Multidisciplinary Care of BRAF-Mutant Stage III Melanoma: A Physicians Perspective Review

Abstract

Prognosis among patients with stage III melanoma can vary widely depending on the risk of disease relapse. Therefore, it is vital to optimize patient care through accurate diagnosis and staging as well as thoughtful treatment planning. A multidisciplinary team (MDT) approach, which involves active collaboration among physician specialists across a patient's disease journey, has been increasingly adopted as the standard of care for treatment of a variety of cancers, including melanoma. This review provides an overview of MDT care principles for patients with BRAF-mutant-positive, stage III cutaneous melanoma and summarizes current literature, clinical experiences, and institutional best practices. Therapeutic goals from dermatologic, surgical, and medical oncologist perspectives regarding MDT care throughout a patient's disease course are discussed. Additionally, the role of each specialty's involvement in testing for predictive biomarkers at relevant time points to facilitate informed treatment decisions is discussed. Last, instances of successful MDT treatment of other cancers and key lessons to optimize MDT patient care in cutaneous melanoma are provided. Several aspects of MDT patient care are considered vital, such as the importance of staging via pathological examination and imaging, biomarker testing, and interdisciplinary physician and patient engagement throughout the course of treatment. Use of MDTs has the potential to improve patient care in cutaneous melanoma by improving the speed and accuracy of diagnosis, implementing a personalized treatment plan early on, and being proactive in adverse event management. Physician perspectives described in this review may lead to better outcomes, quality of life, and overall patient satisfaction. IMPLICATIONS FOR PRACTICE: As more cancer therapies emerge, it is critical to optimize patient care and treatment planning. The multidisciplinary team (MDT) approach, which involves active collaboration among specialists, has led to encouraging survival results in multiple cancer types. As MDT care becomes more widely adopted in the treatment of melanoma, accurate diagnosis and staging are important, as clinical outcomes for stage III disease vary widely by substage. Because ~50% of melanomas harbor BRAF mutations, testing is important for an informed treatment decision. Interdisciplinary physician-patient engagement throughout the course of treatment can improve comorbidity and adverse event management to optimize patients' treatment journeys.

Keywords: BRAF; Diagnosis; Melanoma; Multidisciplinary care; Patient journey.

Figure 1

Best practices for the ideal treatment journey of patients with BRAF‐mutant stage III melanoma. The most common patient journey (dermatologist to surgeon to medical oncologist) is indicated by the white arrows. However, it is important to note that not all patients are first seen by a dermatologist. Therefore, staging must be performed or verified by each member of the MDT. Communication among the MDT (blue arrows) is vital for optimal patient care. Abbreviations: AE, adverse event; CLND, completion lymph node dissection; MDT, multidisciplinary team; SLNB, sentinel lymph node biopsy; T‐VEC, talimogene laherparepvec; TRAE, treatment‐related adverse event.