A review of the recommendations for the treatment of skin melanoma

This study reviewed the 2019 guidelines on the treatment of melanoma.

Cutaneous (skin) melanoma (CM) is a common form of cancer. It can be aggressive if found late. New treatments are constantly being developed. It is important to review these options to improve patient care. Systemic therapy (ST) is one treatment strategy. ST involves taking medications that affect the whole body to kill cancer cells. 

ST is rapidly changing for advanced CM. Many new drugs are under investigation in clinical trials. It is important to understand what treatments are effective in different stages of CM. The National Comprehensive Cancer Network (NCCN) produce a guideline on CM treatment. Recommendations are made for each type of patient. 

Chemotherapy after surgical removal of the tumor is not recommended in early CM. This relates to Stage 1/2 CM.

Patients with inoperable CM may benefit from new drug types. Immune checkpoint inhibitors (ICIs) are one promising option. ICIs allow the immune system to detect and kill cancer cells. Drugs that target the BRAF gene mutation may improve survival in advanced CM. BRAF mutations allow cancer cells to grow rapidly in CM. Nivolumab (Opdivo) is recommended in patients with Stage 3/4 CM. Pembrolizumab (Keytruda) is also recommended in Stage 3/4 CM. A combination of dabrafenib (Tafinlar) and trametinib (Mekinist) are recommended for patients with a BRAFV600 mutation and stage 3 CM. Combining these 2 drugs has been shown to slow cancer cell growth. 

Patients with tumors in distant organs (metastases) should receive several treatments. ST, surgery, and ST after surgery (adjuvant treatment) should be considered. ST should be considered if CM is inoperable. Radiation can be used to manage brain and bone tumors. Patients with advanced CM should be treated initially with either an ICIs or BRAF inhibitor. If ST is unsuccessful, patients should be switched to a different drug type. It is unclear if previous treatment with an ICIs or BRAF/MEK inhibitors affects further treatment. 

This study reviewed guidelines on the treatment of melanoma.