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Malignant Melanoma: Diagnostic and Management Update

Knackstedt, Thomas, M.D.; Knackstedt, Rebecca W., M.D., Ph.D.; Couto, Rafael, M.D.; Gastman, Brian, M.D.

Plastic and Reconstructive Surgery: August 2018 - Volume 142 - Issue 2 - p 202e–216e
doi: 10.1097/PRS.0000000000004571
CME
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Learning Objectives: After studying this article, the participant should be able to: 1. Summarize the changes to the American Joint Committee on Cancer Eighth Edition Melanoma Staging System. 2. List advances in genetic, molecular, and histopathologic melanoma diagnosis and prognostication. 3. Recommend sentinel lymph node biopsy and appropriate surgical margins based on individualized patient needs. 4. Recognize the currently available treatments for in-transit metastasis and advanced melanoma. 5. Describe current and future therapies for melanoma with distant visceral or brain metastases.

Summary: Strides in melanoma surveillance, detection, and treatment continue to be made. The American Joint Committee on Cancer Eighth Edition Cancer Staging System has improved risk stratification of patients, introduced new staging categories, and resulted in stage migration of patients with improved outcomes. This review summarizes melanoma advances of the recent years with an emphasis on the surgical advances, including techniques and utility of sentinel node biopsy, controversies in melanoma margin selection, and the survival impact of time-to-treatment metrics. Once a disease manageable only with surgery, a therapeutic paradigm shift has given a more promising outlook to melanoma patients at any stage. Indeed, a myriad of novel, survival-improving immunotherapies have been introduced for metastatic melanoma and more recently in the high-risk adjuvant setting.

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Cleveland, Ohio

From the Departments of Plastic Surgery and Dermatology, Cleveland Clinic Foundation.

Received for publication December 22, 2017; accepted March 19, 2018.

Disclosure: The authors have no financial interest in relation to the content of this article. There were no sources of funding.

Related Video content is available for this article. The videos can be found under the “Related Videos” section of the full-text article, or, for Ovid users, using the URL citations published in the article.

Brian R. Gastman, M.D., Cleveland Clinic, 9500 Euclid Avenue, Cleveland, Ohio 44195, gastmab@ccf.org

©2018American Society of Plastic Surgeons