The European Society for Medical Oncology (ESMO) has issued updated guidance on the management of cutaneous melamona. Key recommendations include the following:
Mandatory mutation testing for actionable mutations for resectable or unresectable stage III or IV and high-risk resected stage IIC (not stage I or IIA-IIB).
Excision safety margin
- 0.5 cm for in situ melanomas
- 1 cm for tumours
- 2 cm for ≥2 mm
Treatment of locoregional disease
- Complete lymph node dissection (CLND) not recommended for sentinel lymph node (SN)-positive patients.
- CLND indicated for isolated locoregional clinically-detectable lymph node (LN) metastases.
- Adjuvant radiotherapy for local tumours with inadequate margins of lentigo maligna melanoma (LMM), for microscopic tumour at the margin (R1), or after resection of bulky disease.
- Anti-programmed cell death 1 antibodies (PD1) adjuvant therapy or dabrafenib/trametinib are preferred.
Treatment of advanced disease (unresectable stage III and IV)
- Surgical removal or stereotactic irradiation of locoregional recurrence or single distant metastasis.
- First- and second-line treatments include anti-PD1 antibodies, PD-1 and ipilimumab, and BRAFi/MEKi combination for BRAF-mutated melanoma.
- For brain metastases, ipilimumab/nivolumab is preferred first-line treatment.
- For patients failing systemic treatment with 3 cm, stereotactic radiosurgery could be considered as salvage therapy if >5-10 progressing lesions with a maximal size >3 cm are present.