European consensus-based interdisciplinary guideline for melanoma. Part 2: Treatment - Update 2019

Eur J Cancer. 2020 Feb;126:159-177. doi: 10.1016/j.ejca.2019.11.015. Epub 2019 Dec 19.

Abstract

A unique collaboration of multidisciplinary experts from the European Dermatology Forum, the European Association of Dermato-Oncology and the European Organization for Research and Treatment of Cancer (EORTC) was formed to make recommendations on cutaneous melanoma diagnosis and treatment, based on systematic literature reviews and the experts' experience. Cutaneous melanomas are excised with 1- to 2-cm safety margins. Sentinel lymph node dissection shall be performed as a staging procedure in patients with tumour thickness ≥1.0 mm or ≥0.8 mm with additional histological risk factors, although there is as yet no clear survival benefit for this approach. Therapeutic decisions in stage III/IV patients should be primarily made by an interdisciplinary oncology team ("Tumor Board"). Adjuvant therapies in stage III/IV patients are primarily anti-PD-1, independent of mutational status, or dabrafenib plus trametinib for BRAF-mutant patients. In distant metastasis, either resected or not, systemic treatment is indicated. For first-line treatment, particularly in BRAF wild-type patients, immunotherapy with PD-1 antibodies alone or in combination with CTLA-4 antibodies shall be considered. In particular scenarios for patients with stage IV melanoma and a BRAF-V600 E/K mutation, first-line therapy with BRAF/MEK inhibitors can be offered as an alternative to immunotherapy. In patients with primary resistance to immunotherapy and harbouring a BRAF-V600 E/K mutation, this therapy shall be offered in second-line. Systemic therapy in stage III/IV melanoma is a rapidly changing landscape, and it is likely that these recommendations may change in the near future.

Keywords: Adjuvant treatment; Cutaneous melanoma; Excisional margins; Interferon-α; Metastasectomy; Sentinel lymph node dissection; Systemic treatment; Tumour thickness.

MeSH terms

  • Combined Modality Therapy
  • Consensus
  • Diagnostic Imaging / standards*
  • European Union
  • Humans
  • Interdisciplinary Communication*
  • Melanoma / classification
  • Melanoma / diagnosis*
  • Melanoma / therapy*
  • Neoplasm Staging
  • Practice Guidelines as Topic / standards*