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Melanoma Treatment (PDQ®): Treatment - Health Professional Information [NCI] - Stage I Melanoma

Stage I melanoma is defined by the American Joint Committee on Cancer's TNM classification system:[1]

  • T1a, N0, M0
  • T1b, N0, M0
  • T2a, N0, M0

Standard Treatment Options for Patients With Stage I Melanoma

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Melanoma/Skin Cancer Clinical Trials

Major pharmaceutical companies continually research and develop new melanoma/skin cancer drugs and treatments, which must be shown to be safe and effective before doctors can prescribe them to patients. Through clinical trials, researchers test the effects of new medications on a group of volunteers with melanoma/skin cancer. Following a strict protocol and using carefully controlled conditions, researchers evaluate the investigational drugs under development and measure the ability of the new drug...

Read the Melanoma/Skin Cancer Clinical Trials article > >

  • Current evidence suggests that lesions 2 mm or less in thickness may be treated conservatively with radial excision margins of 1 cm. A randomized trial compared narrow margins (1 cm) with wide margins (at least 3 cm) in patients with melanomas no thicker than 2 mm.[2,3] No difference was observed between the two groups in respect to the development of metastatic disease, disease-free survival (DFS), or overall survival (OS). Two other randomized trials compared 2 cm margins with wider margins (i.e., 4 cm or 5 cm) and found no statistically significant difference in local recurrence, distant metastasis, or OS with a median follow-up of 10 years or more for both trials.[4,5,6][Level of evidence:1iiA] In the Intergroup Melanoma Surgical Trial, the reduction in margins from 4 cm to 2 cm was associated with a statistically significant reduction in the need for skin grafting (46% to 11%, P < .001) and a reduction in the length of the hospital stay.[6] Depending on the location of the melanoma, most patients can now have this procedure performed on an outpatient basis.

    Elective regional lymph node dissection is of no proven benefit for patients with stage I melanoma. Lymphatic mapping and sentinel lymph node (SNL) biopsy for patients who have tumors of intermediate thickness and/or ulcerated tumors, however, may allow the identification of individuals with occult nodal disease who might benefit from regional lymphadenectomy and adjuvant therapy.[7,8,9,10]

    The International Multicenter Selective Lymphadenectomy Trial (MSLT-1 [JWCI-MORD-MSLT-1193]) included 1,269 patients with intermediate-thickness (defined as 1.2 mm–3.5 mm in this study) primary melanomas.[11] There was no melanoma-specific survival advantage (the primary endpoint) for those patients randomly assigned to wide excision plus SLN biopsy followed by immediate complete lymphadenectomy for node positivity versus patients randomly assigned to nodal observation and delayed lymphadenectomy for subsequent nodal recurrence at a median of 59.8 months.[11][Level of evidence: 1iiB]

    This trial was not designed to detect a difference in the impact of lymphadenectomy in patients with microscopic lymph node involvement.[11]

Treatment Options Under Clinical Evaluation for Patients With Stage I Melanoma

  • Because of the higher rate of treatment failure in the subset of clinical stage I patients with occult nodal disease, clinical trials are evaluating new techniques to detect submicroscopic SLN metastasis to identify those patients who may benefit from regional lymphadenectomy with or without adjuvant therapy. One of the objectives of the phase III Sunbelt Melanoma Trial (UAB-9735) was to determine the effects of lymphadenectomy with or without adjuvant high-dose interferon-alpha-2b versus observation on DFS and OS in patients with submicroscopic SLN metastasis detected only by the polymerase chain reaction (PCR) (i.e., SLN negative by histology and immunohistochemistry). No survival data have been reported from this study. An ongoing diagnostic study (UCCRC-9308) tested the combination of reverse transcription and PCR in the detection of melanoma tumor antigen transcripts in lymph nodes and peripheral blood samples.

WebMD Public Information from the National Cancer Institute

Last Updated: February 25, 2014
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