Melanoma Diagnosis and Management

Introduction to Melanoma

The American Joint Committee on Cancer (AJCC) recommends that the histopathological report should include specific obligatory information, such as the maximum thickness in millimeters (Breslow method), mitotic index in cases of tumor thickness <1mm, presence of ulceration, presence and extent of regression, and clearance of surgical margins 1, 2, 7

The European incidence of malignant melanoma varies from 3-5/100,000/year in Mediterranean countries to 12-25/100,000/year (and increasing) in Nordic countries, with a crude incidence rate in the European Union of 10/100,000 per year 2, 1, 4
The American Academy of Dermatology recommends that individuals with a history of melanoma, or those with a family history of melanoma, should undergo regular skin examinations by a dermatologist 3

The National Comprehensive Cancer Network (NCCN) recommends that the diagnosis of melanoma should be based on excisional biopsy of the entire lesion with a minimal lateral margin, and that the histopathological report should follow the AJCC classification and include specific obligatory information 2, 1, 5
The American Academy of Dermatology recommends that dermatoscopy should be used by experienced clinicians to improve diagnostic accuracy beyond clinical examination alone 2, 1, 5

The AJCC recommends that the staging of melanoma should be based on the thickness of the tumor, the presence of ulceration, the mitotic index, and the presence of metastasis, and that the prognosis should be estimated based on these factors 2, 1, 4

The National Comprehensive Cancer Network (NCCN) recommends that the treatment of melanoma should be based on the stage of the disease, and that surgical excision with a margin of at least 1 cm should be performed for tumors with a thickness of 1-2 mm, and a margin of at least 2 cm for thicker tumors 4
The American Society of Clinical Oncology (ASCO) recommends that adjuvant therapy with high-dose interferon should be considered for patients with high-risk melanoma, but that the benefits and risks should be carefully weighed 4

The American Academy of Dermatology recommends that individuals should protect themselves from the sun by using sunscreen, wearing protective clothing, and seeking shade, especially during peak sun hours 2, 1, 3
The US Preventive Services Task Force (USPSTF) recommends that adults should undergo regular skin examinations by a clinician to detect skin cancer, including melanoma, early 9