Recommendations

Document Overview

Design and created by Guideline Central in participation with the American Academy of Dermatology.

Management of Primary Cutaneous Melanoma

American Academy of Dermatology

Publication Date: Nov 1, 2018

Page Last Updated: May 5, 2026

American Society of Plastic Surgeons 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 preferences.
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 vs. harm; patient preference should have a substantial influencing role.

Document Overview

Document Title: Management of Primary Cutaneous Melanoma

Authoring Society: American Academy of Dermatology

Document Publication Date: Nov 1, 2018

Page Last Reviewed/Updated: May 5, 2026

Document Type: Guideline

Country of Publication: United States

Full Text Freely Available: Yes

Full Text Guideline: www.jaad.org/article/S0190-9622(18)32588-X/fulltext

Source Citation: DOI:https://doi.org/10.1016/j.jaad.2018.08.055

Document Scope, Criteria, and Use Cases

Document Objectives: This guideline addresses the treatment of pediatric, adolescent, and adult patients with American Joint Committee on Cancer (AJCC) clinical stages 0 to IIC primary cutaneous melanoma (CM), including melanomas arising from the nail unit, who may also have histologic evidence of regional nodal disease at presentation via sentinel lymph node biopsy (SLNB), from the perspective of the US dermatologist and other practitioners who treat melanoma.

Scope: Management, Treatment

Diseases/Conditions (MeSH)

D008545 - Melanoma

D013518 - Surgery, Plastic

D007167 - Immunotherapy

D005820 - Genetic Testing

D010336 - Pathology

D008545 - Melanoma

D013518 - Surgery, Plastic

D007167 - Immunotherapy

D005820 - Genetic Testing

D010336 - Pathology

Keywords: biopsy, cutaneous melanoma, melanoma

Target Patient Population: Patients with cutaneous melanoma

Inclusion Criteria: Male, Female, Adolescent, Adult, Child

Health Care Settings: Ambulatory, Outpatient

Intended Users: Nurse, Nurse Practitioner, Physician, Physician Assistant

Recommendation Development Processes & Methodology

Number of Source Documents: 335

Literature Search Start Date: Friday, January 1, 2010

Literature Search End Date: Sunday, April 30, 2017

Methodologist involvement?: Yes

Includes multi-disciplinary group?: Yes

Grades quality of strength of evidence?: Yes

Grades quality of strength of recommendation?: Yes

Discloses funding source?: No

Discloses conflicts of interest?: Yes

Includes benefits/harms analysis with recommendations?: Yes

Recommended clinical information to be provided to the pathologist
Essential	Strongly recommended	Optional
Age of patient	Biopsy intent (excisional/complete vs partial/incomplete) and technique (elliptical, punch shave/saucerization)	Clinical description/level of suspicion for melanoma/prior change or biopsy (if applicable)
Sex	Size of lesion	Dermoscopic features (with or without photograph)
Anatomic location (including laterality)	Clinical impression/differential diagnosis Macroscopic satellites Clinical photograph (if possible)

Recommended histologic features of primary cutaneous melanoma for inclusion in the pathology report
Essential	Optional
Size of specimen	Gross description of lesion
Tumor thickness (Breslow), nearest 0.1 mm	Angiolymphatic invasion/lymphovascular invasion
Ulceration	Histologic subtype
Dermal mitotic rate; ‘‘hotspot’’ method; No. of mitoses/mm2	Neurotropism/perineural invasion
Peripheral and deep margin status (negative/positive [broad vs. focal transection at deep margin])	Regression
Microsatellitosis	Tumor category for staging Tumor-infiltrating lymphocytes Anatomic level of invasion (Clark level) Vertical growth phase

Management of Primary Cutaneous Melanoma

Recommendations

Diagnostic biopsy of suspected melanoma

Clinical information to be provided to the pathologist

Pathology report

Diagnostic, prognostic, and therapeutic molecular testing

Surgical management of primary cutaneous melanoma

Sentinel lymph node biopsy

SLNB

Discussion of SLNB risks vs. benefits with patients

Baseline and surveillance studies and follow-up

NONSURGICAL MANAGEMENT OF MIS, LM TYPE

Imiquimod or RT

PREGNANCY AND MELANOMA

Management of CM and pregnancy

GENETIC COUNSELING FOR PATIENTS WITH FAMILIAL MELANOMA AND MULTIGENE TESTING

Genetic counseling of patients with CM

Dermatologic toxicities of newer drugs for advanced CM (AJCC stages III and IV)

American Society of Plastic Surgeons Scale for Grading Recommendations

Document Overview

Document Scope, Criteria, and Use Cases

Recommendation Development Processes & Methodology