Vol 63, No 2 (2013)
Guidelines / Expert consensus
Published online: 2013-06-10
Recommendations for diagnostics and therapy of cutaneous melanoma
Nowotwory. Journal of Oncology 2013;63(2):157-170.
Abstract
The classic criteria for clinical diagnosis of cutaneous melanoma are: asymmetry of the lesion, irregularity of the border,
colour heterogeneity and diameter of more than 5 mm. Current data show that over 50% of melanomas do not fulfi ll
these criteria. Thus, dermoscopy is currently the standard method for clinical diff erential diagnosis of cutaneous melanoma
and for qualifying a lesion for excisional biopsy. Full thickness excisional biopsy of suspicious melanomatous
skin lesions likely to be diagnosed as early melanomas is crucial in establishing diagnosis and defi ning prognostic factors. Early diagnosis and surgical removal of cutaneous melanoma not only improves patients’ prognosis, but it
is also associated with a approximately 90% likelihood of cure. The next steps in the therapeutic management of
cutaneous melanoma following excisional biopsy are radical scar excision with adequate margins and sentinel lymph
node biopsy. Radical lymph node dissection is recommended in case of regional lymph node metastases. High-risk
patients (lymph node involvement and/or ulcerated primary lesion) should be advised to participate in prospective
clinical trials on adjuvant therapy. Melanoma patients with distant metastases are still characterised by poor outcomes.
In patients with metastatic disease testing for the presence of BRAF gene mutation is recommended. Long-term
survival is confi ned to selected group of patients undergoing resection of isolated metastatic lesions. In systemic
— mainly fi rst-line — therapy of patients with BRAF V600 mutation vemurafenib (BRAF inhibitor) may be employed
and in second-line treatment — based on indication approved in Europe — ipilimumab (anti-CTLA4 antibody) may
be used. Dacarbazine-based chemotherapy is less eff ective.
colour heterogeneity and diameter of more than 5 mm. Current data show that over 50% of melanomas do not fulfi ll
these criteria. Thus, dermoscopy is currently the standard method for clinical diff erential diagnosis of cutaneous melanoma
and for qualifying a lesion for excisional biopsy. Full thickness excisional biopsy of suspicious melanomatous
skin lesions likely to be diagnosed as early melanomas is crucial in establishing diagnosis and defi ning prognostic factors. Early diagnosis and surgical removal of cutaneous melanoma not only improves patients’ prognosis, but it
is also associated with a approximately 90% likelihood of cure. The next steps in the therapeutic management of
cutaneous melanoma following excisional biopsy are radical scar excision with adequate margins and sentinel lymph
node biopsy. Radical lymph node dissection is recommended in case of regional lymph node metastases. High-risk
patients (lymph node involvement and/or ulcerated primary lesion) should be advised to participate in prospective
clinical trials on adjuvant therapy. Melanoma patients with distant metastases are still characterised by poor outcomes.
In patients with metastatic disease testing for the presence of BRAF gene mutation is recommended. Long-term
survival is confi ned to selected group of patients undergoing resection of isolated metastatic lesions. In systemic
— mainly fi rst-line — therapy of patients with BRAF V600 mutation vemurafenib (BRAF inhibitor) may be employed
and in second-line treatment — based on indication approved in Europe — ipilimumab (anti-CTLA4 antibody) may
be used. Dacarbazine-based chemotherapy is less eff ective.