More than 1 million Americans are living with melanoma, the deadliest form of skin cancer, and one person dies of the disease every hour. Fortunately, melanoma is highly treatable when detected early. As National Healthy Skin Month begins, the American Academy of Dermatology has released new guidelines to help doctors provide the best possible treatment for melanoma patients.
The AAD’s “Guidelines of care for the management of primary cutaneous melanoma,” published online this week in the Journal of the American Academy of Dermatology, outline best practices for treatment of the disease. Developed by a work group composed of dermatologists, oncologists and other experts in the field, the guidelines are based on the latest available evidence; new areas addressed include melanoma in pregnancy and genetic testing for hereditary risk.
“Melanoma is the deadliest form of skin cancer, and we hope these guidelines will help dermatologists and other physicians enhance their delivery of life-saving treatment to patients,” says board-certified dermatologist Susan M. Swetter, MD, FAAD, chair of the work group that developed the guidelines. “In order to provide the best possible resource for practitioners, we reviewed the latest scientific data and addressed certain topics that weren’t covered in the AAD’s previous melanoma guidelines.”
According to the new guidelines, evidence is lacking that pregnancy increases a woman’s risk of developing melanoma or affects the prognosis of the disease. The guidelines indicate that any decisions regarding the management of melanoma in pregnant women should be based on patient health and disease stage, while counseling on future pregnancies should be based on the individual’s history and melanoma risk.
The guidelines also recommend that patients with a family history of melanoma receive education and counseling in genetic risk. According to the guidelines, formal genetic testing may not be appropriate and should be considered on an individual basis after the counseling discussion.
“The guidelines development process included patient advocate and community dermatologist input, and the resulting document emphasizes the importance of the doctor-patient dialogue in all aspects of melanoma management,” says board-certified dermatologist Hensin Tsao, MD, PhD, FAAD, co-chair of the guidelines work group. “Every case is unique, so physicians should work with their patients, and other specialists if necessary, to explain the available options and determine the best possible treatment plan for each patient.”
According to the guidelines, surgical excision remains the gold standard of melanoma treatment, while Mohs surgery or other forms of staged excision may be considered for certain subtypes of melanoma on some parts of the body. Although topical therapy or traditional radiation may be considered as second-line therapy in limited cases when surgery is not possible, the guidelines do not recommend electronic brachytherapy for melanoma treatment due to a lack of scientific evidence.
When melanoma is detected in an early stage and treated before it spreads to the lymph nodes, the five-year survival rate is 99 percent, while patients with more advanced disease have lower survival rates. To facilitate early detection, the AAD encourages the public to conduct regular self-exams to look for signs of skin cancer and see a board-certified dermatologist if they notice any new or suspicious spots on their skin. The ABCDEs of melanoma highlight warning signs of the disease:
- Asymmetry: One half of a spot is unlike the other half.
- Border: A spot has an irregular, scalloped or poorly defined border.
- Color: A spot has varying colors from one area to the next, such as shades of tan, brown or black, or areas of white, red or blue.
- Diameter: While melanomas are usually greater than 6 millimeters — or about the size of a pencil eraser — when diagnosed, they can be smaller.
- Evolving: A spot looks different from the rest or is changing in size, shape or color.
“If you notice any new spots on your skin, any spots that look different from the rest, or any spots that are changing, itching or bleeding, see a board-certified dermatologist,” says AAD President Suzanne M. Olbricht, MD, FAAD. “Dermatologists have the expertise to accurately diagnose melanoma and provide patients with the highest-quality care.”