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New Melanoma Guidelines Identify Recommended Treatments, Weigh In on Genetic Testing

Laura Joszt
New guidelines released by the American Academy of Dermatology will help physicians provide the best treatment for more than 1 million Americans living with melanoma, the deadliest form of skin cancer. The guidelines also highlight the importance of discussions between physicians and patients.
New guidelines released by the American Academy of Dermatology (AAD) will help physicians provide the best treatment for more than 1 million Americans living with melanoma, the deadliest form of skin cancer. The guidelines were published Thursday, November 1, in Journal of the American Academy of Dermatology.

“Guidelines of care for the management of primary cutaneous melanoma” outline best practices for treating the disease and was developed by a work group of dermatologists, oncologists, and other experts.

“Melanoma is the deadliest form of skin cancer, and we hope these guidelines will help dermatologists and other physicians enhance their delivery of life-saving treatment to patients,” board-certified dermatologist Susan M. Swetter, MD, FAAD, chair of the work group that developed the guidelines, said in a statement. “In order to provide the best possible resource for practitioners, we reviewed the latest scientific data and addressed certain topics that weren’t covered in the AAD’s previous melanoma guidelines.”

While melanoma is the deadliest skin cancer, current treatments are curative if the disease is detected early enough. The 5-year survival rate is 99% if melanoma is detected early and treated before it spreads to the lymph nodes.

The guidelines review biopsy techniques for lesions suggestive of melanoma; histopathologic interpretation of cutaneous melanoma; use of laboratory, molecular, and imaging, as well as follow-up for asymptomatic patients; treatment recommendations, including surgical and nonsurgical options; and the latest data regarding pregnancy and melanoma, genetic testing, and management of toxicities related to novel targeted agents and immunotherapies.

According to the guidelines, patients with a family history of melanoma should receive education and counseling regarding their genetic risk, but formal genetic testing may not always be appropriate. The guidelines recommend that genetic testing be considered on an individual basis after counseling.

The guidelines identify surgical excision as the gold standard of treatment but noted that Mohs surgery or other forms of staged excision may be considered for certain subtypes. Topical therapy or traditional radiation may be considered as second-line therapy in cases in which surgery is not possible. However, because of a lack of evidence, the guidelines do not recommend electronic brachytherapy.

“The guidelines development process included patient advocate and community dermatologist input, and the resulting document emphasizes the importance of the doctor–patient dialogue in all aspects of melanoma management,” said board-certified dermatologist Hensin Tsao, MD, PhD, FAAD, cochair of the guidelines work group. “Every case is unique, so physicians should work with their patients, and other specialists if necessary, to explain the available options and determine the best possible treatment plan for each patient.”

Reference

Swetter SM, Tsao H, Bichakjian CK, et al. Guidelines of care for the management of primary cutaneous melanoma. [published online November 1, 2018]. J Am Acad Dermatol. doi: 10.1016/j.jaad.2018.08.055.

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