Diagnosis and treatment of melanoma. European consensus-based interdisciplinary guideline – Update 2016

• Published in: European journal of cancer (1990) Vol. 63; pp. 201 - 217
• Main Authors: Garbe, Claus, Peris, Ketty, Hauschild, Axel, Saiag, Philippe, Middleton, Mark, Bastholt, Lars, Grob, Jean-Jacques, Malvehy, Josep, Newton-Bishop, Julia, Stratigos, Alexander J, Pehamberger, Hubert, Eggermont, Alexander M
• Format: Journal Article
• Language: English
• Published: England Elsevier Ltd 01.08.2016
• Subjects: Adjuvant treatment; Antineoplastic Agents - therapeutic use; Cell Cycle Checkpoints; Chemotherapy, Adjuvant; Combined Modality Therapy - methods; Consensus; Cutaneous melanoma; Dermoscopy - methods; Europe; Excisional margins; Hematology, Oncology and Palliative Medicine; Humans; Immunotherapy - methods; Interferon-α; Lymph Node Excision - methods; Melanoma - classification; Melanoma - diagnosis; Melanoma - therapy; Metastasectomy; Molecular Diagnostic Techniques; Molecular Targeted Therapy - methods; Neoplasm Staging - methods; Practice Guidelines as Topic; Predictive Value of Tests; Prognosis; Sentinel lymph node dissection; Skin Neoplasms - classification; Skin Neoplasms - diagnosis; Skin Neoplasms - therapy; Survival Analysis; Systemic treatment; Tumour thickness; Metastasectomy; Interferon-α; Cutaneous melanoma; Adjuvant treatment; Systemic treatment; Sentinel lymph node dissection; Excisional margins; Tumour thickness
• ISSN: 0959-8049; 1879-0852
• DOI: 10.1016/j.ejca.2016.05.005

Abstract Cutaneous melanoma (CM) is potentially the most dangerous form of skin tumour and causes 90% of skin cancer mortality. A unique collaboration of multi-disciplinary experts from the European Dermatology Forum, the European Association of Dermato-Oncology and the European Organisation of Research and Treatment of Cancer was formed to make recommendations on CM diagnosis and treatment, based on systematic literature reviews and the experts' experience. Diagnosis is made clinically using dermoscopy and staging is based upon the AJCC system. CMs are excised with 1–2 cm safety margins. Sentinel lymph node dissection is routinely offered as a staging procedure in patients with tumours >1 mm in thickness, although there is as yet no clear survival benefit for this approach. Interferon-α treatment may be offered to patients with stage II and III melanoma as an adjuvant therapy, as this treatment increases at least the disease-free survival and less clear the overall survival (OS) time. The treatment is however associated with significant toxicity. In distant metastasis, all options of surgical therapy have to be considered thoroughly. In the absence of surgical options, systemic treatment is indicated. For first-line treatment particularly in BRAF wild-type patients, immunotherapy with PD-1 antibodies alone or in combination with CTLA-4 antibodies should be considered. BRAF inhibitors like dabrafenib and vemurafenib in combination with the MEK inhibitors trametinib and cobimetinib for BRAF mutated patients should be offered as first or second line treatment. Therapeutic decisions in stage IV patients should be primarily made by an interdisciplinary oncology team (‘Tumour Board’).