AAD Releases New Melanoma Guidelines

The American Academy of Dermatology (AAD) has issued new guidelines of care for the management of primary cutaneous melanoma.

Arriving just in time for National Healthy Skin Month, the guidelines are based on a review of the most recent evidence for melanoma care and treatment. The review was conducted by a work group of dermatologists, oncologists and related experts.

In their recommendations, the AAD reaffirms surgical excision as the gold standard of treatment for melanoma. Certain subtypes of melanoma on some parts of the body may warrant consideration for other options including Mohs surgery or other forms of staged excision.

Topical therapy or traditional radiation may be considered as second-line therapy in some cases when surgery is not an option, the AAD noted. However, the group does not recommend electronic brachytherapy for the treatment melanoma, citing a lack of evidence of its benefits.

New areas addressed in the guidelines included melanoma in pregnancy and genetic testing for hereditary melanoma risk. In their guidelines, the AAD states: 

• There is currently not enough evidence to determine whether pregnancy is associated with an elevated risk of melanoma or whether pregnancy affects disease prognosis.

• Treatment decisions for pregnant women with melanoma should be based on patient health and disease stage. In addition, individual history and melanoma risk should serve as the basis for any counseling on future pregnancies.

• Individuals with a family history of melanoma should be educated and counseled on their genetic risk. However, formal genetic testing may not always be appropriate, and clinicians should consider it on an individual basis after counseling patients.

“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,” said board-certified dermatologist Hensin Tsao, MD, PhD, FAAD, co-chair of the guidelines work group, in a press release.¹

The AAD noted that, when melanoma is detected early and treated before it spreads to lymph nodes, patients have a 5-year survival rate of 99%. Survival rates are lower among patients with more advanced disease.

—Christina Vogt

Reference:

1. American Academy of Dermatology releases guidelines for melanoma treatment [press release]. Rosemont, IL. American Academy of Dermatology. November 1, 2018. Accessed on November 1, 2018.