Guidelines for treating early-stage melanoma of the skin

This paper reviewed current guidelines for treating early-stage melanoma (confined to the skin).

Melanoma is a form of cancer that originates in cells called 'melanocytes' that give skin its color. Melanoma is aggressive because it has a very high rate of metastasis (spread to distant organs) if left untreated. However, early detection, usually by self-inspection of suspicious moles on the skin, leads to effective and complete treatment. Early-stage melanoma is usually treated with surgery. Sometimes a procedure called a 'sentinel lymph node biopsy' may be performed to check for the presence of cancer in nearby lymph nodes. If these nodes are negative, there is very little chance of spread to distant organs in the body.

The recommendations in this article were made by a panel of experts who reviewed the current medical literature about melanoma.

For early stage melanoma, the experts advised that  examination of tumor samples ('biopsies') should be performed by experienced pathologists. An accurate report should include 3 key data used to predict the cancer's recurrence rate:
– tumor thickness (Breslow thickness) – or the depth of cancer penetration within the skin
– the mitotic rate, which means how many cancer cells are found in active division per square milimeter.
– the presence/absence of microscopic ulceration, meaning that the epidermis (outer-most layer of the skin) was displaced, leaving a small ulcer behind.

Surgery is the preferred treatment for early stage melanoma, involving a wide excision. This means removal of the tumor with safety margins (healthy tissue around the tumor) to make sure cancer cells are not left behind. Based on research evidence, the authors do not advocate safety margins wider than 2 cm around the tumor.

Other treatments are available for early stage melanoma, such as topical creams with the drug Imiquimod or radiation treatment, but these are usually associated with higher cancer recurrence rates. These options can be considered for melanoma located in areas in which a wide surgical excision is hard to perform.

If the tumor's thickness is found to be greater than 1 mm, the authors recommend performing a sentinel lymph node biopsy. If this comes back positive, a lymph node dissection (removal of regional lymph nodes) should be performed.

The prognosis for early-stage melanoma is excellent. These guidelines offer the most recent evidence concerning the best treatments.