French updated recommendations in Stage I to III melanoma treatment and management

Abstract

As knowledge continues to develop, regular updates are necessary concerning recommendations for practice. The recommendations for the management of melanoma stages I to III were drawn up in 2005. At the request of the Soci et e Franc ßaise de Dermatologie, they have now been updated using the methodology for recommendations proposed by the Haute Autorit e de Sant e in France. In practice, the principal recommendations are as follows: for staging, it is recommended that the 7th edition of AJCC be used. The maximum excision margins have been reduced to 2 cm. Regarding adjuvant therapy, the place of interferon has been reduced and no validated emerging medication has yet been identified. Radiotherapy may be considered for patients in Stage III at high risk of relapse. The sentinel lymph node technique remains an option. Initial examination includes routine ultrasound as of Stage II, with other examinations being optional in stages IIC and III. A shorter strict follow-up period (3 years) is recommended for patients, but with greater emphasis on imaging.

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

“…The Australian and US guidelines were also developed based on a predefined set of rules for guideline development [25,30]. However, it remains unclear whether the French and Spanish consortia had to adhere to specific rules during their respective development processes [26,29]. Importantly, we did not perform an analysis of the content of the included guidelines, but instead focused exclusively on their methodological quality [34].…”

In vivo reflectance confocal microscopy combined with the ‘spaghetti technique’ for the identification of surgical margins of lentigo maligna: experience in 70 patients

“…[1][2][3][4] Complete surgical excision is the recommended treatment. However, this treatment is often challenging because of LM/LMM location in the face and the difficulty in the identification of its surgical margins [1][2][3][4][5] . Local recurrence of LM/LMM still represents a major concern with recurrence rates after conventional surgical excision of 8%-20% of cases, up to 47% in the absence of Mohs micrographic surgery (MMS).…”

“…6 MMS is the gold standard, but it is expensive, requires a long learning curve and is only used by a small number of teams because histological control requires a very close cooperation among surgeons and anatomo-pathologists, which is often difficult to obtain in routine practice. 4,5 Thus, MMS limitations stimulated physicians to search for alternative methods, as the slow MMS 7 and the 'spaghetti' technique. 8 Though more accessible for physicians, slow MMS is not always well accepted by patients as a secondary reconstruction is performed only after the deferred histological examination.…”

Cost–Utility Analysis of Nivolumab in Adjuvant Treatment of Melanoma in France

“…Comparators were selected using national academic recommendations [ 25 ], which explained why only low-dose interferon was retained among the various forms of interferons, on top of observation and recently approved therapies for the adjuvant treatment of resected melanoma, i.e. nivolumab, pembrolizumab and also dabrafenib plus trametinib in patients with BRAF mutation.…”

“…Based on clinical recommendations [ 24 , 25 ], approved indications and clinical practice in France [ 26 , 27 ], the comparators for the overall population were nivolumab, observation, low-dose interferon and pembrolizumab. Dabrafenib plus trametinib was also included in the subgroup with BRAF mutation.…”