Cutaneous Melanoma, Version 2.2019, NCCN Clinical Practice Guidelines in Oncology

Coit, Daniel G.; Thompson, John A.; Albertini, Mark R.; Barker, Christopher A.; Carson, William E.; Contreras, Carlo M.; Daniels, Gregory A.; DiMaio, Dominick J.; Fields, Ryan C.; Fleming, Martin D.; Freeman, Morganna; Galan, Anjela; Gastman, Brian; Guild, Valerie; Johnson, Douglas B.; Joseph, Richard W.; Lange, Julie R.; Nath, Sameer K.; Olszanski, Anthony J.; Ott, Patrick A.; Gupta, Aparna Priyanath; Ross, Merrick I.; Salama, April K.S.; Skitzki, Joseph J.; Sosman, Jeffrey A.; Swetter, Susan M.; Tanabe, Kenneth K.; Wuthrick, Evan; McMillian, Nicole R.; Engh, Anita M.

doi:10.6004/jnccn.2019.0018

Cited by 330 publications

(270 citation statements)

References 157 publications

(451 reference statements)

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“…This case highlights the need to test earlier in the disease course (e.g., in stage III melanoma) rather than waiting until the onset of metastatic disease and could potentially argue for testing of even localized (stage I–II) cancer. Current guidelines suggest testing when clinically actionable (e.g., when therapies including clinical trials are available) ; however, these cases suggest that an ongoing discussion is warranted regarding the timing of genomic testing.…”

Section: Discussionmentioning

confidence: 99%

Empiric Therapy with BRAF and MEK Inhibitors in Metastatic Melanoma

et al. 2019

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BRAF and MEK inhibitors are highly active in the setting of BRAFV600 mutant melanoma. Rarely, patients without previous testing present with fulminant progression necessitating emergent treatment prior to BRAF testing results. The safety and efficacy of empiric treatment in this setting is unclear. Herein, we present two patients treated with empiric BRAF and MEK inhibitors, resulting in dramatic clinical improvement in one patient later found to have a BRAF mutation, and lack of improvement (but no accelerated progression) in a patient lacking this mutation. Empiric BRAF and MEK inhibitor treatment should not be routinely pursued but may be given safely in rare, emergent situations.

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Section: Discussionmentioning

confidence: 99%

Empiric Therapy with BRAF and MEK Inhibitors in Metastatic Melanoma

et al. 2019

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Section: Introductionmentioning

confidence: 99%

“…The crucial importance of regional nodal metastasis for prognostication, disease recurrence, and survival in melanoma is well supported with prospective data reflected by The American Joint Committee on Cancer (AJCC) staging and the National Comprehensive Cancer Network (NCCN) treatment guidelines . Sentinel lymph node biopsy (SLNB) is recommended for cN0 T2–T4 and select T1b melanomas, and until recently immediate completion lymph‐node dissection (iCLND) was recommended following all positive SLNBs . The initial Multicenter Selective Lymphadenectomy Trial (MSLT‐I) demonstrated that SLNB followed by iCLND among patients with regionally metastatic melanoma confers prolonged disease‐free survival (DFS) and melanoma‐specific survival (MSS) over observation .…”

Section: Introductionmentioning

confidence: 99%

Cranial nerve outcomes in regionally recurrent head & neck melanoma after sentinel lymph node biopsy

et al. 2019

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Objective Characterize long‐term cranial nerve (CN) outcomes following sentinel lymph node biopsy (SLNB) based management for head and neck cutaneous melanoma (HNCM). Methods Longitudinal review of HNCM patients undergoing SLNB from 1997–2007. Results Three hundred fifty‐six patients were identified, with mean age 53.5 ± 19.0 years, mean Breslow depth 2.52 ± 1.87 mm, and 4.9 years median follow‐up. One hundred five (29.4%) patients had SLNB mapping to the parotid basin. Eighteen patients had positive parotid SLNs and underwent immediate parotidectomy / immediate completion lymph node dissection (iCLND), with six possessing positive parotid non‐sentinel lymph nodes (NSLNs). Fifty‐two of 356 (14.6%) patients developed delayed regional recurrences, including 20 total intraparotid recurrences: five following false negative (FN) parotid SLNB, three following prior immediate superficial parotidectomy, two following iCLND without parotidectomy, and the remaining 12 parotid recurrences had negative extraparotid SLNBs. Parotid recurrences were multiple (4.9 mean recurrent nodes) and advanced (n = 4 extracapsular extension), and all required salvage dissection including parotidectomy. Immediate parotidectomy/iCLND led to no permanent CN injuries. Delayed regional HNCM macrometastasis precipitated 16 total permanent CN injuries in 13 patients: 10 CN VII, five CN XI, and one CN XII deficits. Fifty percent (n = 10) of parotid recurrences caused ≥1 permanent CN deficits. Conclusions Regional HNCM macrometastases and salvage dissection confer marked CN injury risk, whereas early surgical intervention via SLNB ± iCLND ± immediate parotidectomy yielded no CN injuries. Further, superficial parotidectomy performed in parotid‐mapping HNCM does not obviate delayed intraparotid recurrences, which increase risk of CN VII injury. Despite lack of a published disease‐specific survival advantage in melanoma, early disease control in cervical and parotid basins is paramount to minimize CN complications. Level of Evidence 4 (retrospective case series) Laryngoscope, 130:1707–1714, 2020

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“…2 Current guidelines recommend dermatologic surveillance in patients with good response, nonetheless good response is not clearly specified and timing and frequency are not stated. [3][4][5] This study aimed to specify the need for routine skin examination in patients with durable response to TT and IT.…”

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confidence: 99%

“…Rivaroxaban, a direct factor Xa inhibitor, has demonstrated good effects in LV. 1,3,4 Compared to other treatments such as classic anticoagulants or intravenous immunoglobulin, rivaroxaban is way more convenient since it does not require injection, international normalized ratio monitoring or hospitalization.…”

mentioning

confidence: 99%