Overview
Malignant melanoma is a common cancer, particularly in South Africa, associated with significant mortality, often affecting individuals at a younger age 2. Early detection is a critical factor in its management, though effective prevention strategies have not yet been conclusively achieved 2.Diagnosis
All suspected melanoma patients must be confirmed histologically and resected 1.
Early detection is primarily based on changes in color, diameter, elevation, border irregularity, asymmetry, or a lesion that differs from other nevi 2.
Clinicians should be trained in the recognition of early melanoma 2.
If there is doubt about a lesion, the patient should be referred for specialist opinion or a biopsy should be undertaken 2.
Sentinel node biopsy is recommended for tumors over 1 mm or for smaller tumors with high-risk factors 1.
Individuals at high risk of melanoma should be offered a surveillance program 2.Management
Adjuvant therapy with interferon may be offered for patients with high-risk melanoma, and radiotherapy can be added in selected cases 1.
Treatment for metastatic melanoma is guided by BRAF mutational status 1.
For BRAF wild-type metastatic melanoma, anti-PD1 containing therapy is recommended 1.
For BRAF mutated metastatic melanoma, BRAF/MEK inhibitors or anti-PD1 containing therapy are options 1.
Follow-up for melanoma patients should include dermatologic and physical examinations for up to 10 years 1.Key Recommendations
All suspected melanoma patients must be confirmed histologically and resected 1. (Evidence: Strong)
Sentinel node biopsy must be performed for tumors over 1 mm or for smaller tumors with high-risk factors 1. (Evidence: Strong)
Treatment for metastatic melanoma is guided by BRAF mutational status; BRAF wild-type patients must receive anti-PD1 containing therapy, while BRAF mutated patients should receive BRAF/MEK inhibitors or anti-PD1 containing therapy 1. (Evidence: Strong)
Melanoma patients should undergo dermatologic and physical examinations for follow-up for up to 10 years 1. (Evidence: Moderate)
Clinicians should be trained in the recognition of early melanoma, and high-risk individuals should be offered a surveillance program 2. (Evidence: Expert opinion)References
1 Berrocal A, Arance A, Castellon VE, de la Cruz L, Espinosa E, Cao MG et al.. SEOM clinical guideline for the management of malignant melanoma (2017). Clinical & translational oncology : official publication of the Federation of Spanish Oncology Societies and of the National Cancer Institute of Mexico 2018. link
2 Whitaker DK, Sinclair W. Guideline on the management of melanoma. South African medical journal = Suid-Afrikaanse tydskrif vir geneeskunde 2004. link