[Guideline 'Melanoma' (3rd revision)].
The guidelines 'Melanoma' (3rd revision) are evidence-based in nature. A number of outcomes are summarised in this article. Dermatoscopy deserves a standard role in the clinical diagnosis of pigmented skin abnormalities. Pathological findings from a diagnostic excision should be recorded meticulously to include anatomical localisation, type of intervention used, excision margin, diagnosis, Breslow thickness, and the completeness of the removal. The sentinel node procedure should be reserved for patients who want to be as informed as possible about their prognosis. The procedure is not considered a part of standard diagnosis. Sentinel node assessment should include stains for specific markers and should be conducted in multiple sections. The following margins of non-affected skin are recommended for therapeutic re-excision of melanoma: in situ melanoma, 0.5 cm; Breslow thickness < or = 2 mm, 1 cm; Breslow thickness > 2 mm, 2 cm. Pathological assessment of a re-excised specimen depends on the completeness of the first excision. Systematic adjuvant treatment of patients with melanoma is not recommended outside the context of a clinical study. Patients with metastatic melanoma are preferably treated within a clinical study. Outside of a clinical study, these patients should be treated with dacarbazine. There is no evidence to suggest that survival is improved by frequent follow-up. However, follow-up can be a useful way to meet the information needs of patients and care requirements for physicians.
van Everdingen
J J E
JJ
Kwaliteitsinstituut voor de Gezondheidszorg CBO, Postbus 20.064, 3502 LB Utrecht.
van der Rhee
H J
HJ
Koning
C C E
CC
Nieweg
O E
OE
Kruit
W H J
WH
Coebergh
J W W
JW
Ruiter
D J
DJ
D003880:Dermatology / Q000592:standards*; D046169:Dermoscopy; D003937:Diagnosis, Differential; D019317:Evidence-Based Medicine; D006801:Humans; D008545:Melanoma / Q000175:diagnosis* / Q000473:pathology / Q000628:therapy; D009426:Netherlands; D012878:Skin Neoplasms / Q000175:diagnosis* / Q000473:pathology / Q000628:therapy; D015996:Survival Rate