Cutaneous Melanoma: An Updated Sign Guideline

Brown, Ewan; Fraser, Scott; Quaba, O; Simms, Alexandria; Stein, Annette

doi:10.4997/jrcpe.2017.302

Cited by 7 publications

(6 citation statements)

References 8 publications

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“…Furthermore, we identified four more duplicates [ 15 , 16 , 17 , 18 ] and two records were excluded due to unclear methodological approaches [ 19 , 20 ]. One record did not present any recommendations [ 21 ], and two records provided a summary of existing guidelines [ 22 , 23 , 24 ]. Hence, six relevant guidelines published between 2017 and 2019 by consortia of Australia, France, Germany, Scotland, Spain and the United States of America were included in the appraisal ( Table 1 ) [ 25 , 26 , 27 , 28 , 29 , 30 ].…”

Section: Resultsmentioning

confidence: 99%

The Quality of Practice Guidelines for Melanoma: A Methodologic Appraisal with the AGREE II and AGREE-REX Instruments

Steeb

Wessely

Drexler

et al. 2020

Cancers

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Multiple guidelines on cutaneous melanoma (CM) are available from several consortia and countries. To provide up-to-date guidance in the rapidly changing field of melanoma treatment, guideline developers have to provide regular updates without compromises of quality. We performed a systematic search in guideline databases, Medline and Embase to identify guidelines on CM. The methodological quality of the identified guidelines was independently assessed by five reviewers using the instruments “Appraisal of Guidelines for Research and Evaluation” (AGREE II) and “Recommendation EXcellence” (AGREE-REX). We performed descriptive analysis, explored subgroup differences using the Kruskal–Wallis (H) test and examined the relationship between distinct domains and items of the instruments with Spearman’s correlation. Six guidelines by consortia from Australia, France, Germany, Scotland, Spain and the United States of America were included. The German guideline fulfilled 71%–98% of criteria in AGREE II and 78%–96% for AGREE-REX, obtaining the highest scores. Deficiencies in the domains of “applicability” and “values and preferences” were observed in all guidelines. The German and Spanish guidelines significantly differed from each other in most of the domains. The domains “applicability” and “values and preferences” were identified as methodological weaknesses requiring careful revision and improvement in the future.

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Section: Resultsmentioning

confidence: 99%

The Quality of Practice Guidelines for Melanoma: A Methodologic Appraisal with the AGREE II and AGREE-REX Instruments

Steeb

Wessely

Drexler

et al. 2020

Cancers

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“…Surgical excision and subsequent soft-tissue reconstruction for melanoma is preceded by a thorough process of initial diagnosis and staging. General practitioners are encouraged to refer all suspicious lesions in secondary or tertiary care 11. Excisional biopsy remains the most accurate modality of confirmation of the diagnosis, furthered by the use of immunohistochemistry in case of diagnostic doubt.…”

Section: Discussionmentioning

confidence: 99%

“…Excisional biopsy remains the most accurate modality of confirmation of the diagnosis, furthered by the use of immunohistochemistry in case of diagnostic doubt. Sentinel lymph node (SLN) biopsy should be additionally offered with IB–IIC and a Breslow thickness of >1 mm 1112.…”

Section: Discussionmentioning

confidence: 99%

Application of the pinwheel flap for closure of a large defect of the scalp

Varnalidis¹,

Mantelakis²,

Spiers

et al. 2019

BMJ Case Rep

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A 74-year-old man had a resultant large oval scalp defect of 12×6 cm (72 cm2) following an excision of a stage IIIA melanoma. We decided to cover the defect with the pinwheel flap, with the aim to provide a good cosmetic result, preservation of hair follicles and minimal donor-site morbidity. This local flap has been traditionally used for much smaller defects. Four L-shaped flaps were designed at equal distances on the vertical and horizontal axes of the defect. The L-shaped flap had a length of 1.5 times the half diameter of the defect (4.5 cm). The incision was made through galea aponeurosis and subsequently undermined at least 3 cm to assist flap advancement. Z-plasties increased the rotation of the flap when it was required. This yielded an excellent reconstructive result at 1-year follow-up, demonstrating the usefulness of the pinwheel flap in large defects on the scalp region.

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“…The clinical management information detailed earlier is reflected in most melanoma guidelines from around the world, but some contain recommendations that do not appear to be evidence‐based. Eleven guidelines provide specific advice for the management of DM and DNM, 39,41–50 seven simply suggest reporting the subtype in the pathology report, 51–57 and 11 do not address the management of DM as a separate entity 41,58–67 . The guidelines that do provide advice base their recommendations on low‐level evidence (case series) or low‐level evidence in combination with expert consensus.…”

Section: Current National and International Treatment Guidelines For Desmoplastic And Desmoplastic Neurotropic Melanomasmentioning

confidence: 99%

“…Nine guidelines recommend that if a melanoma is of the desmoplastic subtype, this should be noted in the pathology report 39,42,48,50,52–54,56,68 . Two guidelines state that it is important for the reporting pathologist to distinguish between pure and mixed DM 39,52 . Seven guidelines advise that the presence of neurotropism should be reported 42,48,51,53–55,57 …”

Section: Current National and International Treatment Guidelines For Desmoplastic And Desmoplastic Neurotropic Melanomasmentioning

confidence: 99%

Desmoplastic melanoma: a review of its pathology and clinical behaviour, and of management recommendations in published guidelines

Hughes

Williams

Gyorki

et al. 2021

Acad Dermatol Venereol

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Desmoplastic melanomas are uncommon. Their behaviour differs from that of other melanoma subtypes; therefore, management guidelines for non-desmoplastic melanomas may not be applicable. This review sought to examine all available evidence relating to the behaviour and management of desmoplastic melanomas, based on review of all relevant English-language publications, and to critically assess the recommendations for their management in current published melanoma management guidelines. Compared with other melanoma subtypes, patients with 'pure' desmoplastic melanomas (where ≥90% of the invasive melanoma is of desmoplastic melanoma subtype) have much lower rates of sentinel node positivity and distant metastasis. Local recurrence rates are higher for desmoplastic melanomas, but resection margins wider than those recommended for non-desmoplastic melanomas have not been shown to be of benefit. Adjuvant radiotherapy reduces the risk of local recurrence when a satisfactory histological clearance (≥8 mm) cannot be achieved. Of 29 published melanoma management guidelines identified, only 11 specified management for desmoplastic melanomas, while seven simply stated that the feature should be reported. Desmoplastic melanoma is a unique melanoma subtype with biology that differs from that of other melanoma subtypes. It requires specific management strategies but few current guidelines address these.

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Cutaneous Melanoma: An Updated Sign Guideline

Cited by 7 publications

References 8 publications

The Quality of Practice Guidelines for Melanoma: A Methodologic Appraisal with the AGREE II and AGREE-REX Instruments

The Quality of Practice Guidelines for Melanoma: A Methodologic Appraisal with the AGREE II and AGREE-REX Instruments

Application of the pinwheel flap for closure of a large defect of the scalp

Desmoplastic melanoma: a review of its pathology and clinical behaviour, and of management recommendations in published guidelines

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