Overview
Superficial spreading melanoma is a subtype of cutaneous melanoma characterized by radial growth along the epidermis and superficial dermis 1. Metastatic superficial spreading melanoma implies the cancer has spread beyond the primary site to regional lymph nodes or distant organs 1.Diagnosis
Diagnosis is based on histopathological examination of a biopsy specimen, assessing features such as tumor thickness (Breslow depth), ulceration, mitotic rate, and presence of regression 1.
Staging workup typically includes sentinel lymph node biopsy for clinically node-negative patients with intermediate-thickness melanomas 1.
Further staging may involve imaging studies like CT, PET-CT, or MRI depending on clinical suspicion for distant metastasis 1.Management
For unresectable or metastatic melanoma, systemic therapy is indicated 1.
Neoadjuvant systemic therapy options include immune checkpoint inhibitors (e.g., anti-PD-1, anti-CTLA-4) and targeted therapies (e.g., BRAF/MEK inhibitors) for patients with resectable stage III/IV disease 1.
Adjuvant therapy options for resected stage IIB-IV melanoma include immune checkpoint inhibitors (e.g., nivolumab, pembrolizumab) and targeted therapies (e.g., dabrafenib plus trametinib) 1.
Specific treatment decisions are guided by the presence of BRAF mutations and the extent of disease 1.Key Recommendations
Consider neoadjuvant systemic therapy for patients with resectable stage III or IV melanoma to potentially downstage disease and improve surgical outcomes 1. (Evidence: Moderate)
Adjuvant therapy with immune checkpoint inhibitors or targeted therapy should be considered for patients with resected stage IIB-IV melanoma to reduce the risk of recurrence 1. (Evidence: Strong)
Sentinel lymph node biopsy is recommended for staging clinically node-negative patients with melanomas of intermediate thickness (e.g., >0.8 mm to 1.0 mm) 1. (Evidence: Moderate)References
1 Swetter SM, Johnson D, Albertini MR, Barker CA, Bateni S, Baumgartner J et al.. NCCN Guidelines® Insights: Melanoma: Cutaneous, Version 2.2024. Journal of the National Comprehensive Cancer Network : JNCCN 2024. link