Fast Five Quiz: Malignant Melanoma

William James, MD


August 21, 2020

Current guidelines from the AAD on the evaluation and management of primary cutaneous melanoma include:

  • Evidence strongly indicates that Breslow thickness, ulceration, and dermal mitotic rate are important predictors of patient outcome in primary cutaneous melanoma.

  • The recommended first-line treatment for any-thickness primary cutaneous melanoma, as well as for melanoma in situ, is surgical excision with histologically negative margins; tumor thickness should dictate the margins.

  • When clinically indicated, sentinel lymph node biopsy should be performed prior to wide excision of the primary cutaneous melanoma in the same operative setting (whenever possible).

  • Surgical margins for invasive cutaneous melanoma, as measured clinically around the primary tumor, should be a minimum of 1 cm and a maximum of 2 cm, although narrower margins can be used to accommodate function and/or anatomic location. It is recommended that the excision be as deep as, but not inclusive of, the fascia.

  • It is not recommended that asymptomatic patients with newly diagnosed stage 0-II primary cutaneous melanoma undergo baseline radiologic imaging and laboratory studies.

  • For cutaneous melanoma at baseline, radiologic imaging and laboratory studies should be conducted only to assess the specific signs or symptoms of synchronous metastasis (regional nodal or distant).

  • At baseline or when physical examination of lymph nodes is equivocal and requires surveillance, the use of lymph node ultrasonography is encouraged. Surveillance with such imaging is also encouraged in these patients:

    • Those who meet criteria for sentinel lymph node biopsy but do not undergo the procedure

    • Those in whom sentinel lymph node biopsy is not possible or is technically unsuccessful (eg, because lymphoscintigraphic dye has failed to migrate and a draining sentinel lymph node cannot be identified)

    • Those in whom complete lymph node dissection is not performed despite a positive sentinel lymph node biopsy

Read more about current AAD guidelines.

This Fast Five Quiz was excerpted and adapted from the Medscape Drugs & Diseases articles Malignant Melanoma, Melanoma, and Cutaneous Melanoma.

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