Overview
Neurotropic malignant melanoma is a subtype of melanoma characterized by invasion of the nervous system. This can manifest as perineural invasion on histology or clinically as neurological symptoms.Diagnosis
Histopathological examination for perineural invasion is a key diagnostic feature.Management
For distant metastases (stage IV), systemic treatment is always indicated 1.
First-line treatment for stage IV melanoma, particularly in BRAF wild-type patients, should consider PD-1 antibodies alone or in combination with CTLA-4 antibodies 1.
In stage IV melanoma with a BRAF-V600 E/K mutation, BRAF/MEK inhibitors can be offered as a first-line alternative to immunotherapy 1.
Adjuvant therapies can be proposed in stage III and completely resected stage IV patients, primarily anti-PD-1, independent of mutational status, or alternatively dabrafenib plus trametinib for BRAF mutant patients 1.
Therapeutic decisions for stage III/IV patients should be made by an interdisciplinary oncology team 1.Key Recommendations
Systemic treatment is always indicated for distant metastases (stage IV melanoma) 1. (Evidence: Strong)
For first-line treatment of stage IV melanoma, particularly in BRAF wild-type patients, consider immunotherapy with PD-1 antibodies alone or in combination with CTLA-4 antibodies 1. (Evidence: Strong)
In stage IV melanoma with a BRAF-V600 E/K mutation, BRAF/MEK inhibitors can be offered as a first-line alternative to immunotherapy 1. (Evidence: Moderate)
Adjuvant therapies, primarily anti-PD-1 or dabrafenib plus trametinib for BRAF mutant patients, can be proposed in stage III and completely resected stage IV patients 1. (Evidence: Moderate)
Therapeutic decisions in stage III/IV patients should be primarily made by an interdisciplinary oncology team 1. (Evidence: Expert opinion)References
1 Garbe C, Amaral T, Peris K, Hauschild A, Arenberger P, Basset-Seguin N et al.. European consensus-based interdisciplinary guideline for melanoma. Part 2: Treatment - Update 2022. European journal of cancer (Oxford, England : 1990) 2022. link