Diagnosis and treatment of melanoma: European consensus-based interdisciplinary guideline

• Published in: European journal of cancer (1990) Vol. 46; no. 2; pp. 270 - 283
• Main Authors: Garbe, Claus, Peris, Ketty, Hauschild, Axel, Saiag, Philippe, Middleton, Mark, Spatz, Alain, Grob, Jean-Jacques, Malvehy, Josep, Newton-Bishop, Julia, Stratigos, Alexander, Pehamberger, Hubert, Eggermont, Alexander
• Format: Journal Article
• Language: English
• Published: Kidlington Elsevier Ltd 01.01.2010; Elsevier
• Subjects: Adjuvant treatment; Antineoplastic Agents - therapeutic use; Biological and medical sciences; Combined Modality Therapy - methods; Cutaneous melanoma; Europe; Excisional margins; Hematology, Oncology and Palliative Medicine; Humans; Interferon-α; Long-Term Care; Lymph Node Excision; Medical sciences; Melanoma - pathology; Melanoma - therapy; Metastasectomy; Neoplasm Metastasis - therapy; Neoplasm Staging - methods; Pharmacology. Drug treatments; Sentinel Lymph Node Biopsy - methods; Sentinel lymph node dissection; Skin Neoplasms - pathology; Skin Neoplasms - therapy; Systemic medical treatment; Tumors; Tumour thickness; Europe; Metastasectomy; Interferon-α; Systemic medical treatment; Cutaneous melanoma; Adjuvant treatment; Sentinel lymph node dissection; Excisional margins; Tumour thickness; Skin disease; Sentinel lymph node; Alpha interferon; Malignant tumor; Consensus; Skin cancer; Thickness; Medicine; Lymphadenectomy; Cancerology; Surgery; European directive; Malignant melanoma; Diagnosis; Cancer
• ISSN: 0959-8049; 1879-0852
• DOI: 10.1016/j.ejca.2009.10.032

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 Organization 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 and staging is based upon the AJCC system. CMs are excised with one to two centimetre safety margins. Sentinel lymph node dissection is routinely offered as a staging procedure in patients with tumours more than 1 mm in thickness, although there is as yet no resultant survival benefit. Interferon-α treatment can be offered to patients with more than 1.5 mm in thickness and stage II to III melanoma as an adjuvant therapy, as this treatment increases the relapse-free survival. The lack of a clear survival benefit and the presence of toxicity however limit its use in practice. In distant metastasis, all options of surgical therapy have to be considered thoroughly. In the absence of surgical options, systemic medical treatment is indicated, but with, to date, low response rates. Therapeutic decisions should be made by the melanoma team and the informed patient after full discussion of the options.