Melanoma, Version 2.2016, NCCN Clinical Practice Guidelines in Oncology

Coit, Daniel G.; Thompson, John A.; Algazi, Alain P.; Andtbacka, Robert H.I.; Bichakjian, Christopher K.; Carson, William E.; Daniels, Gregory A.; DiMaio, Dominick J.; Ernstoff, Marc S.; Fields, Ryan C.; Fleming, Martin D.; González, René; Guild, Valerie; Halpern, Allan C.; Hodi, F. Stephen; Joseph, Richard W.; Lange, Julie R.; Martini, Mary C.; Materin, Miguel A.; Olszanski, Anthony J.; Ross, Merrick I.; Salama, April K.S.; Skitzki, Joseph J.; Sosman, Jeff; Swetter, Susan M.; Tanabe, Kenneth K.; Torres-Roca, Javier F.; Trisal, Vijay; Urist, Marshall M.; McMillian, Nicole R.; Engh, Anita M.

doi:10.6004/jnccn.2016.0051

Cited by 214 publications

(172 citation statements)

References 112 publications

(146 reference statements)

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“…If palpable lymphadenopathy is encountered, nodal status should be confirmed via ultrasound-guided fine needle aspiration. If no clinical evidence of nodal involvement is present preoperatively, sentinel lymph node biopsy (SLB) should be performed at the time of surgery for all (20). M (metastatic) stage is assigned based on the presence or absence of metastatic disease and, if present, is further classified by the location (skin, lymph nodes, viscera, lungs, or increased serum lactate dehydrogenase).…”

Section: Melanoma Stagingmentioning

confidence: 99%

Clinical Presentation and Staging of Melanoma

Ward

Lambreton

Goel

et al. 2017

Cutaneous Melanoma: Etiology and Therapy

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Cutaneous melanoma is responsible for the vast majority of skin cancer-related deaths in the United States. Known risk factors include genetic defects, environmental exposures, and a combination of both. Among environmental risks, exposure to ultraviolet rays is the most important and the most modifiable risk factor. Several genetic syndromes involve increased risk of melanoma, including xeroderma pigmentosum, familial atypical multiple moles and melanoma syndrome, BRCA2 mutation, and congenital melanocytic nevi. Although the necessity of implementation remains controversial, the most effective melanoma screening technique is the whole-body skin examination. Typically, melanoma lesions are incidentally discovered during routine skin examination using the "ABCDE" mnemonic. Once suspected, questions pertaining to the sites of potential metastasis should be asked and excisional or partial biopsy should be considered. The primary histologic subtypes of melanoma include superficial spreading, lentigo maligna, nodular, acral lentiginous, desmoplastic, and amelanotic. Melanoma staging is completed via clinical and histologic assessment using the American Joint Committee on Cancer TNM system. Delayed or deficient elements of initial melanoma evaluation can limit patient outcomes and increase disease-related mortality. Clinicians involved in the diagnosis or treatment of cutaneous melanoma must be familiar with the available screening options, key steps of diagnosis, and the staging ramifications of disease discovery.

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Section: Melanoma Stagingmentioning

confidence: 99%

Clinical Presentation and Staging of Melanoma

Ward

Lambreton

Goel

et al. 2017

Cutaneous Melanoma: Etiology and Therapy

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“…As described in the NCCN (Coit et al, 2016) and ESMO guidelines (Dummer et al, 2015), radiotherapy should also be considered for local control.…”

Section: Radiation Oncologymentioning

confidence: 99%

ECCO essential requirements for quality cancer care for melanoma: Defining how to organise care

Wouters

2018

European Journal of Surgical Oncology

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“…The combination of ipilimumab and nivolumab provides higher response rates, greater tumor control, and longer progression-free survival as compared to monotherapy with either of these agents. Ipilimumab alone is no longer considered as the first-line therapy option, as CheckMate 067 phase III trial proved that improved outcomes are feasible with anti-PD-1 monotherapy or nivolumab/ipilimumab combination therapy [12] .…”

mentioning

confidence: 99%

“…Reliable predictive biomarkers are needed to guide management decisions and to help identify patients with BRAF V600 mutations who are most likely to benefit from first-line BRAF/MEK inhibitor therapy rather than immunotherapy, and vice versa. The appropriate selection of systemic therapy, choice of agents to be used alone or in combination, and sequencing of these novel agents continue to evolve as more and more results are being made available [12,16] .…”

mentioning

confidence: 99%

“…BRAF-inhibitors for BRAF-mutated patients are best given in combination with MEK inhibitors. Systemic chemotherapy can be offered to patients with good performance status who have developed resistance to the immunotherapeutic agents [4,12] . Ongoing research is likely to address certain challenging issues such as drug development against novel immune targets, genetically modified oncolytic viruses, optimization and sequencing of combination strategies, and consensus on predictive biomarkers to help select appropriate treatment regimen [7,[17][18][19][20] .…”

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confidence: 99%

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Shifting paradigms in the management of metastatic and unresectable melanoma

Suhag

Vats

2017

Adv Mod Oncol Res

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[1,2] . More than 80% of cases occur in developed countries and melanoma forms the sixth most common cancer in the developed world. The incidence of melanoma has witnessed an upward trend in the last five decades and the number of new cases diagnosed annually is increasing faster than for any other cancer in most of the developed countries [3] . The mainstay of management of melanoma is essentially early detection and surgical excision, and five-year survival rates of >90% and 80% for stage I and II lesions, respectively, have been reported. The chances for cure for locoregionally advanced and metastatic disease decrease drastically, with a survival of 50% for Stage III patients while Stage IV patients historically had a median survival of about 8-9 months and a three-year overall survival rate of about less than 15% [4,5] . Systemic treatment with a definitive survival benefit appeared to be a remote possibility traditionally. There has been recently established data which indicates an encouraging therapeutic response for metastatic melanoma with the evolution of several heterogeneous novel agents, and there is a hope for better overall survival for such patients, most of whom were deemed unfit for any curative systemic therapy until recently [6] .Traditionally, the systemic treatment for metastatic melanoma was characterized by low response rates and significant toxicities. One such agent was dacarbazine, which used to yield a response rate of about 20% and median response of a duration of about six months without any benefit in overall survival. Another such agent was high-dose interleukin (IL)-2, which provided about 6%-16% response rate and a progression-free survival of about 13 months. Interferon (IFN)-α was approved as the first agent in the adjuvant setting for selected high-risk resected cases and resulted in significant improvement in diseasefree survival (DFS) and in some prospective randomized trials, with a benefit on overall survival in some studies; however, its use was associated with significant toxicity. Temozolomide is an oral alkylator with a cytotoxic effect identical to dacarbazine. Unlike the later drug, temozolomide is administered easily through oral route and it crosses the blood-brain barrier, thus exhibiting cytotoxic effect on brain metastases. Combination chemotherapy has also been tested in several studies, without showing any improvement in response rates [7,8] .Immunotherapy for advanced and metastatic melanoma has been extensively evaluated in the recent years, and Suhag V and Vats P

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Melanoma, Version 2.2016, NCCN Clinical Practice Guidelines in Oncology

Cited by 214 publications

References 112 publications

Clinical Presentation and Staging of Melanoma

Clinical Presentation and Staging of Melanoma

ECCO essential requirements for quality cancer care for melanoma: Defining how to organise care

Shifting paradigms in the management of metastatic and unresectable melanoma

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