Guideline:
Treatment of cutaneous melanoma
National Guideline Clearinghouse (NGC). Guideline summary: Treatment of cutaneous melanoma In: National Guideline Clearinghouse (NGC) [Web site]. Rockville (MD): cited 2007 May. Available: http://www.guideline.gov.
Bibliographic Source(s)
- American Society of Plastic Surgeons. Evidence-based clinical practice guideline: treatment of cutaneous melanoma. Arlington Heights (IL): American Society of Plastic Surgeons; 2007 May. 14 p. [81 references]
Guideline Status
This is the current release of the guideline.
Guideline Category
Evaluation
Management
Treatment
Intended Users
Physicians
Guideline Objective(s)
To address the assessment and treatment of cutaneous melanoma and to develop a set of recommendations that fairly reflect current accepted medical standards
Target Population
Patients with cutaneous melanoma
Interventions and Practices Considered
Assessment
- Patient history including assessment of risk factors
- Physical examination including examination of entire skin focused examination of pigmented lesions and palpitation of major lymph node bases
- Biopsy of primary lesion (excisional or incisional)
- Pathological staging of the primary melanoma
- Other assessments (blood work chest x-ray or other radiological examination screening for molecular markers)
- Follow-up assessment including regular physical examinations and diagnostic tests
Treatment/Management
- Surgical excision of primary melanoma
- Sentinel lymph node biopsy using multiple imaging techniques
- Complete lymph node dissection
- Referral to oncologist for systemic treatment
- Surveillance including patient education and adequate follow-up
Major Outcomes Considered
Not stated
Methods Used to Collect/Select Evidence
Searches of Electronic Databases
Description of Methods used to Collect/Select the Evidence
Literature Search and Admission of Evidence
This study was carried out with a prospective systematic method for identifying and evaluating current literature on the treatment of cutaneous melanoma. To identify relevant literature a comprehensive search of Medline the Cochrane Database of Systematic Reviews and the National Guideline Clearinghouse™ was performed by using various combinations of the following search terms: melanoma cutaneous melanoma diagnosis staging biopsy treatment excision margins sentinel node biopsy as well as a wide range of indexing terms free text words and word variants. Search limits restricted results to English-language manuscripts that were published from 1997 to 2007 and also indexed as human studies clinical trials randomized controlled trials systematic reviews and/or guidelines.
Articles were selected if they were relevant to clinical questions about patient assessment staging prognosis treatment follow-up and surveillance. Excluded from the literature selection were articles that specifically addressed assessment and treatment of patients with non-cutaneous melanoma.
Number of Source Documents
Not stated
Methods Used to Assess the Quality and Strength of the Evidence
Weighting According to a Rating Scheme (Scheme Given)
Rating Scheme for the Strength of the Evidence
Evidence Rating Scale for Diagnostic Studies
| Level of Evidence | Qualifying Studies |
|---|---|
| I | High-quality multi-centered or single-centered cohort study validating a diagnostic test (with "gold" standard as reference) in a series of consecutive patients; or a systematic review of these studies |
| II | Exploratory cohort study developing diagnostic criteria (with "gold" standard as reference) in a series of consecutive patients; or a systematic review of these studies |
| III | Diagnostic study in nonconsecutive patients (without consistently applied "gold" standard as reference); or a systematic review of these studies |
| IV | Case-control study; or any of the above diagnostic studies in the absence of a universally accepted "gold" standard |
| V | Expert opinion; case report or clinical example; or evidence based on physiology bench research or "first principles" |
Evidence Rating Scale for Prognostic Studies
| Level of Evidence | Qualifying Studies |
|---|---|
| I | High-quality multi-centered or single-centered prospective cohort study with adequate power; or a systematic review of these studies |
| II | Lesser-quality prospective cohort study; retrospective study; untreated controls from a randomized controlled trial; or a systematic review of these studies |
| III | Case-control study; or a systematic review of these studies |
| IV | Case series |
| V | Expert opinion; case report or clinical example; or evidence based on physiology bench research or "first principles" |
Evidence Rating Scale for Therapeutic Studies
| Level of Evidence | Qualifying Studies |
|---|---|
| I | High-quality multi-centered or single-centered randomized controlled trial with adequate power; or a systematic review of these studies |
| II | Lesser-quality randomized controlled trial; prospective cohort study; or a systematic review of these studies |
| III | Retrospective comparative study; case-control study; or a systematic review of these studies |
| IV | Case series |
| V | Expert opinion; case report or clinical example; or evidence based on physiology bench research or "first principles" |
Methods Used to Analyze the Evidence
Systematic Review
Description of the Methods Used to Analyze the Evidence
Critical Appraisal of the Literature
Relevant articles were categorized by study type: randomized controlled trial systematic review cohort study case-control study case series and case report. Each article was critically appraised for study quality according to criteria referenced in key publications on evidence-based medicine. Depending on type (prognostic diagnostic or therapeutic) and quality of study each article was assigned a corresponding level of evidence according to the American Society of Plastic Surgeons (ASPS) Evidence Rating Scales (see "Rating Scheme for the Strength of the Evidence" above) which were modified from scales developed by other surgical specialties and authorities on evidence-based medicine.
Methods Used to Formulate the Recommendations
Expert Consensus
Description of Methods Used to Formulate the Recommendations
Development of Clinical Practice Recommendations
Practice recommendations were developed through critical appraisal of the literature and consensus of the American Society of Plastic Surgeons (ASPS) Health Policy Committee. Recommendations are based on the strength of supporting evidence and were graded according to the ASPS Grades of Recommendation Scale (see "Rating Scheme for the Strength of the Recommendations" below) which was modified from scales used by other surgical specialties and authorities in the practice of evidence-based medicine.
Rating Scheme for the Strength of the Recommendations
| Grade | Descriptor | Qualifying Evidence | Implications for Practice |
|---|---|---|---|
| A | Strong Recommendation | Level I evidence or consistent findings from multiple studies of levels II III or IV | Clinicians should follow a strong recommendation unless a clear and compelling rationale for an alternative approach is present. |
| B | Recommendation | Levels II III or IV evidence and findings are generally consistent | Generally clinicians should follow a recommendation but should remain alert to new information and sensitive to patient preference. |
| C | Option | Levels II III or IV evidence but findings are inconsistent | Clinicians should be flexible in their decision-making regarding appropriate practice although they may set bounds on alternatives; patient preference should have a substantial influencing role. |
| D | Option | Level V; little or no systematic empirical evidence | Clinicians should consider all options in their decision-making and be alert to new published evidence that clarifies the balance of benefit versus harm; patient preference should have a substantial influencing role. |
Cost Analysis
A formal cost analysis was not performed and published cost analyses were not reviewed.
Method of Guideline Validation
Peer Review
Description of Method of Guideline Validation
Approved by the Executive Committee of the American Society of Plastic Surgeons May 2007
Major Recommendations
Definitions for the levels of evidence for diagnostic prognostic and therapeutic studies (I–V) and the strength of the recommendations (A–D) are provided at the end of the "Major Recommendations" field.
| Recommendations for Patient Assessment | Supporting Evidence | Grade |
|---|---|---|
| Patient History Assess risk factors:
| (Carli et al. 2003; Naldi et al. 2005; Gandini et al. 2005) | B |
| Physical Exam Exam should include:
| (Hazen et al. 1999; Abbasi et al. 2004) | B |
| Biopsy of the Primary Lesion For pigmented lesions suspect for melanoma:
| (Lorusso Sarma & Sarwar 2005; Karimipour et al. 2005; Bong Herd & Hunter 2002) | B |
| Other Clinical and Diagnostic Assessments | ||
For all patients consider:
| (Wang et al. 2004; Tsao et al. 2004; Hofmann et al. 2002) | C |
For patients with more advanced disease consider:
| (Hoffmann et al. 2002; Deichmann et al. 2004; Banfalvi et al. 2002; Mohammed et al. 2001; Keilholz et al. 2004) | C |
*ABCDEF criteria include the following factors:
- Asymmetry
- Border irregularity
- Color variegation or changes
- Diameter greater than 6 mm
- Evolutionary changes in color size symmetry surface characteristics and symptoms
- Funny-looking lesions
| Recommendations for Treatment | Supporting Evidence | Grade |
|---|---|---|
Surgical Excision of Primary Melanoma
| (Balch et al. 2001; Cohn-Cedermark et al. 2000; Haigh DiFronzo & McCready 2003; Khayat et al. 2003; Thomas et al. 2004) | A |
| Sentinel Lymph Node Biopsy (SNLB) | ||
SNLB should be considered for patients with:
| (Estourgie et al. 2003; Essner et al. 1999; Morton et al. 2006; Landi et al. 2000; Bedrosian et al. 2000; Wagner et al. 2000; Morton et al. 2005) | B |
Recommend use of multiple imaging techniques:
| (Estourgie et al. 2003; Essner et al. 1999; Morton et al. 2006; Landi et al. 2000; Duprat et al. 2005; Cafiero et al. 1998; Rossi et al. 2006; Morton et al. 2005) | B |
Measures to minimize probability of missed sentinel node metastasis include:
| (Estourgie et al. 2003; Essner et al. 1999; Morton et al. 2006; Landi et al. 2000; Duprat et al. 2005; Cafiero et al. 1998; Rossi et al. 2006; Giese et al. 2005; Gradilone et al. 2004; Kammula et al. 2004; Morton et al. 2005) | B |
| Complete Lymph Node Dissection (CLND) CLND is recommended for patients with:
| (Morton et al. 2006; Pu et al. 2003; Balch et al. 2000; Morton et al. 2005; Kretschmer et al. 2004) | C |
Systemic Treatment
| Expert Opinion | D |
| Recommendations for Follow-up | Supporting Evidence | Grade |
|---|---|---|
| Physical Exam | ||
Perform every 3 months for the first year; every 6 months for 5 years then at least yearly thereafter:
| (DiFronzo et al. 1999; DiFronzo Wanek & Morton 2001; Brobeil et al. 1997) | B |
For patients with the following high-risk features more frequent visits may be necessary:
| (DiFronzo et al. 1999; DiFronzo Wanek & Morton 2001; Ferrone et al. 2005) | B |
| Diagnostic Tests For patients with at least stage II or III disease or signs/symptoms of possible systemic involvement consider:
| (Miranda et al. 2004; Wang et al. 2004; Tsao et al. 2004; Hofmann et al. 2002; Deichmann et al. 2004; Banfalvi et al. 2002; Mohammed et al. 2001; Keilholz et al. 2004) | C |
| Recommendations for Surveillance | Supporting Evidence | Grade |
|---|---|---|
| Educational Intervention Patients and family members should be educated about:
| (DiFronzo Wanek & Morton 2001; Uliasz & Lebwohl 2007; Brady et al. 2000) | B |
| Adequate Follow-up Physicians should assess patients for symptoms of recurrence and risk factors associated with recurrence:
| (Estourgie et al. 2003; DiFronzo et al. 1999; Brobeil et al. 1997; Cerovac et al. 2006; Chao et al. 2002) | B |
Definitions:
Scale for Grading Recommendations
| Grade | Descriptor | Qualifying Evidence | Implications for Practice |
|---|---|---|---|
| A | Strong Recommendation | Level I evidence or consistent findings from multiple studies of levels II III or IV | Clinicians should follow a strong recommendation unless a clear and compelling rationale for an alternative approach is present. |
| B | Recommendation | Levels II III or IV evidence and findings are generally consistent | Generally clinicians should follow a recommendation but should remain alert to new information and sensitive to patient preference. |
| C | Option | Levels II III or IV evidence but findings are inconsistent | Clinicians should be flexible in their decision-making regarding appropriate practice although they may set bounds on alternatives; patient preference should have a substantial influencing role. |
| D | Option | Level V; little or no systematic empirical evidence | Clinicians should consider all options in their decision-making and be alert to new published evidence that clarifies the balance of benefit versus harm; patient preference should have a substantial influencing role. |
Evidence Rating Scale for Diagnostic Studies
| Level of Evidence | Qualifying Studies |
|---|---|
| I | High-quality multi-centered or single-centered cohort study validating a diagnostic test (with "gold" standard as reference) in a series of consecutive patients; or a systematic review of these studies |
| II | Exploratory cohort study developing diagnostic criteria (with "gold" standard as reference) in a series of consecutive patients; or a systematic review of these studies |
| III | Diagnostic study in nonconsecutive patients (without consistently applied "gold" standard as reference); or a systematic review of these studies |
| IV | Case-control study; or any of the above diagnostic studies in the absence of a universally accepted "gold" standard |
| V | Expert opinion; case report or clinical example; or evidence based on physiology bench research or "first principles" |
Evidence Rating Scale for Prognostic Studies
| Level of Evidence | Qualifying Studies |
|---|---|
| I | High-quality multi-centered or single-centered prospective cohort study with adequate power; or a systematic review of these studies |
| II | Lesser-quality prospective cohort study; retrospective study; untreated controls from a randomized controlled trial; or a systematic review of these studies |
| III | Case-control study; or a systematic review of these studies |
| IV | Case series |
| V | Expert opinion; case report or clinical example; or evidence based on physiology bench research or "first principles" |
Evidence Rating Scale for Therapeutic Studies
| Level of Evidence | Qualifying Studies |
|---|---|
| I | High-quality multi-centered or single-centered randomized controlled trial with adequate power; or a systematic review of these studies |
| II | Lesser-quality randomized controlled trial; prospective cohort study; or a systematic review of these studies |
| III | Retrospective comparative study; case-control study; or a systematic review of these studies |
| IV | Case series |
| V | Expert opinion; case report or clinical example; or evidence based on physiology bench research or "first principles" |
Clinical Algorithm(s)
None provided
References Supporting the Recommendations
- Abbasi NR Shaw HM Rigel DS Friedman RJ McCarthy WH Osman I Kopf AW Polsky D. Early diagnosis of cutaneous melanoma: revisiting the ABCD criteria. JAMA 2004 Dec 8;292(22):2771-6. [46 references] PubMed
- Balch CM Soong S Ross MI Urist MM Karakousis CP Temple WJ Mihm MC Barnhill RL Jewell WR Wanebo HJ Harrison R. Long-term results of a multi-institutional randomized trial comparing prognostic factors and surgical results for intermediate thickness melanomas (1.0 to 4.0 mm). Intergroup Melanoma Surgical Trial. Ann Surg Oncol 2000 Mar;7(2):87-97. PubMed
- Balch CM Soong SJ Smith T Ross MI Urist MM Karakousis CP Temple WJ Mihm MC Barnhill RL Jewell WR Wanebo HJ Desmond R Investigators from the Intergroup Melanoma Surgical Trial. Long-term results of a prospective surgical trial comparing 2 cm vs. 4 cm excision margins for 740 patients with 1-4 mm melanomas. Ann Surg Oncol 2001 Mar;8(2):101-8. PubMed
- Banfalvi T Boldizsar M Gergye M Gilde K Kremmer T Otto S. Comparison of prognostic significance of serum 5-S-Cysteinyldopa LDH and S-100B protein in Stage III-IV malignant melanoma. Pathol Oncol Res 2002;8(3):183-7. PubMed
- Bedrosian I Faries MB Guerry D 4th Elenitsas R Schuchter L Mick R Spitz FR Bucky LP Alavi A Elder DE Fraker DL Czerniecki BJ. Incidence of sentinel node metastasis in patients with thin primary melanoma (
PubMed - Bong JL Herd RM Hunter JA. Incisional biopsy and melanoma prognosis. J Am Acad Dermatol 2002 May;46(5):690-4. PubMed
- Brady MS Oliveria SA Christos PJ Berwick M Coit DG Katz J Halpern AC. Patterns of detection in patients with cutaneous melanoma. Cancer 2000 Jul 15;89(2):342-7. PubMed
- Brobeil A Rapaport D Wells K Cruse CW Glass F Fenske N Albertini J Miliotis G Messina J DeConti R Berman C Shons A Cantor A Reintgen DS. Multiple primary melanomas: implications for screening and follow-up programs for melanoma. Ann Surg Oncol 1997 Jan;4(1):19-23.
- Cafiero F Peressini A Gipponi M Rainero ML Villa G Sertoli MR Bertoglio S Moresco L. Sentinel node biopsy in patients with cutaneous melanoma. Semin Surg Oncol 1998 Dec;15(4):284-6. PubMed
- Carli P Balzi D de Giorgi V Massi D Palli D Chiarugi A Nardini P Giannotti B. Results of surveillance programme aimed at early diagnosis of cutaneous melanoma in high risk Mediterranean subjects. Eur J Dermatol 2003 Sep-Oct;13(5):482-6. PubMed
- Cerovac S Mashhadi SA Williams AM Allan RA Stanley PR Powell BW. Is there increased risk of local and in-transit recurrence following sentinel lymph node biopsy. J Plast Reconstr Aesthet Surg 2006;59(5):487-93. PubMed
- Chao C Wong SL Ross MI Reintgen DS Noyes RD Cerrito PB Edwards MJ McMasters KM Sunbelt Melanoma Trial Group. Patterns of early recurrence after sentinel lymph node biopsy for melanoma. Am J Surg 2002 Dec;184(6):520-4; discussion 525. PubMed
- Cohn-Cedermark G Rutqvist LE Andersson R Breivald M Ingvar C Johansson H Jonsson PE Krysander L Lindholm C Ringborg U. Long term results of a randomized study by the Swedish Melanoma Study Group on 2-cm versus 5-cm resection margins for patients with cutaneous melanoma with a tumor thickness of 0.8-2.0 mm. Cancer 2000 Oct 1;89(7):1495-501. PubMed
- Deichmann M Kahle B Moser K Wacker J Wust K. Diagnosing melanoma patients entering American Joint Committee on Cancer stage IV C-reactive protein in serum is superior to lactate dehydrogenase. Br J Cancer 2004 Aug 16;91(4):699-702. PubMed
- DiFronzo LA Wanek LA Elashoff R Morton DL. Increased incidence of second primary melanoma in patients with a previous cutaneous melanoma. Ann Surg Oncol 1999 Oct-Nov;6(7):705-11. PubMed
- DiFronzo LA Wanek LA Morton DL. Earlier diagnosis of second primary melanoma confirms the benefits of patient education and routine postoperative follow-up. Cancer 2001 Apr 15;91(8):1520-4. PubMed
- Duprat JP Silva DC Coimbra FJ Lima IA Lima EN Almeida OM Brechtbuhl ER Landman G Scramim AP Neves RI. Sentinel lymph node biopsy in cutaneous melanoma: analysis of 240 consecutive cases. Plast Reconstr Surg 2005 Jun;115(7):1944-51; discussion 1952-. PubMed
- Essner R Conforti A Kelley MC Wanek L Stern S Glass E Morton DL. Efficacy of lymphatic mapping sentinel lymphadenectomy and selective complete lymph node dissection as a therapeutic procedure for early-stage melanoma. Ann Surg Oncol 1999 Jul-Aug;6(5):442-9.
- Estourgie SH Nieweg OE Valdes Olmos RA Hoefnagel CA Kroon BB. Review and evaluation of sentinel node procedures in 250 melanoma patients with a median follow-up of 6 years. Ann Surg Oncol 2003 Jul;10(6):681-8. PubMed
- Ferrone CR Ben Porat L Panageas KS Berwick M Halpern AC Patel A Coit DG. Clinicopathological features of and risk factors for multiple primary melanomas. JAMA 2005 Oct 5;294(13):1647-54. PubMed
- Gandini S Sera F Cattaruzza MS Pasquini P Zanetti R Masini C Boyle P Melchi CF. Meta-analysis of risk factors for cutaneous melanoma: III. Family history actinic damage and phenotypic factors. Eur J Cancer 2005 Sep;41(14):2040-59. [113 references] PubMed
- Giese T Engstner M Mansmann U Hartschuh W Arden B. Quantification of melanoma micrometastases in sentinel lymph nodes using real-time RT-PCR. J Invest Dermatol 2005 Mar;124(3):633-7. PubMed
- Gradilone A Ribuffo D Silvestri I Cigna E Gazzaniga P Nofroni I Zamolo G Frati L Scuderi N Agliano AM. Detection of melanoma cells in sentinel lymph nodes by reverse transcriptase-polymerase chain reaction: prognostic significance. Ann Surg Oncol 2004 Nov;11(11):983-7. PubMed
- Haigh PI DiFronzo LA McCready DR. Optimal excision margins for primary cutaneous melanoma: a systematic review and meta-analysis. Can J Surg 2003 Dec;46(6):419-26. [22 references] PubMed
- Hazen BP Bhatia AC Zaim T Brodell RT. The clinical diagnosis of early malignant melanoma: expansion of the ABCD criteria to improve diagnostic sensitivity. Dermatol Online J 1999 Nov;5(2):3. PubMed
- Hofmann U Szedlak M Rittgen W Jung EG Schadendorf D. Primary staging and follow-up in melanoma patients--monocenter evaluation of methods costs and patient survival. Br J Cancer 2002 Jul 15;87(2):151-7. PubMed
- Kammula US Ghossein R Bhattacharya S Coit DG. Serial follow-up and the prognostic significance of reverse transcriptase-polymerase chain reaction--staged sentinel lymph nodes from melanoma patients. J Clin Oncol 2004 Oct 1;22(19):3989-96. PubMed
- Karimipour DJ Schwartz JL Wang TS Bichakjian CK Orringer JS King AL Huang CC Johnson TM. Microstaging accuracy after subtotal incisional biopsy of cutaneous melanoma. J Am Acad Dermatol 2005 May;52(5):798-802. PubMed
- Keilholz U Goldin-Lang P Bechrakis NE Max N Letsch A Schmittel A Scheibenbogen C Heufelder K Eggermont A Thiel E. Quantitative detection of circulating tumor cells in cutaneous and ocular melanoma and quality assessment by real-time reverse transcriptase-polymerase chain reaction. Clin Cancer Res 2004 Mar 1;10(5):1605-12. PubMed
- Khayat D Rixe O Martin G Soubrane C Banzet M Bazex JA Lauret P Verola O Auclerc G Harper P Banzet P French Group of Research on Malignant Melanoma. Surgical margins in cutaneous melanoma (2 cm versus 5 cm for lesions measuring less than 2.1-mm thick). Cancer 2003 Apr 15;97(8):1941-6. PubMed
- Kretschmer L Hilgers R Mohrle M Balda BR Breuninger H Konz B Kunte C Marsch WC Neumann C Starz H. Patients with lymphatic metastasis of cutaneous malignant melanoma benefit from sentinel lymphonodectomy and early excision of their nodal disease. Eur J Cancer 2004 Jan;40(2):212-8. PubMed
- Landi G Polverelli M Moscatelli G Morelli R Landi C Fiscelli O Erbazzi A. Sentinel lymph node biopsy in patients with primary cutaneous melanoma: study of 455 cases. J Eur Acad Dermatol Venereol 2000 Jan;14(1):35-45. [36 references] PubMed
- Lorusso GD Sarma DP Sarwar SF. Punch biopsies of melanoma: a diagnostic peril. Dermatol Online J 2005;11(1):7. PubMed
- Miranda EP Gertner M Wall J Grace E Kashani-Sabet M Allen R Leong SP. Routine imaging of asymptomatic melanoma patients with metastasis to sentinel lymph nodes rarely identifies systemic disease. Arch Surg 2004 Aug;139(8):831-6; discussion 836-7. PubMed
- Mohammed MQ Abraha HD Sherwood RA MacRae K Retsas S. Serum S100beta protein as a marker of disease activity in patients with malignant melanoma. Med Oncol 2001;18(2):109-20. PubMed
- Morton DL Cochran AJ Thompson JF Elashoff R Essner R Glass EC Mozzillo N Nieweg OE Roses DF Hoekstra HJ Karakousis CP Reintgen DS Coventry BJ Wang HJ Multicenter Selective Lymphadenectomy Trial Group. Sentinel node biopsy for early-stage melanoma: accuracy and morbidity in MSLT-I an international multicenter trial. Ann Surg 2005 Sep;242(3):302-11; discussion 311-3. PubMed
- Morton DL Thompson JF Cochran AJ Mozzillo N Elashoff R Essner R Nieweg OE Roses DF Hoekstra HJ Karakousis CP Reintgen DS Coventry BJ Glass EC Wang HJ MSLT Group. Sentinel-node biopsy or nodal observation in melanoma. N Engl J Med 2006 Sep 28;355(13):1307-17. PubMed
- Naldi L Altieri A Imberti GL Gallus S Bosetti C La Vecchia C Oncology Study Group of the Italian Group for Epidemiologic Research in. Sun exposure phenotypic characteristics and cutaneous malignant melanoma. An analysis according to different clinico-pathological variants and anatomic locations (Italy). Cancer Causes Control 2005 Oct;16(8):893-9. PubMed
- Pu LL Wells KE Cruse CW Shons AR Reintgen DS. Prevalence of additional positive lymph nodes in complete lymphadenectomy specimens after positive sentinel lymphadenectomy findings for early-stage melanoma of the head and neck. Plast Reconstr Surg 2003 Jul;112(1):43-9. PubMed
- Rossi CR De Salvo GL Trifiro G Mocellin S Landi G Macripo G Carcoforo P Ricotti G Giudice G Picciotto F Donner D Di Filippo F Montesco MC Casara D Schiavon M Foletto M Baldini F Testori A. The impact of lymphoscintigraphy technique on the outcome of sentinel node biopsy in 1313 patients with cutaneous melanoma: an Italian Multicentric Study (SOLISM-IMI). J Nucl Med 2006 Feb;47(2):234-41. PubMed
- Thomas JM Newton-Bishop J A'Hern R Coombes G Timmons M Evans J Cook M Theaker J Fallowfield M O'Neill T Ruka W Bliss JM United Kingdom Melanoma Study Group British Association of Plastic Surgeons Scottish Cancer Therapy Network. Excision margins in high-risk malignant melanoma. N Engl J Med 2004 Feb 19;350(8):757-66. PubMed
- Tsao H Feldman M Fullerton JE Sober AJ Rosenthal D Goggins W. Early detection of asymptomatic pulmonary melanoma metastases by routine chest radiographs is not associated with improved survival. Arch Dermatol 2004 Jan;140(1):67-70. PubMed
- Uliasz A Lebwohl M. Patient education and regular surveillance results in earlier diagnosis of second primary melanoma. Int J Dermatol 2007 Jun;46(6):575-7. PubMed
- Wagner JD Corbett L Park HM Davidson D Coleman JJ Havlik RJ Hayes JT 2nd. Sentinel lymph node biopsy for melanoma: experience with 234 consecutive procedures. Plast Reconstr Surg 2000 May;105(6):1956-66. PubMed
- Wang TS Johnson TM Cascade PN Redman BG Sondak VK Schwartz JL. Evaluation of staging chest radiographs and serum lactate dehydrogenase for localized melanoma. J Am Acad Dermatol 2004 Sep;51(3):399-405. PubMed
Type of Evidence supporting the Recommendations
The type of supporting evidence is identified and graded for each recommendation.
Potential Benefits
Appropriate treatment and management of cutaneous melanoma
Potential Harms
- Incisional biopsies that leave at least 50% of the clinical lesion are sometimes inadequate for accurate melanoma staging and upstaging may be required after complete excision of the residual lesion.
- Chest x-ray and blood work-up for various protein markers may have limited value in the initial assessment of asymptomatic patients with primary cutaneous melanoma that is 4 mm or less in thickness. These tests may be associated with a high false-positive rate and initial imaging studies are insensitive and nonspecific for the detection of clinically occult and distant disease.
- Surgical excision can cause functional or cosmetic disfigurement.
- As with any medical procedure there are several possible complications that may arise in association with surgical treatment of melanoma:
- Lymphedema
- Hematoma and/or seroma formation
- Wound infection
- Sensory nerve injury typically transient
- Allergic reactions to isosulfan blue dye
- Edema
Qualifying Statements
- Clinical practice guidelines are strategies for patient management and are developed to assist physicians in clinical decision making. This guideline based on a thorough evaluation of the scientific literature and relevant clinical experience describes a range of generally acceptable approaches to diagnosis management or prevention of specific diseases or conditions. This guideline attempts to define principles of practice that should generally meet the needs of most patients in most circumstances.
- However this guideline should not be construed as a rule nor should it be deemed inclusive of all proper methods of care or exclusive of other methods of care reasonably directed at obtaining the appropriate results. It is anticipated that it will be necessary to approach some patients' needs in different ways. The ultimate judgment regarding the care of a particular patient must be made by the physician in light of all circumstances presented by the patient the available diagnostic and treatment options and other available resources.
- This guideline is not intended to define or serve as the standard of medical care. Standards of medical care are determined on the basis of all facts or circumstances involved in an individual case and are subject to change as scientific knowledge and technology advance and as practice patterns evolve. This guideline reflects the state of knowledge current at the time of publication. Given the inevitable changes in the state of scientific information and technology periodic review updating and revision will be done.
Description of Implementation Strategy
An implementation strategy was not provided.
IOM Care Need
Getting Better
Living with Illness
IOM Domain
Effectiveness
Patient-centeredness
Bibliographic Source(s)
- American Society of Plastic Surgeons. Evidence-based clinical practice guideline: treatment of cutaneous melanoma. Arlington Heights (IL): American Society of Plastic Surgeons; 2007 May. 14 p. [81 references]
Adaptation
Not applicable: The guideline was not adapted from another source.
Source(s) of Funding
American Society of Plastic Surgeons
Guideline Committee
Health Policy Committee of the American Society of Plastic Surgeons
Composition of Group that Authored the Guideline
Not stated
Financial Disclosures/Conflicts of Interest
Not stated
Guideline Status
This is the current release of the guideline.
Guideline Availability
Electronic copies: Available in Portable Document Format (PDF) from the American Society of Plastic Surgeons Web site.
Print copies: Available from the American Society of Plastic Surgeons 444 East Algonquin Road Arlington Heights IL 6005-4664
Availability of Companion Documents
The following is available:
- Description and development of evidence-based practice guidelines. American Society for Plastic Surgeons. Electronic copies: Available from the American Society of Plastic Surgeons Web site.
Print copies: Available from the American Society of Plastic Surgeons 444 East Algonquin Road Arlington Heights IL 6005-4664
Patient Resources
None available
NGC STATUS
This NGC summary was completed by ECRI Institute on October 15 2007. The information was verified by the guideline developer on October 23 2007.
COPYRIGHT STATEMENT
This NGC summary is based on the original guideline which is subject to the guideline developer's copyright restrictions.
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