Current controversies in early-stage melanoma

Management of Transected Invasive Melanoma: A Single Institution Retrospective Review

“…10,12 One study found that 12% of tumors excised by incisional, punch, or shave biopsy demonstrated deeper tumor thickness on excisional biopsy. 13 Klapperich and colleagues 14 found that Breslow depth was greater in resection specimens compared with initial biopsy specimens in 4% of cases that had been excisionally biopsied and 22% of cases that had been tangentially biopsied comparatively, highlighting the impact of initial biopsy technique on final Breslow depth. After biopsy transection, subsequent excisional biopsy may impact initial biopsy technique on final Breslow depth.…”

Analyzing Controversies in Management and Surveillance of Early-Stage Melanoma

“…The majority of these patients are managed exclusively by their general dermatologist [5]. Because of the limited number of randomized clinical trials to support evidence-based guidelines for follow-up surveillance, dermatologic and oncologic organizations have developed their own recommendations based on expert opinion [7].…”

“…However, the guidelines published by these organizations (listed in Table 1) differ widely in the frequency of the in-office examinations and skin self-examinations as well as the longitudinal duration of the followup period. Moreover, even within each organization, guidelines range widely and are quite vague, resulting in considerable variability in the management of early-stage melanoma among clinicians [7]. The frequency of the follow-up visits ranges from 3 to 12 months.…”

“…A relatively universal recommendation is to tailor the follow-up regimen to the relative risk of recurrence [6][7][8][9]. Risk factors presented in guidelines include multiple primary melanomas, familial melanoma with first melanoma diagnosed before 40 years of age, family history of melanoma, documented genetic predisposition to melanoma, personal history of nonmelanoma skin cancer, immunosuppression, and physical features associated with increased risk (blond or red hair, more than 40 nevi, more than two clinically atypical nevi, freckling, and other signs of ultraviolet radiation overexposure) [6][7][8][9]. The follow-up surveillance can also be modified in accordance with the perceived difficulty of examination: patients with numerous atypical nevi may be monitored by photography or digital dermoscopy, and patients not able to routinely perform skin selfexamination may benefit from more frequent office visits [7].…”

“…Lastly, the importance of patient education on thorough skin self-examination should not be underestimated. Multiple studies have shown that about 50% to 62% of patients detect recurrent lesions between office visits [2,7,[14][15][16][17]. In Australia, where melanoma prevention and awareness have been receiving active promotion, the number was even higher, at about 75% of patients [10].…”