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. 2016 Aug:63:201-17.
doi: 10.1016/j.ejca.2016.05.005. Epub 2016 Jun 29.

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

Claus Garbe  1 , Ketty Peris  2 , Axel Hauschild  3 , Philippe Saiag  4 , Mark Middleton  5 , Lars Bastholt  6 , Jean-Jacques Grob  7 , Josep Malvehy  8 , Julia Newton-Bishop  9 , Alexander J Stratigos  10 , Hubert Pehamberger  11 , Alexander M Eggermont  12 ; European Dermatology Forum (EDF); European Association of Dermato-Oncology (EADO); European Organisation for Research and Treatment of Cancer (EORTC)
Affiliations

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

Claus Garbe et al. Eur J Cancer. 2016 Aug.

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').

Keywords: Adjuvant treatment; Cutaneous melanoma; Excisional margins; Interferon-α; Metastasectomy; Sentinel lymph node dissection; Systemic treatment; Tumour thickness.

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