Updates to the National Comprehensive Cancer Network guidelines on melanoma

This study described the updates to the National Comprehensive Cancer Network (NCCN) skin melanoma guidelines.

Melanoma is one of the most aggressive forms of skin cancer. Patients often have a biopsy of a suspected melanoma to evaluate the severity of the tumor. Treatment for melanoma includes surgery to remove the tumor. In some patients, the tumor can come back after surgery (recurrence). In more advanced melanoma, the tumor can spread to other parts of the body (metastasis). Targeted therapy (TT) and immunotherapy (IT) can also be given to ensure all tumor cells are killed. Tumor cells develop specific genetic changes to help them survive and grow. TT stops these genetic changes from working. The tumor cells rely on these genetic changes so heavily that when they no longer work, the tumor cells die. IT activates the patient’s immune system to target and kill the cancer cells.

The NCCN gives recommendations for different types of therapy for patients with melanoma. The guidelines cover therapy for all stages of cutaneous (skin) melanoma. Updates to the NCCN guidelines are focused on biopsies, treatment for metastasis.

The NCCN guidelines were updated to indicate that if a suspected melanoma with a thickness below 0.8mm, the patient should have a biopsy of the nearby lymph nodes to evaluate if there is any metastasis (cancer spread).

Studies have shown that patients who have a small number of tumor cells that are in the process of moving to another location have a worse survival outcome. These are called microsatellite metastasis. The NCCN guidelines have been updated to ensure that evidence of microsatellite metastasis needs to be included in a patient’s initial workup. The guidelines also now include treatment options to manage microsatellite metastasis.

Surgery to remove the tumor is a common melanoma therapy. The guidelines have updated the amount of normal tissue around the tumor a surgeon should remove depending on the type of melanoma. If the melanoma is removed and the 1-2 cm of skin around the removed melanoma is clean of cancer cells, 96% of patients will not have cancer return at the initial place (local control).

Some patients have tumors that cannot be removed. For these patients, the NCCN guidelines have been updated to include the best current treatment options. One option includes combining ITs nivolumab (Opdivo) 3mg/kg or pembrolizumab (Keytruda) 2mg/kg with ipilimumab (Yervoy) 1mg/kg. Other options include combining TT and IT such as vemurafenib (Zelboraf)/cobimetinib (Cotellic)/atezolizumab (Tecentriq) and dabrafenib (Tafinlar)/trametinib (Mekinist)/pembrolizumab.

This article provided updates to the NCCN guidelines for skin melanoma.