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Maximizing Melanoma Management

Cutaneous Melanoma: Contemporary 2020 Management Pearls

On-Demand Session

Cecelia E. Schmalbach, MD, MSc

“This year in 2020, it’s expected that in our country we will see over 100,000 new cases of invasive melanoma diagnosed,” said Cecelia E. Schmalbach, MD, MSc, of Temple University in Philadelphia, Pennsylvania. “If you look at the diagnosis, treatment, and follow-up for all of our skin cancers in the United States, it’s projected to cost over $3 billion.”

While there’s been a slight downward trend in mortality since 2018, the statistics are still staggering.

“Melanoma is second to adult leukemia in lost potential life years,” said Dr. Schmalbach. “Many will argue that melanoma and skin cancer are an epidemic, and it’s a public health issue that we’re actively trying to address.”

This Expert Lecture, which was presented Monday, September 14, but is now available on demand provides virtual attendees with pearls for managing cutaneous melanoma. A few highlights include:

  1. Know the American Cancer Society’s ABCDEs for recognizing melanoma.
  • A- Asymmetry
  • B- Border irregularity
  • C- Color variation
  • D- Diameter > 6 mm
  • E- Evolution of change
  1. Make a wide local excision.

“Essentially, the deeper the invasion of the melanoma, the wider your incision needs to be,” said Dr. Schmalbach. Recommended margins are as follows based on tumor thickness:

  • In Situ: 0.5-1 cm excision margin
  • Up to 1 mm: 1.0 cm excision margin
  • 01-2 mm: 1-2 cm
  • 01-4 mm: 2 cm
  • Greater than 4 mm: 2 cm
  1. Consider a Sentinel Lymph Node Biopsy (SLNB).

A SNLB is minimally invasive, can identify patients harboring occult nodal disease, and spares 80% of patients without regional disease the morbidity of a neck dissection and parotidectomy.

  1. For patients with Stage III/IV disease, consider systemic therapy.

Although systemic therapy is a highly individualized decision based on a patient’s goals and performance, you may consider PD-1 inhibitors with or without ipilimumab in an effort to combat the melanoma. BRAF inhibition is recommended for patients with mutation requiring a rapid response.

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