Melanoma Treatment (PDQ®): Treatment - Health Professional Information [NCI]-Stage II Melanoma Treat
Melanoma Treatment (PDQ®): Treatment - Health Professional Information [NCI]-Stage II Melanoma Treatment
Standard Treatment Options for Stage II Melanoma
Standard treatment options for stage II melanoma include the following:
Stay Safe in the Sun After Skin Cancer
If you've had skin cancer, you don't need to stay indoors and read a book while everyone else is out riding a bike or at a ball game. You do need to be extra careful in the sun, though. "We want to encourage a healthy lifestyle," says Lisa Chipps, MD, director of dermatologic surgery at Harbor-UCLA Medical Center.But once you've had a skin cancer, she says, you're more likely to have another. If you've had a melanoma, the most serious skin cancer, you're nine times more likely to have a new one...
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Excision
For melanomas with a thickness between 2 mm and 4 mm, surgical margins need to be 2 cm to 3 cm or smaller.
Few data are available to guide treatment in patients with melanomas thicker than 4 mm; however, most guidelines recommend margins of 3 cm whenever anatomically possible.
Depending on the location of the melanoma, most patients can have the excision performed on an outpatient basis.
Evidence (excision):
Lymph Node Management
Lymphatic mapping and sentinel lymph node biopsy (SLNB)
Lymphatic mapping and SLNB have been used to assess the presence of occult metastasis in the regional lymph nodes of patients with stage II disease, potentially identifying individuals who may be spared the morbidity of regional lymph node dissections (LNDs) and individuals who may benefit from adjuvant therapy.[3,4,5,6,7]
To ensure accurate identification of the sentinel lymph node (SLN), lymphatic mapping and removal of the SLN should precede wide excision of the primary melanoma.
Standard treatment options for stage II melanoma include the following:
Recommended Related to Melanoma/Skin Cancer
Stay Safe in the Sun After Skin Cancer
If you've had skin cancer, you don't need to stay indoors and read a book while everyone else is out riding a bike or at a ball game. You do need to be extra careful in the sun, though. "We want to encourage a healthy lifestyle," says Lisa Chipps, MD, director of dermatologic surgery at Harbor-UCLA Medical Center.But once you've had a skin cancer, she says, you're more likely to have another. If you've had a melanoma, the most serious skin cancer, you're nine times more likely to have a new one...
Read the Stay Safe in the Sun After Skin Cancer article > >
- Excision with or without lymph node management.
Excision
For melanomas with a thickness between 2 mm and 4 mm, surgical margins need to be 2 cm to 3 cm or smaller.
Few data are available to guide treatment in patients with melanomas thicker than 4 mm; however, most guidelines recommend margins of 3 cm whenever anatomically possible.
Depending on the location of the melanoma, most patients can have the excision performed on an outpatient basis.
Evidence (excision):
- The Intergroup Melanoma Surgical Trial Task 2b compared 2-cm versus 4-cm margins for patients with melanomas that were 1 mm to 4 mm thick.[1]
- With a median follow-up of more than 10 years, no significant difference in local recurrence or survival was observed between the two groups.
- The reduction in margins from 4 cm to 2 cm was associated with the following:
- A statistically significant reduction in the need for skin grafting (from 46% to 11%; P < .001).
- A reduction in the length of the hospital stay.
- A study conducted in the United Kingdom randomly assigned patients with melanomas thicker than 2 mm to undergo excision with either 1-cm or 3-cm margins.[2]
- Patients treated with excision with 1-cm margins had higher rates of local regional recurrence (hazard ratio [HR], 1.26; 95% confidence interval [CI], 1.00-1.59; P = .05).
- No difference in survival was seen (HR, 1.24; 95% CI, 0.96-1.61; P = .1).
- This study suggests that 1-cm margins may not be adequate for patients with melanomas thicker than 2 mm.
Lymph Node Management
Lymphatic mapping and sentinel lymph node biopsy (SLNB)
Lymphatic mapping and SLNB have been used to assess the presence of occult metastasis in the regional lymph nodes of patients with stage II disease, potentially identifying individuals who may be spared the morbidity of regional lymph node dissections (LNDs) and individuals who may benefit from adjuvant therapy.[3,4,5,6,7]
To ensure accurate identification of the sentinel lymph node (SLN), lymphatic mapping and removal of the SLN should precede wide excision of the primary melanoma.