The Therapeutic Approach for Malignant Melanoma: Case 1

Source: Targeted Oncology, May 2017

Michael A. Davies, MD, PhD: So, one of the questions we often get asked is about the appropriate diagnostic and staging workup for patients who present with primary melanoma. For patients who present with a primary melanoma that is at least 1-mm thick without clinical evidence of lymph node involvement, we generally recommend that patients undergo a sentinel lymph node biopsy to determine if there is microscopic lymph node involvement. We also consider sentinel lymph node biopsy for patients with thinner primary melanomas, but with high-risk features, such as the evidence of tumor ulceration. For patients who undergo a sentinel lymph node biopsy that does confirm metastatic involvement to the lymph nodes, we often recommend complete lymph node dissection, as it can actually be very informative, in terms of the patient’s subsequent risk, to know if other lymph nodes are involved. Notably, it’s unclear at this point if the completion lymph node dissection actually has therapeutic benefit for patients, and hopefully, we’ll have data in the near future in those regards.

For patients who have lymph node involvement, it is routine for us to evaluate whether the patient has evidence of distant metastatic disease with imaging of the body, either by CAT scans of the chest, abdomen, and pelvis or potentially by PET/CT, particularly for patients who aren’t amenable to IV contrast studies. In addition, melanoma is a disease that has high risk of metastasis to the brain, and therefore, we usually include an initial baseline MRI of the brain in the evaluation of any new patient with regional involvement.

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