Guidelines of care for primary cutaneous melanoma

Sober, Arthur J.; Chuang, Tsu‐Yi; Duvic, Madeleine; Farmer, Evan R.; Grichnik, James M.; Halpern, Allan C.; Ho, Vincent; Holloway, V.; Hood, Antoinette F.; Johnson, Timothy M.; Lowery, Barbara J.

doi:10.1067/mjd.2001.117044

Cited by 189 publications

(104 citation statements)

References 47 publications

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“…Several groups have issued consensus guidelines, including most recently the National Comprehensive Cancer Network (NCCN), 7 the British Association of Dermatologists jointly with the Melanoma Study Group for the United Kingdom (UK), 8 and the American Academy of Dermatology (AAD). 9 For asymptomatic patients with !1-mm thick melanomas and clinically negative nodes the NCCN guidelines state a baseline chest x-ray (CXR) and lactate dehydrogenase (LDH) level are optional. In contrast, the AAD does not endorse any screening in patients with 4-mm thick melanomas, whereas the UK guidelines recommend that patients with stage IIB or more (2.01-mm thick primary melanoma with ulceration or more advanced primary disease or evidence of nodal or distant metastases) should have the following staging investigations: CXR, liver ultrasound or computed tomography (CT) scan of chest/abdomen/pelvis, liver function tests, LDH level, and complete blood count.…”

Section: P Atients Diagnosed With Intermediate Risk Cutaneous Melanomamentioning

confidence: 99%

Role of radiologic imaging at the time of initial diagnosis of stage T1b‐T3b melanoma

Yancovitz

Finelt

Warycha

et al. 2007

Cancer

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BACKGROUND. In patients with T1b‐T3b cutaneous melanoma the utility of radiologic imaging at the time of diagnosis is unclear. Whether initial imaging led to a change in stage or treatment plan was investigated. METHODS. The melanoma database was searched for patients with T1b‐T3b primary lesions, clinically N0, and asymptomatic for metastatic disease. Radiologic studies conducted before wide local excision ± sentinel lymph node biopsy as well as all further imaging and investigations were analyzed. Outcome measures included upstaging, change in initial surgical management, true‐positive, false‐positive, true‐negative, and false‐negative rates of each imaging modality. RESULTS. In all, 344 preoperative imaging studies (chest x‐ray [CXR], computed tomography [CT], positron emission tomography [PET]/CT) were performed on 158 patients, resulting in 49 findings suspicious for metastatic melanoma and 134 findings suggestive of nonmelanoma pathology. Only 1 of 344 (0.3%) studies, a PET/CT, correlated with confirmed metastatic melanoma. The false‐positive rates were CXR 5 of 7 (71.4%), chest CT 21 of 24 (87.5%), abdomen/pelvis CT 10 of 11 (90.9%), head CT 2 of 2 (100.0%), PET/CT 3 of 5 (60.0%). No patient was upstaged or had a change in initial surgical management based on preoperative imaging. The cost of all initial imaging and imaging to follow‐up abnormal findings was estimated as $555,308 for the 158 patients studied. CONCLUSIONS. Imaging at the time of initial diagnosis of T1b‐T3b, clinically N0, M0 melanoma was of low yield with a high false‐positive rate, and did not lead to upstaging or change in initial surgical management. These findings suggest that imaging of asymptomatic patients at the time of diagnosis may not be warranted. Cancer 2007. © 2007 American Cancer Society.

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Section: P Atients Diagnosed With Intermediate Risk Cutaneous Melanomamentioning

confidence: 99%

Role of radiologic imaging at the time of initial diagnosis of stage T1b‐T3b melanoma

Yancovitz

Finelt

Warycha

et al. 2007

Cancer

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“…An SLN involvement was found in 100/603 patients (16.6%). Patients were enrolled on the basis of guideline criteria [3], [22], [23] and [24]. SLN was performed in the presence of melanoma >1 mm, or even lower if ulcerated or Clark IV-V or presence of mitoses more than or equal to 1/mm2.…”

Section: Methodsmentioning

confidence: 99%

Clinico-pathologic features of primary melanoma and sentinel lymph node predictive for non-sentinel lymph node involvement and overall survival in melanoma patients: A single centre observational cohort study

Quaglino

Ribero²,

Osella‐Abate

et al. 2011

Surgical Oncology

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Dec 9. Clinico-pathologic features of primary melanoma and sentinel lymph node predictive for nonsentinel lymph node involvement and overall survival in melanoma patients: a single centre observational cohort study. Quaglino P, Ribero S, Osella-Abate S, Macrì L, Grassi M, Caliendo V, Asioli S, Sapino A, Macripò G, Savoia P, Bernengo MG.You may download, copy and otherwise use the AAM for non-commercial purposes provided that your license is limited by the following restrictions:(1) You may use this AAM for non-commercial purposes only under the terms of the CC-BY-NC-ND license.(2) The integrity of the work and identification of the author, copyright owner, and publisher must be preserved in any copy. AbstractObjective: Completion Lymph Node Dissection (CLND) is the current standard of practice for patients with a positive Sentinel Lymph Node Biopsy (SLNB). Significant morbidity is associated to CLND, so we tried to evaluate which prognostic variables could predict NSLN invasion in SLN-positive patients and their impact on the overall survival (OS). Methods: A retrospective chart review of 603 patients that had undergone SLNB for melanoma between 2000 and 2009 at our department was done. 100 SLN were positive at the histopathological analysis of SLN. Demographic variables, primary melanoma, SLN pathologic features and results of CLND were analysed. Multivariate logistic regression and OS analyses were carried out to test the prognostic relevance of clinicopathologic variables on CLND results and disease course. Results: Breslow thickness, ulceration and micro/macrometastatic pattern of SLN invasion carried a significantly independent higher likelihood of NSLN involvement; Starz classification did not maintain a statistical significance in multivariate analysis. Only one patient (4.3%) without adverse prognostic factors showed NSLN involvement, which was found in 33.3% of patients with one and 55.9% with two or more adverse parameters (p = 0.0001). OS analyses confirmed the prognostic significance of these factors. Conclusion: Waiting for the results of Multicenter Selective Lymphadenectomy Trial II, our study suggests a clinically useful and easily applicable means of identifying patients with an unfavourable disease course. The presence of one or more adverse factors identifies patients in whom CLND is mandatory to include thereafter in a more strict follow-up program. Moreover, the finding of no adverse prognostic indicators associated to the presence of significant co-morbidities and/or elderly age, could be useful in identifying patients not to treat by CLND.

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“…Excisional biopsy was performed with total thickness excision and a narrow margin, as described in the American Association of Dermatology Guidelines and the National Cancer Comprehensive Network Clinical Practice Guidelines [14,15]. Date of diagnosis was defined as the date of excisional biopsy.…”

Section: Melanoma Diagnosismentioning

confidence: 99%

The interval between primary melanoma excision and sentinel node biopsy is not associated with survival in sentinel node positive patients – An EORTC Melanoma Group study

Ophuis

Verhoef

Rutkowski

et al. 2016

European Journal of Surgical Oncology (EJSO)

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SynopsisThis study examines >1000 sentinel node (SN) positive melanoma patients. Time interval between primary excision and SN biopsy (SNB) is no prognostic factor for disease free and melanoma specific survival. Guidelines advocating SNB <6 weeks should be reconsidered. M A N U S C R I P T A C C E P T E D ACCEPTED MANUSCRIPT 3 AbstractBackground: Worldwide, sentinel node biopsy (SNB) is the recommended staging procedure for

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Guidelines of care for primary cutaneous melanoma

Cited by 189 publications

References 47 publications

Role of radiologic imaging at the time of initial diagnosis of stage T1b‐T3b melanoma

Role of radiologic imaging at the time of initial diagnosis of stage T1b‐T3b melanoma

Clinico-pathologic features of primary melanoma and sentinel lymph node predictive for non-sentinel lymph node involvement and overall survival in melanoma patients: A single centre observational cohort study

The interval between primary melanoma excision and sentinel node biopsy is not associated with survival in sentinel node positive patients – An EORTC Melanoma Group study

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