Management of Malignant Melanoma: Best Practices

Abstract

The Canadian Expert Panel on Malignant Melanoma has developed best practices to improve the management of malignant melanoma. Sections include recommendations on primary diagnosis, dermatopathologic assessment, and reporting; use of preoperative lymphoscintigraphy and an intraoperative gamma probe to map and biopsy the sentinel lymph node; indications for surgical resection, sentinel node biopsy, and surgery for advance disease; use of interferon-alpha adjuvant therapy and treatment options for stage IV disease; and management of central nervous system metastases.

Diagnosis and management of melanoma with regional lymph node metastases: a population‐based study in France

“…However, the global efficacy of adjuvant IFN remains limited, with a benefit ⁄ risk ratio restricted by high toxicity, so that this treatment is generally considered as optional in France, 5 as in other countries. 12,14,15 Interestingly, we observed significant evolutions between 2004 and 2008 in physicians' habits regarding this option. In both periods high-dose IFN was most often chosen, as opposed to low-dose IFN, which was mainly used in patients with thick melanoma without nodal metastases, 23 according to French recommendations.…”

“…, ASCO 2007) which showed the effect of IFN both on disease‐free and overall survival. However, the global efficacy of adjuvant IFN remains limited, with a benefit/risk ratio restricted by high toxicity, so that this treatment is generally considered as optional in France, 5 as in other countries 12,14,15 . Interestingly, we observed significant evolutions between 2004 and 2008 in physicians’ habits regarding this option.…”

“…4 Consequently, regional nodal involvement is a very challenging issue for melanoma management, leading to the publication in many countries of numerous clinical practice guidelines, including recommendations for stage III disease. [5][6][7][8][9][10][11][12][13][14][15] These guidelines often differ between countries and over time, however, and are not consistently applied. Major discrepancies concern modalities of diagnosis of nodal metastases [especially regarding the use or not of sentinel lymph node biopsy (SLNB)], adjuvant therapies and surveillance procedures.…”

“…Stage III disease represents a borderline situation regarding the potential curability of melanoma, with 5‐year survival rates ranging from 40% to 78% 4 . Consequently, regional nodal involvement is a very challenging issue for melanoma management, leading to the publication in many countries of numerous clinical practice guidelines, including recommendations for stage III disease 5–15 . These guidelines often differ between countries and over time, however, and are not consistently applied.…”