant metastases to detect additional asymptomatic metastatic disease. This is especially true for patients being considered for high-dose interleukin-2 treatment. MRI of the brain in patients without known metastatic disease should be done only in those who have neurologic symptoms.

Computed Tomography

A chest CT scan should be included in the staging workup of a patient with stage IV disease (ie, the patient with known distant metastases) to detect asymptomatic metastatic lesions. In patients with stage I, II, or III disease, a chest CT scan should be performed only if clinically indicated.

A CT scan of the abdomen often is obtained when evaluating a patient with stage III, locally recurrent, or in transit disease. Although the yield is low, a negative CT scan provides a baseline study for future comparison.

CT scan of the pelvis is indicated only if a patient has local regional recurrence below the waist, is symptomatic, or has known metastatic disease with a history of primary tumors below the waist.

Positron Emission Tomography

PET/CT is currently the most sensitive tool for the diagnosis of metastatic disease. PET scans are not indicated in early-stage disease (stage I or II), but a PET scan may aid in staging patients with known node involvement or in-transit or satellite lesions. Many studies report that PET scans have greater sensitivity than conventional radiographic studies for the detection of metastatic disease.

One meta-analysis found PET/CT scanning to be the best imaging study for finding other sites of metastasis.^[20]In particular, fluorodeoxyglucose (FDG) PET/CT scans are a valuable tool for detecting additional metastasis as part of the preoperative evaluation of patients with advanced and metastatic melanoma.^[33]Finally, PET scans often are useful in evaluating the response of metastatic disease to therapy.

Staging

The American Joint Committee on Cancer (AJCC) tumor/node/metastasis (TNM) classification and staging systems for cutaneous melanoma are provided below.^[34] The TNM system has incorporated the older Breslow classification of melanoma thickness, whose four classes of lesion depth correspond with levels T1-4. Clark levels, another older classification of melanoma, are now largely used for historical reference.

T classification (thickness) is as follows:

TX: Primary tumor cannot be assessed (shave biopsy)
T0 : No evidence of primary tumor
Tis: Melanoma in situ
T1: ≤1.0 mm (ulceration unknown or unspecified)
T1a: < 0.8 mm without ulceration
T1b: < 0.8 mm with ulceration; 0.8-1.0 mm with or without ulceration
T2 : >1.0-2.0 mm (ulceration unknown or unspecified)
T2a: >1.0-2.0 mm without ulceration
T2b: >1.0-2.0 mm with ulceration
T3: >2.0-4.0 mm (ulceration unknown or unspecified)
T3a: >2.0-4.0 mm without ulceration
T3b: >2.0-4.0 mm with ulceration
T4: >4.0 mm (ulceration unknown or unspecified)
T4a: >4.0 mm without ulceration
T4b: >4.0 mm with ulceration

N classification (regional lymph node and/or lymphatic metastasis) is as follows:

NX: Regional nodes not assessed
N0: No regional metastases detected
N1: One tumor-involved node; or in-transit, satellite, and/or microsatellite metastases with no tumor-involved nodes
N1a: One clinically occult (ie, detected by sentinel lymph node biopsy); no in-transit, satellite, or microsatellite metastases
N1b: One clinically detected; no in-transit, satellite, or microsatellite metastases
N1c: No regional lymph node disease; in-transit, satellite, and/or microsatellite metastases found
N2: Two or three tumor-involved nodes; or in-transit, satellite, or microsatellite metastases
N2a: Two or three clinically occult (ie, detected by sentinel lymph node biopsy); no in-transit, satellite, or microsatellite metastases
N2b: Two or three clinically detected; no in-transit, satellite, or microsatellite metastases
N2c: One clinically occult or clinically detected; in-transit, satellite, and/or microsatellite metastases found
N3: ≥4 tumor-inolved nodes or in-transit, satellite, and/or microsatellite metastases with ≥2 tumor-involved nodes or any number of matted nodes without or with in-transit, satellite, and/or microsatellite metastases
N3a: ≥4 clinically occult (ie, detected by sentinel lymph node biopsy); no in-transit, satellite, or microsatellite metastases
N3b: ≥4, at least one of which was clinicallly detected, or presence of any matted nodes; no in-transit, satellite, or microsatellite metastases
N3c: ≥2 clinically occulr or clinically detected and/or presence of any matted nodes, with presence of in-transit, satellite, and/or microsatellite metastases

Note that micrometastases are diagnosed after elective or sentinel lymphadenectomy. Macrometastases are defined as clinically detectable nodal metastases confirmed by therapeutic lymphadenectomy or when nodal metastasis exhibits gross extracapsular extension.

M classification is as follows:

M0: No evidence of distant metastasis
M1a: Distant skin, subcutaneous, or nonregional nodal metastases;
M1a: Distant skin, subcutaneous, or nonregional nodal metastases
M1b: Lung metastasis, with or without M1a involvement
M1c - Distant metastasis to non–central nervous system (CNS) visceral sites, with or without M1a or M1b involvement
M1d: Distant metastasis to CNS, with or without M1a-c involvement

Cases (beyond M0) in which the lactate dehydrogenase (LDH) level is known are given the suffix (0), for normal LDH level, or (1), for elevated LDH level.

AJCC prognostic staging is as follows:

Stage 0 - Tis/N0/M0
Stage IA - T1a,/N0/M0
Stage IB - T1b, T2b/ N0/ M0
Stage IIA - T2b, t3a/N0/M0
Stage IIB - T3b, T4a/N0/M0
Stage IIC - T4b/N0/M0
Stage III (clinical staging) - Any T, Tis/≥N1/M0
Stage IIIA (pathologic staging) - T1a/b, T2a/N1a, N2a/M0
Stage IIIB (pathologic staging) - T0/N1b, N1c/M0; T1a-b, T2a/N1b-c, N2b/M0; T2b,T3a/N1a-c, N2a-b/M0
Stage IIIC (pathologic staging) - T0/N2b-c, N3b-c/M0; T1a-T3a/N2c, N3a-c/M0; T4b/N1a-c, N2a-c/MO
Stage IV - Any T/Any N/M1t

Also see Malignant Melanoma Staging.

Treatment & Management

Melanoma Treatment (PDQ®)–Health Professional Version. National Cancer Institute. Available at https://www.cancer.gov/types/skin/hp/melanoma-treatment-pdq#link/_25_toc. October 14, 2022; Accessed: January 26, 2023.
Eggermont AM, Suciu S, Santinami M, Testori A, Kruit WH, Marsden J, et al. Adjuvant therapy with pegylated interferon alfa-2b versus observation alone in resected stage III melanoma: final results of EORTC 18991, a randomised phase III trial. Lancet. 2008 Jul 12. 372(9633):117-26. [QxMD MEDLINE Link].
Robert C, Ribas A, Wolchok JD, Hodi FS, Hamid O, Kefford R, et al. Anti-programmed-death-receptor-1 treatment with pembrolizumab in ipilimumab-refractory advanced melanoma: a randomised dose-comparison cohort of a phase 1 trial. Lancet. 2014 Jul 14. [QxMD MEDLINE Link].
Weber JS, D'Angelo SP, Minor D, Hodi FS, Gutzmer R, Neyns B, et al. Nivolumab versus chemotherapy in patients with advanced melanoma who progressed after anti-CTLA-4 treatment (CheckMate 037): a randomised, controlled, open-label, phase 3 trial. Lancet Oncol. 2015 Apr. 16(4):375-84. [QxMD MEDLINE Link].
Tawbi HA, et al; RELATIVITY-047 Investigators. Relatlimab and Nivolumab versus Nivolumab in Untreated Advanced Melanoma. N Engl J Med. 2022 Jan 6. 386 (1):24-34. [QxMD MEDLINE Link].
Carvajal RD, Antonescu CR, Wolchok JD, et al. KIT as a therapeutic target in metastatic melanoma. JAMA. 2011 Jun 8. 305(22):2327-34. [QxMD MEDLINE Link]. [Full Text].
Dalvin LA, Damento GM, Yawn BP, Abbott BA, Hodge DO, Pulido JS. Parkinson Disease and Melanoma: Confirming and Reexamining an Association. Mayo Clin Proc. 2017 Jul. 92 (7):1070-1079. [QxMD MEDLINE Link]. [Full Text].
American Cancer Society. Cancer Facts & Figures 2023. American Cancer Society. Available at https://www.cancer.org/content/dam/cancer-org/research/cancer-facts-and-statistics/annual-cancer-facts-and-figures/2023/2023-cancer-facts-and-figures.pdf. Accessed: January 26, 2023.
Adamson AS, Suarez EA, Welch HG. Estimating Overdiagnosis of Melanoma Using Trends Among Black and White Patients in the US. JAMA Dermatol. 2022 Mar 16. [QxMD MEDLINE Link].
Ward WH, Farma JM. Cutaneous Melanoma: Etiology and Therapy. 2017 Dec 21. [QxMD MEDLINE Link]. [Full Text].
Cancer Stat Facts: Melanoma of the Skin. National Cancer Institute. Available at https://seer.cancer.gov/statfacts/html/melan.html. Accessed: January 26, 2023.
Shaikh WR, Xiong M, Weinstock MA. The contribution of nodular subtype to melanoma mortality in the United States, 1978 to 2007. Arch Dermatol. 2012 Jan. 148(1):30-6. [QxMD MEDLINE Link].
Mocellin S, Pasquali S, Riccardo Rossi C, Nitti D. Validation of the prognostic value of lymph node ratio in patients with cutaneous melanoma: A population-based study of 8,177 cases. Surgery. 2011 Jul. 150(1):83-90. [QxMD MEDLINE Link].
Survival Rates for Melanoma Skin Cancer, by Stage. American Cancer Society. Available at https://www.cancer.org/cancer/melanoma-skin-cancer/detection-diagnosis-staging/survival-rates-for-melanoma-skin-cancer-by-stage.html. March 1, 2022; Accessed: January 26, 2023.
Brewer JD, Christenson LJ, Weaver AL, et al. Malignant melanoma in solid transplant recipients: collection of database cases and comparison with surveillance, epidemiology, and end results data for outcome analysis. Arch Dermatol. 2011 Jul. 147(7):790-6. [QxMD MEDLINE Link].
Jethanamest D, Vila PM, Sikora AG, Morris LG. Predictors of survival in mucosal melanoma of the head and neck. Ann Surg Oncol. 2011 Oct. 18(10):2748-56. [QxMD MEDLINE Link]. [Full Text].
Sandru A, Voinea S, Panaitescu E, Blidaru A. Survival rates of patients with metastatic malignant melanoma. J Med Life. 2014 Oct-Dec. 7 (4):572-6. [QxMD MEDLINE Link]. [Full Text].
Kantor J, Kantor DE. Routine dermatologist-performed full-body skin examination and early melanoma detection. Arch Dermatol. 2009 Aug. 145(8):873-6. [QxMD MEDLINE Link].
Sabel MS, Wong SL. Review of evidence-based support for pretreatment imaging in melanoma. J Natl Compr Canc Netw. 2009 Mar. 7(3):281-9. [QxMD MEDLINE Link].
Xing Y, Bronstein Y, Ross MI, Askew RL, Lee JE, Gershenwald JE, et al. Contemporary diagnostic imaging modalities for the staging and surveillance of melanoma patients: a meta-analysis. J Natl Cancer Inst. 2011 Jan 19. 103(2):129-42. [QxMD MEDLINE Link]. [Full Text].
[Guideline] National Comprehensive Cancer Network. NCCN Clinical Practice Guidelines in Oncology: Melanoma: Cutaneous. NCCN. Available at https://www.nccn.org/professionals/physician_gls/pdf/cutaneous_melanoma.pdf. Version 1.2023 — December 22, 2022; Accessed: January 26, 2023.
Gillgren P, Drzewiecki KT, Niin M, et al. 2-cm versus 4-cm surgical excision margins for primary cutaneous melanoma thicker than 2 mm: a randomised, multicentre trial. Lancet. 2011 Nov 5. 378(9803):1635-42. [QxMD MEDLINE Link].
Hu J, Cai X, Lv JJ, Wan XC, Zeng XY, Feng ML, et al. PRAME Immunohistochemistry as an Adjunct for Differential Diagnosis in Acral Lentiginous Melanoma and Acral Nevi. Hum Pathol. 2021 Nov 17. [QxMD MEDLINE Link].
Cesinaro AM, Piana S, Paganelli A, Pedroni G, Santandrea G, Maiorana A. PRAME expression in cellular neurothekeoma: A study of 11 cases. J Cutan Pathol. 2021 Nov 10. [QxMD MEDLINE Link].
Ricci C, Franceschini T, Giunchi F, Grillini M, Ambrosi F, Massari F, et al. Immunohistochemical Expression of Preferentially Expressed Antigen in Melanoma (PRAME) in the Uninvolved Background Testis, Germ Cell Neoplasia in Situ, and Germ Cell Tumors of the Testis. Am J Clin Pathol. 2021 Dec 1. [QxMD MEDLINE Link].
Farah M, Chung HJ. Diagnostic utility of preferentially expressed antigen in melanoma immunohistochemistry in the evaluation of melanomas with a co-existent nevoid melanocytic population: A single-center retrospective cohort study. J Am Acad Dermatol. 2021 Oct 28. [QxMD MEDLINE Link].
Wilson ML. Histopathologic and Molecular Diagnosis of Melanoma. Clin Plast Surg. 2021 Oct. 48 (4):587-598. [QxMD MEDLINE Link].
Revythis A, Shah S, Kutka M, Moschetta M, Ozturk MA, Pappas-Gogos G, et al. Unraveling the Wide Spectrum of Melanoma Biomarkers. Diagnostics (Basel). 2021 Jul 26. 11 (8):[QxMD MEDLINE Link]. [Full Text].
Rashid S, Tsao H. Recognition, Staging, and Management of Melanoma. Med Clin North Am. 2021 Jul. 105 (4):643-661. [QxMD MEDLINE Link].
Deacon DC, Smith EA, Judson-Torres RL. Molecular Biomarkers for Melanoma Screening, Diagnosis and Prognosis: Current State and Future Prospects. Front Med (Lausanne). 2021. 8:642380. [QxMD MEDLINE Link]. [Full Text].
Bachter D, Michl C, Buchels H, Vogt H, Balda BR. The predictive value of the sentinel lymph node in malignant melanomas. Recent Results Cancer Res. 2001. 158:129-36. [QxMD MEDLINE Link].
Cadili A, McKinnon G, Wright F, Hanna W, Macintosh E, Abhari Z, et al. Validation of a scoring system to predict non-sentinel lymph node metastasis in melanoma. J Surg Oncol. 2010 Mar 1. 101(3):191-4. [QxMD MEDLINE Link].
Bronstein Y, Ng CS, Rohren E, Ross MI, Lee JE, Cormier J, et al. PET/CT in the Management of Patients With Stage IIIC and IV Metastatic Melanoma Considered Candidates for Surgery: Evaluation of the Additive Value After Conventional Imaging. AJR Am J Roentgenol. 2012 Apr. 198(4):902-8. [QxMD MEDLINE Link].
American Joint Committee on Cancer. Melanoma of the Skin. Amin MB, Edge S, Greene F, Byrd DR, Brookland RK, et al, eds. AJCC Staging Manual. 8th edition. New York: Springer; 2016.
McWilliams RR, Rao RD, Buckner JC, Link MJ, Markovic S, Brown PD. Melanoma-induced brain metastases. Expert Rev Anticancer Ther. 2008 May. 8(5):743-55. [QxMD MEDLINE Link].
Lee AY, Brady MS. Neoadjuvant immunotherapy for melanoma. J Surg Oncol. 2021 Mar. 123 (3):782-788. [QxMD MEDLINE Link]. [Full Text].
Erstad DJ, Witt RG, Wargo JA. Neoadjuvant therapy for melanoma: new and evolving concepts. Clin Adv Hematol Oncol. 2022 Jan. 20 (1):47-55. [QxMD MEDLINE Link].
Faries MB, Thompson JF, Cochran AJ, Andtbacka RH, Mozzillo N, et al. Completion Dissection or Observation for Sentinel-Node Metastasis in Melanoma. N Engl J Med. 2017 Jun 8. 376 (23):2211-2222. [QxMD MEDLINE Link].
Leiter U, Stadler R, Mauch C, et al. Survival of SLNB-positive melanoma patients with and without complete lymph node dissection: A multicenter, randomized DECOG trial. Journal of Clinical Oncology. 2015. 33 (suppl):Abstract LBA9002. [Full Text].
Gould Rothberg BE, Berger AJ, Molinaro AM, Subtil A, Krauthammer MO, Camp RL, et al. Melanoma prognostic model using tissue microarrays and genetic algorithms. J Clin Oncol. 2009 Dec 1. 27(34):5772-80. [QxMD MEDLINE Link]. [Full Text].
Saberian C, Sperduto P, Davies MA. Targeted therapy strategies for melanoma brain metastasis. Neurooncol Adv. 2021 Nov. 3 (Suppl 5):v75-v85. [QxMD MEDLINE Link]. [Full Text].
Khaddour K, Maahs L, Avila-Rodriguez AM, Maamar Y, Samaan S, Ansstas G. Melanoma Targeted Therapies beyond BRAF-Mutant Melanoma: Potential Druggable Mutations and Novel Treatment Approaches. Cancers (Basel). 2021 Nov 22. 13 (22):[QxMD MEDLINE Link]. [Full Text].
Varrone F, Mandrich L, Caputo E. Melanoma Immunotherapy and Precision Medicine in the Era of Tumor Micro-Tissue Engineering: Where Are We Now and Where Are We Going?. Cancers (Basel). 2021 Nov 18. 13 (22):[QxMD MEDLINE Link]. [Full Text].
Zeng H, Liu F, Zhou H, Zeng C. Individualized Treatment Strategy for Cutaneous Melanoma: Where Are We Now and Where Are We Going?. Front Oncol. 2021. 11:775100. [QxMD MEDLINE Link]. [Full Text].
Dietz H, Weinmann SC, Salama AK. Checkpoint Inhibitors in Melanoma Patients with Underlying Autoimmune Disease. Cancer Manag Res. 2021. 13:8199-8208. [QxMD MEDLINE Link]. [Full Text].
Boutros A, Bruzzone M, Tanda ET, Croce E, Arecco L, Cecchi F, et al. Health-related quality of life in cancer patients treated with immune checkpoint inhibitors in randomised controlled trials: A systematic review and meta-analysis. Eur J Cancer. 2021 Nov 6. 159:154-166. [QxMD MEDLINE Link].
Ferrucci PF, Lens M, Cocorocchio E. Combined BRAF-Targeted Therapy with Immunotherapy in BRAF-Mutated Advanced Melanoma Patients. Curr Oncol Rep. 2021 Nov 4. 23 (12):138. [QxMD MEDLINE Link].
Aleksakhina SN, Imyanitov EN. Cancer Therapy Guided by Mutation Tests: Current Status and Perspectives. Int J Mol Sci. 2021 Oct 10. 22 (20):[QxMD MEDLINE Link]. [Full Text].
Pisibon C, Ouertani A, Bertolotto C, Ballotti R, Cheli Y. Immune Checkpoints in Cancers: From Signaling to the Clinic. Cancers (Basel). 2021 Sep 12. 13 (18):[QxMD MEDLINE Link]. [Full Text].
Teixido C, Castillo P, Martinez-Vila C, Arance A, Alos L. Molecular Markers and Targets in Melanoma. Cells. 2021 Sep 5. 10 (9):[QxMD MEDLINE Link]. [Full Text].
Yuan J, Khilnani A, Brody J, Andtbacka RHI, Hu-Lieskovan S, Luke JJ, et al. Current strategies for intratumoural immunotherapy - Beyond immune checkpoint inhibition. Eur J Cancer. 2021 Nov. 157:493-510. [QxMD MEDLINE Link].
Carlino MS, Larkin J, Long GV. Immune checkpoint inhibitors in melanoma. Lancet. 2021 Sep 11. 398 (10304):1002-1014. [QxMD MEDLINE Link].
Sevilla-Ortega L, Ferrándiz-Pulido L, Palazón-Carrión N, et al. Role of Isolated Limb Perfusion in the Era of Targeted Therapies and Immunotherapy in Melanoma. A Systematic Review of The Literature. Cancers (Basel). 2021 Oct 31. 13 (21):[QxMD MEDLINE Link]. [Full Text].
Soldozy S, Mulligan KM, Zheng DX, Levoska MA, Cullison CR, Elarjani T, et al. Oncolytic Virotherapy for Melanoma Brain Metastases, a Potential New Treatment Paradigm?. Brain Sci. 2021 Sep 23. 11 (10):[QxMD MEDLINE Link]. [Full Text].
Carr MJ, Sun J, DePalo D, Rothermel LD, Song Y, Straker RJ, et al. Talimogene Laherparepvec (T-VEC) for the Treatment of Advanced Locoregional Melanoma After Failure of Immunotherapy: An International Multi-Institutional Experience. Ann Surg Oncol. 2021 Oct 14. [QxMD MEDLINE Link].
Zawit M, Swami U, Awada H, Arnouk J, Milhem M, Zakharia Y. Current status of intralesional agents in treatment of malignant melanoma. Ann Transl Med. 2021 Jun. 9 (12):1038. [QxMD MEDLINE Link]. [Full Text].
Long GV, Hauschild A, Santinami M, Atkinson V, Mandalà M, Chiarion-Sileni V, et al. Adjuvant Dabrafenib plus Trametinib in Stage III BRAF-Mutated Melanoma. N Engl J Med. 2017 Nov 9. 377 (19):1813-1823. [QxMD MEDLINE Link]. [Full Text].
Hauschild A, Dummer R, Santinami M, et al. Long-term benefit of adjuvant dabrafenib + trametinib (D+T) in patients (pts) with resected stage III BRAF V600–mutant melanoma: Five-year analysis of COMBI-AD. J Clin Oncol. 2020. 38:15 suppl:[Full Text].
Eggermont AMM, Blank CU, Mandala M, Long GV, Atkinson V, Dalle S, et al. Adjuvant Pembrolizumab versus Placebo in Resected Stage III Melanoma. N Engl J Med. 2018 May 10. 378 (19):1789-1801. [QxMD MEDLINE Link]. [Full Text].
Eggermont AM, Blank CU, Mandalà M, et al. Pembrolizumab versus placebo after complete resection of high-risk stage III melanoma: New recurrence-free survival results from the EORTC 1325-MG/Keynote 054 double-blinded phase III trial at three-year median follow-up. J Clin Oncol. 2020. 38:15 suppl:[Full Text].
FDA approves pembrolizumab for adjuvant treatment of Stage IIB or IIC melanoma. U.S. Food & Drug Administration. Available at https://www.fda.gov/drugs/resources-information-approved-drugs/fda-approves-pembrolizumab-adjuvant-treatment-stage-iib-or-iic-melanoma. December 6, 2021; Accessed: January 26, 2023.
Weber J, et al; CheckMate 238 Collaborators. Adjuvant Nivolumab versus Ipilimumab in Resected Stage III or IV Melanoma. N Engl J Med. 2017 Nov 9. 377 (19):1824-1835. [QxMD MEDLINE Link].
Eggermont AM, Chiarion-Sileni V, Grob JJ, et al. Prolonged Survival in Stage III Melanoma with Ipilimumab Adjuvant Therapy. N Engl J Med. 2016 Nov 10. 375 (19):1845-1855. [QxMD MEDLINE Link]. [Full Text].
Nelson, R. FDA approves Imlygic, First Oncolytic Viral Therapy in the US. Medscape Medical News. October 27, 2015. Available at http://www.medscape.com/viewarticle/853345.
Andtbacka RH, Kaufman HL, Collichio F, Amatruda T, Senzer N, Chesney J, et al. Talimogene Laherparepvec Improves Durable Response Rate in Patients With Advanced Melanoma. J Clin Oncol. 2015 Sep 1. 33 (25):2780-8. [QxMD MEDLINE Link].
Dummer R, Hoeller C, Gruter IP, Michielin O. Combining talimogene laherparepvec with immunotherapies in melanoma and other solid tumors. Cancer Immunol Immunother. 2017 Jun. 66 (6):683-695. [QxMD MEDLINE Link]. [Full Text].
Kirkwood JM, Strawderman MH, Ernstoff MS, Smith TJ, Borden EC, Blum RH. Interferon alfa-2b adjuvant therapy of high-risk resected cutaneous melanoma: the Eastern Cooperative Oncology Group Trial EST 1684. J Clin Oncol. 1996 Jan. 14(1):7-17. [QxMD MEDLINE Link].
Kirkwood JM, Manola J, Ibrahim J, Sondak V, Ernstoff MS, Rao U. Eastern Cooperative Oncology Group. A pooled analysis of Eastern Cooperative Oncology Group and intergroup trials of adjuvant high dose alpha interferon for melanoma. Clin Cancer Res. 2004. 10:1670-77.
Pectasides D, Dafni U, Bafaloukos D, Skarlos D, Polyzos A, Tsoutsos D, et al. Randomized phase III study of 1 month versus 1 year of adjuvant high-dose interferon alfa-2b in patients with resected high-risk melanoma. J Clin Oncol. 2009 Feb 20. 27(6):939-44. [QxMD MEDLINE Link].
Hauschild A, Weichenthal M, Rass K, Linse R, Ulrich J, Stadler R, et al. Prospective randomized multicenter adjuvant dermatologic cooperative oncology group trial of low-dose interferon alfa-2b with or without a modified high-dose interferon alfa-2b induction phase in patients with lymph node-negative melanoma. J Clin Oncol. 2009 Jul 20. 27(21):3496-502. [QxMD MEDLINE Link].
Hauschild A, Weichenthal M, Rass K, Linse R, Berking C, Böttjer J, et al. Efficacy of low-dose interferon (alpha)2a 18 versus 60 months of treatment in patients with primary melanoma of >= 1.5 mm tumor thickness: results of a randomized phase III DeCOG trial. J Clin Oncol. 2010 Feb 10. 28 (5):841-6. [QxMD MEDLINE Link].
Eggermont AM, Suciu S, Testori A, et al. Ulceration and stage are predictive of interferon efficacy in melanoma: results of the phase III adjuvant trials EORTC 18952 and EORTC 18991. Eur J Cancer. 2012 Jan. 48(2):218-25. [QxMD MEDLINE Link].
Spitler LE, Grossbard ML, Ernstoff MS, Silver G, Jacobs M, Hayes FA, et al. Adjuvant therapy of stage III and IV malignant melanoma using granulocyte-macrophage colony-stimulating factor. J Clin Oncol. 2000 Apr. 18(8):1614-21. [QxMD MEDLINE Link].
Lawson DH, Lee S, Zhao F, Tarhini AA, Margolin KA, Ernstoff MS, et al. Randomized, Placebo-Controlled, Phase III Trial of Yeast-Derived Granulocyte-Macrophage Colony-Stimulating Factor (GM-CSF) Versus Peptide Vaccination Versus GM-CSF Plus Peptide Vaccination Versus Placebo in Patients With No Evidence of Disease After Complete Surgical Resection of Locally Advanced and/or Stage IV Melanoma: A Trial of the Eastern Cooperative Oncology Group-American College of Radiology Imaging Network Cancer Research Group (E4697). J Clin Oncol. 2015 Dec 1. 33 (34):4066-76. [QxMD MEDLINE Link]. [Full Text].
Lazarus HM, Ragsdale CE, Gale RP, Lyman GH. Sargramostim (rhu GM-CSF) as Cancer Therapy (Systematic Review) and An Immunomodulator. A Drug Before Its Time?. Front Immunol. 2021. 12:706186. [QxMD MEDLINE Link]. [Full Text].
Larkin J, Chiarion-Sileni V, Gonzalez R, Grob JJ, Cowey CL, Lao CD, et al. Combined Nivolumab and Ipilimumab or Monotherapy in Untreated Melanoma. N Engl J Med. 2015 Jul 2. 373 (1):23-34. [QxMD MEDLINE Link]. [Full Text].
Larkin J, Chiarion-Sileni V, Gonzalez R, et al. Five-Year Survival with Combined Nivolumab and Ipilimumab in Advanced Melanoma. N Engl J Med. 2019 Oct 17. 381 (16):1535-1546. [QxMD MEDLINE Link]. [Full Text].
Chapman PB, Hauschild A, Robert C, et al. Improved survival with vemurafenib in melanoma with BRAF V600E mutation. N Engl J Med. 2011 Jun 30. 364(26):2507-16. [QxMD MEDLINE Link].
Chustecka Z. Dabrafenib and Trametinib Approved for Metastatic Melanoma. Medscape Medical News. Available at http://www.medscape.com/viewarticle/804918. Accessed: June 4, 2013.
Hauschild A, Grob JJ, Demidov LV, Jouary T, Gutzmer R, Millward M, et al. Dabrafenib in BRAF-mutated metastatic melanoma: a multicentre, open-label, phase 3 randomised controlled trial. Lancet. 2012 Jul 28. 380(9839):358-65. [QxMD MEDLINE Link].
Flaherty KT, Robert C, Hersey P, Nathan P, Garbe C, Milhem M, et al. Improved survival with MEK inhibition in BRAF-mutated melanoma. N Engl J Med. 2012 Jul 12. 367(2):107-14. [QxMD MEDLINE Link].
Flaherty KT, Infante JR, Daud A, Gonzalez R, Kefford RF, Sosman J, et al. Combined BRAF and MEK inhibition in melanoma with BRAF V600 mutations. N Engl J Med. 2012 Nov. 367(18):1694-703. [QxMD MEDLINE Link]. [Full Text].
US Food and Drug Administration. FDA approves Mekinist in combination with Tafinlar for advanced melanoma. FDA. Available at https://wayback.archive-it.org/7993/20170112222928/http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm381159.htm. Accessed: January 26, 2023.
Ascierto PA, McArthur GA, Dréno B, Atkinson V, Liszkay G, Di Giacomo AM, et al. Cobimetinib combined with vemurafenib in advanced BRAF(V600)-mutant melanoma (coBRIM): updated efficacy results from a randomised, double-blind, phase 3 trial. Lancet Oncol. 2016 Sep. 17 (9):1248-60. [QxMD MEDLINE Link].
Dummer R, Ascierto PA, Gogas HJ, Arance A, Mandala M, Liszkay G, et al. Encorafenib plus binimetinib versus vemurafenib or encorafenib in patients with BRAF-mutant melanoma (COLUMBUS): a multicentre, open-label, randomised phase 3 trial. Lancet Oncol. 2018 May. 19 (5):603-615. [QxMD MEDLINE Link].
Gutzmer R, Stroyakovskiy D, Gogas H, Robert C, Lewis K, Protsenko S, et al. Atezolizumab, vemurafenib, and cobimetinib as first-line treatment for unresectable advanced BRAF^V600 mutation-positive melanoma (IMspire150): primary analysis of the randomised, double-blind, placebo-controlled, phase 3 trial. Lancet. 2020 Jun 13. 395 (10240):1835-1844. [QxMD MEDLINE Link].
Postow MA, Chesney J, Pavlick AC, Robert C, Grossmann K, McDermott D, et al. Nivolumab and ipilimumab versus ipilimumab in untreated melanoma. N Engl J Med. 2015 May 21. 372 (21):2006-17. [QxMD MEDLINE Link].
Johnson DB, Balko JM, Compton ML, Chalkias S, Gorham J, et al. Fulminant Myocarditis with Combination Immune Checkpoint Blockade. N Engl J Med. 2016 Nov 3. 375 (18):1749-1755. [QxMD MEDLINE Link].
Wolchok JD, Chiarion-Sileni V, Gonzalez R, et al. Long-Term Outcomes With Nivolumab Plus Ipilimumab or Nivolumab Alone Versus Ipilimumab in Patients With Advanced Melanoma. J Clin Oncol. 2022 Jan 10. 40 (2):127-137. [QxMD MEDLINE Link].
Robert C, Long GV, Brady B, Dutriaux C, Maio M, Mortier L, et al. Nivolumab in previously untreated melanoma without BRAF mutation. N Engl J Med. 2015 Jan 22. 372 (4):320-30. [QxMD MEDLINE Link]. [Full Text].
US Food and Drug Administration. FDA approves Keytruda for advanced melanoma: first PD-1 blocking drug to receive agency approval [press release]. September 4, 2014. Available at https://wayback.archive-it.org/7993/20170112023823/http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm412802.htm. Accessed: January 26, 2023.
Robert C, Schachter J, Long GV, Arance A, Grob JJ, Mortier L, et al. Pembrolizumab versus Ipilimumab in Advanced Melanoma. N Engl J Med. 2015 Jun 25. 372 (26):2521-32. [QxMD MEDLINE Link].
Sarnaik AA, Weber JS. Recent advances using anti-CTLA-4 for the treatment of melanoma. Cancer J. 2009 May-Jun. 15(3):169-73. [QxMD MEDLINE Link].
Yervoy (ipilimumab) [package insert]. Princeton, NJ: Bristol-Myers Squibb Company. 2017 July. Available at [Full Text].
Hodi FS, O'Day SJ, et al. Improved survival with ipilimumab in patients with metastatic melanoma. N Engl J Med. 2010 Aug 19. 363(8):711-23. [QxMD MEDLINE Link].
Robert C, Thomas L, Bondarenko I, et al. Ipilimumab plus dacarbazine for previously untreated metastatic melanoma. N Engl J Med. 2011 Jun 30. 364(26):2517-26. [QxMD MEDLINE Link].
Weber JS, Dummer R, de Pril V, Lebbe C, Stephen Hodi F. Patterns of onset and resolution of immune-related adverse events of special interest with ipilimumab: Detailed safety analysis from a phase 3 trial in patients with advanced melanoma. Cancer. 2013 Feb 7. [QxMD MEDLINE Link].
FDA approves Opdualag for unresectable or metastatic melanoma. U.S. Food & Drug Administration. Available at https://www.fda.gov/drugs/resources-information-approved-drugs/fda-approves-opdualag-unresectable-or-metastatic-melanoma. March 21, 2022; Accessed: January 26, 2023.
Hodi FS, Corless CL, Giobbie-Hurder A, et al. Imatinib for melanomas harboring mutationally activated or amplified KIT arising on mucosal, acral, and chronically sun-damaged skin. J Clin Oncol. 2013 Jul 8. [QxMD MEDLINE Link]. [Full Text].
Carvajal RD. Another option in our KIT of effective therapies for advanced melanoma. J Clin Oncol. 2013 Aug 12. [QxMD MEDLINE Link]. [Full Text].
Guo J, Si L, Kong Y, et al. Phase II, open-label, single-arm trial of imatinib mesylate in patients with metastatic melanoma harboring c-Kit mutation or amplification. J Clin Oncol. 2011 Jul 20. 29(21):2904-9. [QxMD MEDLINE Link].
Hirai I, Tanese K, Fukuda K, Fusumae T, Nakamura Y, Sato Y, et al. Imatinib mesylate in combination with pembrolizumab in patients with advanced KIT-mutant melanoma following progression on standard therapy: A phase I/II trial and study protocol. Medicine (Baltimore). 2021 Dec 10. 100 (49):e27832. [QxMD MEDLINE Link].
In Melanoma, Personalized Treatment Vaccines Show Promise. National Cancer Institute. Available at https://www.cancer.gov/news-events/cancer-currents-blog/2017/melanoma-personalized-vaccine. August 4, 2017; Accessed: January 26, 2023.
Ellingsen EB, Bjørheim J, Gaudernack G. Therapeutic cancer vaccination against telomerase: clinical developments in melanoma. Curr Opin Oncol. 2023 Jan 17. [QxMD MEDLINE Link].
Middleton MR, Grob JJ, Aaronson N, Fierlbeck G, Tilgen W, Seiter S, et al. Randomized phase III study of temozolomide versus dacarbazine in the treatment of patients with advanced metastatic malignant melanoma. J Clin Oncol. 2000 Jan. 18(1):158-66. [QxMD MEDLINE Link].
Atkins MB, Lotze MT, Dutcher JP, Fisher RI, Weiss G, Margolin K, et al. High-dose recombinant interleukin 2 therapy for patients with metastatic melanoma: analysis of 270 patients treated between 1985 and 1993. J Clin Oncol. 1999 Jul. 17(7):2105-16. [QxMD MEDLINE Link].
Hauschild A, Agarwala SS, Trefzer U, Hogg D, Robert C, Hersey P, et al. Results of a phase III, randomized, placebo-controlled study of sorafenib in combination with carboplatin and paclitaxel as second-line treatment in patients with unresectable stage III or stage IV melanoma. J Clin Oncol. 2009 Jun 10. 27(17):2823-30. [QxMD MEDLINE Link].
Perez DG, Suman VJ, Fitch TR, Amatruda T III, Morton RF, Jilani SZ, et al. Phase II trial of carboplatin, weekly paclitaxel, and weekly bevacizumab in patients with unresectable stage IV melanoma: a North Central Cancer Treatment Group study, N047A. Cancer. Jan 2009. 115(1):119-27.
Tobin RP, Cogswell DT, Cates VM, Davis DM, Borgers JSW, Van Gulick RJ, et al. Targeting MDSC differentiation using ATRA: a phase I/II clinical trial combining pembrolizumab and all-trans retinoic acid for metastatic melanoma. Clin Cancer Res. 2022 Nov 15. [QxMD MEDLINE Link].
Rohaan MW, Borch TH, van den Berg JH, et al. Tumor-Infiltrating Lymphocyte Therapy or Ipilimumab in Advanced Melanoma. N Engl J Med. 2022 Dec 8. 387 (23):2113-2125. [QxMD MEDLINE Link]. [Full Text].
Huncharek M, Kupelnick B. Use of topical sunscreen and the risk of malignant melanoma. Results of a meta-analysis of 9,067 patients. Ann Epidemiol. 2000 Oct 1. 10(7):467. [QxMD MEDLINE Link].
Autier P, Boniol M, Dore JF. Sunscreen use and increased duration of intentional sun exposure: still a burning issue. Int J Cancer. 2007 Jul 1. 121(1):1-5. [QxMD MEDLINE Link].
Kling J. Study Calls Into Question Sunscreen in Melanoma Prevention. Medscape Medical News. Available at http://www.medscape.com/viewarticle/871438?src=soc_fb_161108-pm_mscpedt_news_pharm. November 4, 2016; Accessed: January 26, 2023.
Blank CU, Rozeman EA, Fanchi LF, et al. Neoadjuvant versus adjuvant ipilimumab plus nivolumab in macroscopic stage III melanoma. Nat Med. 2018 Nov. 24 (11):1655-1661. [QxMD MEDLINE Link].
Rozeman EA, Menzies AM, van Akkooi ACJ, et al. Identification of the optimal combination dosing schedule of neoadjuvant ipilimumab plus nivolumab in macroscopic stage III melanoma (OpACIN-neo): a multicentre, phase 2, randomised, controlled trial. Lancet Oncol. 2019 Jul. 20 (7):948-960. [QxMD MEDLINE Link].
Martinez-Perez D, Viñal D, Solares I, Espinosa E, Feliu J. Gp-100 as a Novel Therapeutic Target in Uveal Melanoma. Cancers (Basel). 2021 Nov 27. 13 (23):[QxMD MEDLINE Link]. [Full Text].
FDA approves tebentafusp-tebn for unresectable or metastatic uveal melanoma. U.S. Food & Drug Administration. Available at https://www.fda.gov/drugs/resources-information-approved-drugs/fda-approves-tebentafusp-tebn-unresectable-or-metastatic-uveal-melanoma. January 26, 2022; Accessed: March 31, 2023.
US Preventive Services Task Force, Bibbins-Domingo K, Grossman DC, Curry SJ, Davidson KW, Ebell M, et al. Screening for Skin Cancer: US Preventive Services Task Force Recommendation Statement. JAMA. 2016 Jul 26. 316 (4):429-35. [QxMD MEDLINE Link]. [Full Text].
American Academy of Dermatology. Free Skin Cancer Screenings: Skin Cancer Screening Program. Available at https://www.aad.org/public/public-health/skin-cancer-screenings. Accessed: January 26, 2023.
[Guideline] Bichakjian CK, Halpern AC, Johnson TM, Foote Hood A, Grichnik JM, Swetter SM, et al. Guidelines of care for the management of primary cutaneous melanoma. American Academy of Dermatology. J Am Acad Dermatol. 2011 Nov. 65 (5):1032-47. [QxMD MEDLINE Link]. [Full Text].
[Guideline] Swetter SM, Tsao H, Bichakjian CK, Curiel-Lewandrowski C, Elder DE, Gershenwald JE, et al. Guidelines of care for the management of primary cutaneous melanoma. J Am Acad Dermatol. 2019 Jan. 80 (1):208-250. [QxMD MEDLINE Link]. [Full Text].
[Guideline] Michielin O, van Akkooi ACJ, Ascierto PA, Dummer R, Keilholz U, ESMO Guidelines Committee. Electronic address: clinicalguidelines@esmo.org. Cutaneous melanoma: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up†. Ann Oncol. 2019 Dec 1. 30 (12):1884-1901. [QxMD MEDLINE Link]. [Full Text].
[Guideline] Garbe C, et al; European Dermatology Forum (EDF), the European Association of Dermato-Oncology (EADO), and the European Organization for Research and Treatment of Cancer (EORTC). European consensus-based interdisciplinary guideline for melanoma. Part 1: Diagnostics - Update 2019. Eur J Cancer. 2020 Jan 9. [QxMD MEDLINE Link]. [Full Text].
[Guideline] Michielin O, van Akkooi A, Lorigan P, et al. ESMO consensus conference recommendations on the management of locoregional melanoma: the ESMO Guidelines Committee. Ann Oncol. 2020 Jul 22. [QxMD MEDLINE Link]. [Full Text].
Kirkland EB, Zitelli JA. Mitotic rate for thin melanomas: should a single mitotic figure warrant a sentinel lymph node biopsy?. Dermatol Surg. 2014 Sep. 40 (9):937-45. [QxMD MEDLINE Link].
McClain SE, Shada AL, Barry M, Patterson JW, Slingluff CL Jr. Outcome of sentinel lymph node biopsy and prognostic implications of regression in thin malignant melanoma. Melanoma Res. 2012 Aug. 22 (4):302-9. [QxMD MEDLINE Link].
[Guideline] Wong SL, Faries MB, Kennedy EB, Agarwala SS, Akhurst TJ, Ariyan C, et al. Sentinel Lymph Node Biopsy and Management of Regional Lymph Nodes in Melanoma: American Society of Clinical Oncology and Society of Surgical Oncology Clinical Practice Guideline Update. Ann Surg Oncol. 2018 Feb. 25 (2):356-377. [QxMD MEDLINE Link].
Kunishige JH, Brodland DG, Zitelli JA. Surgical margins for melanoma in situ. J Am Acad Dermatol. 2012 Mar. 66 (3):438-44. [QxMD MEDLINE Link].
Ad Hoc Task Force, Connolly SM, Baker DR, Coldiron BM, et al. AAD/ACMS/ASDSA/ASMS 2012 appropriate use criteria for Mohs micrographic surgery: a report of the American Academy of Dermatology, American College of Mohs Surgery, American Society for Dermatologic Surgery Association, and the American Society for Mohs Surgery. J Am Acad Dermatol. 2012 Oct. 67 (4):531-50. [QxMD MEDLINE Link].
[Guideline] Garbe C, et al; European Dermatology Forum (EDF), the European Association of Dermato-Oncology (EADO), and the European Organization for Research and Treatment of Cancer (EORTC). European consensus-based interdisciplinary guideline for melanoma. Part 2: Treatment - Update 2019. Eur J Cancer. 2019 Dec 19. [QxMD MEDLINE Link]. [Full Text].

Media Gallery

A 1.5-cm melanoma with characteristic asymmetry, irregular borders, and color variation.
Malignant melanoma. Image courtesy of Hon Pak, MD.
Lentigo maligna melanoma, right lower cheek. The centrally located erythematous papule represents invasive melanoma with surrounding macular lentigo maligna (melanoma in situ). Image courtesy of Susan M. Swetter, MD.

of 3

Author

Winston W Tan, MD, FACP Associate Professor of Medicine, Mayo Medical School; Consultant and Person-in-Charge of Genitourinary Oncology-Medical Oncology, Division of Hematology/Oncology, Department of Internal Medicine, Mayo Clinic Jacksonville; Vice Chairman, Division of Hematology/Oncology Education, Chair, Cancer Survivorship Program, Associate Chair, Department of Medicine Faculty Development, Mayo Clinic Florida; Vice President, Florida Society of Clinical Oncology

Winston W Tan, MD, FACP is a member of the following medical societies: American College of Physicians, American Society of Clinical Oncology, American Society of Hematology, Philippine Medical Association, Texas Medical Association

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Chief Editor

Dirk M Elston, MD Professor and Chairman, Department of Dermatology and Dermatologic Surgery, Medical University of South Carolina College of Medicine

Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

Additional Contributors

Philip Schulman, MD Chief, Medical Oncology, Department of Medicine, Memorial Sloan-Kettering Cancer Center

Philip Schulman, MD is a member of the following medical societies: American Association for Cancer Research, American College of Physicians, American Society of Hematology, Medical Society of the State of New York

Disclosure: Nothing to disclose.

Mohsin R Mir, MD Private Practice, Mohs Micrographic Surgery and Dermatologic Surgery, Kelsey-Seybold Clinic; Assistant Professor, Baylor College of Medicine

Mohsin R Mir, MD is a member of the following medical societies: American Academy of Dermatology, American College of Mohs Surgery, American Society for Dermatologic Surgery

Disclosure: Nothing to disclose.

Wesley Wu, MD Mohs Surgeon, Department of Dermatology, VA Puget Sound and University of Washington School of Medicine

Wesley Wu, MD is a member of the following medical societies: American Academy of Dermatology, American College of Mohs Surgery, American Society for Dermatologic Surgery

Disclosure: Nothing to disclose.