New Guidelines for Treating Melanoma

By Jane Farrell

Melanoma may seem less scary than other cancers (breast, ovarian) that we read about, but this deadliest form of skin cancer kills one person every hour.

The good news is that melanoma is highly treatable. As with any illness, guidelines for treatment can change as researchers learn more about the disease. The American Academy of Dermatology (AAD) has released new guidelines to help doctors provide the best possible treatment for melanoma patients.

The AAD’s “Guidelines of Care for The Management of Primary Cutaneous <elanoma,” published online in November 2018 in the Journal of the American Academy of Dermatolo experts in the field, the guidelines are based on the latest available evidence.

“Every case is unique,so physicians should work with their patients to explain the available options.”

“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,” said board-certified dermatologist Susan M. Swetter, MD, FAAD, chair of the work group that developed the guidelines.

According to the new guidelines, which address the issue of pregnancy and melanoma, a subject that the AAD hadn’t covered before, evidence is lacking that pregnancy increases a woman’s risk of developing melanoma or affects the prognosis of the disease. Any decisions about the management of melanoma in pregnant women, the guidelines say, should be based on the health of the patient and the stage of the disease.

The guidelines also recommend that patients with a family history of melanoma receive education and counseling in genetic risk. However, the guidelines caution, formal genetic testing may not be appropriate and should be considered after the counseling discussion between the doctor and the patient.

“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, co-chair 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.”

According to the AAD guidelines, surgical excision remains the best technique for melanoma treatment, while Mohs surgery or other forms of staged excision may be considered for certain melanoma subtypes. (See our story, “Skin Cancer: When Mohs Surgery Is The Best Treatment.”)Although topical therapy or traditional radiation may be considered as second-line therapy in limited cases when surgery isn’t possible, the guidelines don’t recommend electronic brachytherapy (a treatment that uses radioactive rods) because there isn’t enough scientific evidence on its safety and usefulness.

When melanoma is detected in an early stage and treated before it spreads to the lymph nodes, the five-year survival rate is 99 percent, while patients with more advanced disease have lower survival rates. To make early detection more common, the AAD encourages the public to conduct regular self-exams to look for signs of skin cancer and see a board-certified dermatologist if they notice any new or suspicious spots on their skin. The ABCDEs of melanoma highlight warning signs of the disease:

Asymmetry: One half of a spot is unlike the other half.

Border: A spot has an irregular, scalloped or poorly defined border.

Color: A spot has varying colors from one area to the next, such as shades of tan, brown or black, or areas of white, red or blue.

Diameter: While melanomas are usually greater than 6 millimeters — or about the size of a pencil eraser — when diagnosed, they can be smaller.

Evolving: A spot looks different from the rest or is changing in size, shape or color.

“If you notice any new spots on your skin, any spots that look different from the rest, or any spots that are changing, itching or bleeding, see a board-certified dermatologist,” said AAD President Suzanne M. Olbricht, MD, FAAD. “Dermatologists have the expertise to accurately diagnose melanoma and provide patients with the highest-quality care.”

To find a board-certified dermatologist near you, click here. For more information on melanoma, click here.